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Depression among athletes: When sport becomes a problem

Melanie Last
February 28, 2023

Depression is a taboo subject in professional sports. While doctors recommend exercise to their patients as a therapy for depressive episodes, it is sport itself that can trigger the disease in competitive environments.

Two biathletes compete, long shadows behind them
Elite athletes find themselves under enormous pressure to perform when it mattersImage: Alexey Filippov/SNA/IMAGO

There are days I'll never forget. November 10 is one of those days, the day Robert Enke, goalkeeper of the German national team, committed suicide aged 32.

It was my birthday and I was in the middle of celebrating when the news came through. The celebration came to an abrupt end after that. Robert Enke was dead.

He suffered from depression. So did I. He was a professional athlete, I was a recreational one. Until this day, sport helps me to get through difficult times. For Robert Enke though, the sport — combined with the pressure of having to be the best between the posts  — was possibly one of the decisive factors in ending his own life.

The dark side of a sick competitive system

Enke was just one of many athletes who have suffered or currently suffer from depression. For a long time very few publicly acknowledged their condition. Only recently have athletes started to raise their voices, causing the taboo around mental health to crumble.

One prime example is Simone Biles, the American once-in-a-generation gymnast. She accumulated 25 medals at World Championships, making her the most successful athlete of the competition. At the 2021 Olympic Games in Tokyo, the then 24-year-old decided to forgo several competitions and explained her withdrawal with psychological problems, linked to sexual abuse by the US team doctor Larry Nassar.

Simone Biles performs at the gymnastics final at the Ariake Gymnastics Centre
Simone Biles has spoken openly about her mental strugglesImage: PA Wire/dpa/picture alliance

That same year, tennis player Naomi Osaka retired from the French Open after her first-round win against Patricia Maria Țig of Romania. Osaka, then number two in the world rankings, explained her shock decision by saying she was suffering from depression and was crumbling under immense media pressure.

"You don’t talk about it," French World Cup winner Paul Pogba said of depression in the Le Figaro newspaper last year. Pogba himself started suffering from the disease when he played under coach Jose Mourinho at Manchester United. Pressure and self-doubt came to a point that was no longer bearable, Pogba said.

Anyone can be affected

Athletes in elite sports are just as likely to suffer from depression than anyone else. "It affects around 5%," says professor Jens Kleinert from the psychological institute of the German Sport University in Cologne.

Professor Jens Kleinert from the psychological institute of the German Sport University in Cologne
Professor Jens Kleinert from the psychological institute of the German Sport University in CologneImage: Deutsche Sporthochschule Köln

He and his colleagues have compiled and evaluated countless studies on the subject.

"Those studies show numbers ranging from 4-9%, which are the same numbers as among non-professional athletes. It is within the normal range."

After injuries however, that number can be as high as 10-15%. Sports can protect people from depressive disorders in their leisure time, but it can also create additional stress in the professional performance sector.

Athletes are expected to constantly deliver top performances. The German Olympic Sports Confederation (DOSB), for example, measures its federations according to how many athletes are allowed to participate in World Championships and Olympic Games.

When the pressure becomes too much

Preparing for sporting events over many years can take a lot out of athletes. It's a fight for seconds, minutes, distances, heights, the most hits or the most accurate jumps. If you can't focus on the goal, many years of preparation might just go astray.

Often the entire world is watching in that very moment. Once a losing streak sets in or injuries cause athletes out of training for months, self-doubts creep in and long-pursued goals burst like soap bubbles. "Being unable to function grinds the self-confidence of an athlete."

"The suffering then reaches severe levels, which can lead to depressive episodes," Kleinert tells DW.

The sports and health psychologist thinks those moods can be amplified by the belief of some athletes, that they have to maintain the image or the strong athlete or hero in public.

Signs of depression

The typical signs among those affected are numbness, sadness and little to no joy. Cristina Baldasarre is a Swiss sports psychologist who looks after top national and international athletes in a wide range of sports.

"When they come to me, they cry a lot. Often they don't know how to deal with the pressure in training and competition," Baldasarre tells DW. "Their training performance gets worse or fluctuates extremely."

"Some cancel their competitions or stop going to training. The don't have any motivation anymore, feel tired and no longer trust themselves to do anything. Some also feel they are not being treated well by their coaches. And quite a few develop anxiety and compulsions."

Performance vs. joy

Baldasarre advocates for a modified performance support for top athletes. Self-confidence and joy must be in the center of this, says the psychotherapist from the Zurich-based sports psychology firm Mind2win.

"When I ask athletes what they did well in a certain exercise, they first tell me what was wrong and not okay," she says. "They almost never come up with things that have gone well on their own." 

Portrait photo of Cristina Baldasarre
Sports psychologist Cristina Baldasarre: 'Point out the positives'Image: privat

It is of course a coach's job to bring out the best in athletes, but always pointing out the mistakes does very little to boost their self-confidence. Baldasarre says there needs to be a paradigm shift. Athletes should not only be judged by their performance, but should be allowed to develop their skills and feel pleasure.

In other words: The focus must be on the individual, rather than the time, height or distance achieved. Baldasarre would like to see sports psychologists become an integral part of training, similar to the system at colleges in the United States.

Objective and subjective success

Kleinert has a similar view. He says, the personal development of each individual athlete must be recognized.

For example: If a triathlete doesn't perform up to the standard to be at the top of the German or World Championships, coaches, physiotherapists and parents should look at the personal athletic development of that individual. What has gone well? What has improved?

This approach allows setting realistic goals. Even a 10th place finish could subjectively be a success.

"We can't change the performance environment, at least not very quickly. But we sport psychologists can help athletes deal with this environment," says Kleinert.

That's why it is important to deploy sports psychologists to the junior performance centers at Germany's Bundesliga soccer teams — something made mandatory during the 2018-19 season. It should be noted, however, that the approach has not seen blanket implementation.

This article was translated from German.