A recent Nature Portfolio study shows that at least one in three elite athletes report anxiety (ranging up to 45%) as a result of performance outcomes and satisfaction, injuries, and selection pressures. Another analysis of physical activity and perceived stress in university students, a population particularly vulnerable to stress, indicates that those who exercise report overall better mental health. Thus, there appears to be a difference in the relationship between exercise and mental health for different groups. According to clinicians, the mental toll on elite athletes is especially overlooked.
The Nature study examined 272 competitive athletes and found that emotion dysregulation and sport performance concerns were positively associated with symptoms of depression and anxiety. It followed that athletes who struggled to regulate their emotions were more concerned about performance and thus suffered higher levels of mental health symptoms.
“These findings underscore what many clinicians observe in practice,” says Dr. Hannah Nearney, M.D., clinical psychiatrist and Medical Director at Flow Neuroscience, a company behind the first FDA-approved non-drug, non-invasive depression treatment. “In high-performance environments, difficulties with emotion regulation can significantly heighten vulnerability to depression and anxiety. By identifying emotion dysregulation as a key factor, this study moves the conversation toward actionable psychological skills that can be strengthened. It highlights an evidence-based target for prevention and intervention, which could have a meaningful impact on both well-being and sustained performance.”
With globally watched sporting events such as the Winter Olympics ongoing, the physical and mental toll on elite athletes is such that mental health disorders can occur in up to 35% over a follow-up period of up to 12 months.
In university students, as opposed to elite and competitive athletes, higher physical activity was consistently linked to lower perceived stress, depression, and anxiety, even after adjusting for confounders. Active individuals showed a 30-40% lower risk of experiencing anxiety or depression, with said risk decreasing progressively as adherence to physical activity guidelines increased.
“From a neurobiological perspective, elite athletes and students benefit from the same exercise-induced mechanisms such as endorphin release, improved sleep, and regulation of stress hormones,” adds Dr. Nearney.
“However, elite sport layers of pressure and uncertainty onto that foundation, which can override the psychological benefits typically associated with physical activity. For students, exercise provides relief because it takes place outside daily pressures, offering psychological distance, stress reduction, and a restorative break from academic demands.”
Elite athletes remain highly vulnerable to unique pressures. In contrast, students and recreational athletes who are seeking improvements regarding their mental well-being can find relief in undertaking physical exercise. But exercise alone does not guarantee protection from mental health challenges, clinicians emphasise. For those elite athletes who suffer mental health difficulties and casual athletes for whom physical activity does not relieve stress or anxiety, there is little recourse to choose.
“This paradox highlights a treatment issue. Elite athletes often need alternative treatments. But even before that, they need additional tools to take care of their mental well-being, every day,” adds Dr. Nearney.
Pharmacological solutions such as SSRIs can cause fatigue, meaning they may not be suitable for elite athletes or hard to tolerate for the general population alike, making non-drug treatments increasingly relevant.
One of the latest alternatives, transcranial direct current stimulation (tCDS), has just been approved by the FDA for at-home depression treatment, following approvals in the UK, EU, Australia, and other countries. tDCS devices that help regulate daily emotional well-being also exist, with improvements in sleep quality and mood expressed.
In addition to its effectiveness, tCDS does not carry the concerns that are commonly associated with pharmacological solutions.
The unique pressures faced by elite athletes underscore how we need to change our thinking with regard to treatment availability, preference, and overall suitability. It also highlights the need to reevaluate commonly held beliefs about how exercise, stress, and mental health intersect, particularly in high-performance sport.
