How Mental Health Affects Injury Risk and Outcomes in Athletes

by Geoffrey Dreher and Davis Lane Rogers

In the sports world, the physical aspect often takes center stage. We admire athletes for their strength, agility, and skill, yet there is a commonly forgotten crucial factor that significantly impacts athlete performance and well-being: mental health. This article explores the intricate connection between mental health and sports injuries, shedding light on how an athlete's state of mind can affect their risk of injury and the outcomes of those injuries.

We often envision athletes in peak physical condition and mental resilience. However, behind the scenes, many athletes grapple with mental health challenges. Stress, anxiety, performance pressures, depression, mood and eating disorders can take a toll on an athlete's psyche, and this emotional strain can manifest physically.

Literature has shown that poor mental health can increase performance failure as well as an athlete's risk of injury in several ways. Preseason depression or anxiety has been linked with increased injuries during the season. Broken down further, there is evidence that competitive anxiety can increase injury frequency, while a negative mood can increase injury severity. We discuss a stress-injury model that can result from the cumulative impact of internal factors (personality, genetics, and perceptions) and external elements (coping mechanisms, support systems, and social environment) in an athlete's life.

There are also links to physiological theories on why poor mental health may increase injury risk. Mental health issues and stress can worsen situational awareness, impair cognitive processes, decreased concentration, reduced reaction time, increase muscle tension, make tissue more vulnerable, reduced physical preparedness, increase risky behaviors or inappropriate decision making. After injury, mental health issues can also slow down the recovery process and delay return to play. Athletes who overtrain, potentially from an unhealthy obsession, can also weaken their bodies and minds. Frequently masked by hard work ethic, overtraining can lead to neglecting recovery, nutrition, sleep and the mind. Any of these factors can ultimately make an athlete more susceptible to injuries and burnout.

Recognizing the profound impact of mental health on athletes, sports organizations and professionals are increasingly prioritizing mental well-being. Teams now employ sports psychologists and mental health experts to provide support and resources for athletes. They also encourage open conversations about mental health, reducing the stigma that has long surrounded this topic. Certain techniques that have demonstrated success among athletes include the practicing of coping strategies, cognitive behavioral stress management, emotion-focused therapy, mindfulness training, and stress-based treatments. Increasing mental health literacy is also a focus by improving awareness and access to mental health care specialists as well as training both teammates and coaches on the signs and symptoms of common mental health disorders.

Ultimately, the relationship between mental health and injury outcomes in athletes is a complex and multifaceted one. Athletes are not invincible, and their mental well-being is as crucial as their physical ability. As our understanding of this relationship deepens, we can expect to see more emphasis on mental health support in the world of sports. This shift is not only beneficial for athletes’ overall well-being, but also for their performance and longevity in their chosen sport.

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Article Details
How Mental Health Affects Injury Risk and Outcomes in Athletes
Davis L. Rogers, Miho J. Tanaka, Andrew J. Cosgarea, Richard D. Ginsburg, Geoffrey M. Dreher
First Published June 16, 2023 Research Article
DOI: 10.1177/19417381231179678
Sports Health: A Multidisciplinary Approach

About the Authors

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Geoffrey Dreher, DO is a primary care sports medicine physician and associate director of osteopathic education at Penn Medicine Lancaster General Health Family & Community Medicine department. Previously at Johns Hopkins University School of Medicine, where he worked with the PM&R and orthopaedic residents, including lead author Davis Rogers. As a team physician, at the high school, collegiate DI and DIII, and professional levels, he has had a research and clinical focus on the physical and mental well being of athletes.

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Davis Lane Rogers, MD, is a chief resident in the Department of Orthopaedic Surgery at the Johns Hopkins Hospital. He earned his bachelor's degree in Physics at the University of Mississippi before moving to Baltimore to complete his Medical Doctorate degree at the Johns Hopkins University School of Medicine. He has maintained a focus on research involving the psychological effect of injuries/trauma since medical school. He will complete his Orthopaedic residency training in June of 2024; afterwards, he will be completing a fellowship in surgery of the Hand and Upper Extremity at the University of Alabama in Birmingham, AL.