The 2020 Tokyo Olympic Games will be remembered not only because of the extraordinary sports performance in the middle of an environment marked by the Covid-19 pandemic, but also by the brave act of the Gimnasta Simone Biles by putting its mental and physical health on any Prese. The pressure and looks of the world on it echoed a reality: athletes, even the most iconic, are human beings susceptible to pressure and stress. Two years after that shocking moment, Biles has made a triumphal return to the sports stage, ensuring an essential victory on his route to the Olympic Games of Paris 2024 . This week, in a reminder that mental health care is still essential in elite sport, the Spanish basisist Ricky Rubio has decided to pause his career to focus on his emotional well -being, absent from the next basketball World Cup. It is evident that the conversation about mental health in professional sport remains more in force than ever.

However, Biles is not an isolated case, much less. There are many elite athletes who, in a context of maximum physical and especially mental demand, need to go to specialists to treat and train an aspect that many people obvious: the mind. From Biles to the former world tennis 1, the Japanese Naomi Osaka, passing through Robin Soderling, Michael Phelps, Kevin Love, Álex Abrines or Ian Thorpe. Unfortunately, in some cases when the problem is noticed, it is already too late and it ends the worst of ways, with the person taking their lives. This is what happened to the American cyclist Kelly Catlin (silver medalist in Rio 2016). Paradoxically, behind many of these mental problems is sometimes sports success. Something like what at the beginning of the s. XX described Freud: " Those who fail when they succeed ."

So far having mental problems was often perceived as a weakness - especially among athletes (1). Therefore, the fact that they verbalize their mental problems is allowing to give visibility to a problem that, in addition, is not uncommon. In fact, a meta-analysis that included more than 7,000 elite athletes showed that the prevalence of symptoms related to some mental health disorder ranges from 19–34% for those who are active and between 16–26 % for those already removed (2). The sport of elite and the environment generated around it could compromise mental health, increasing the symptoms of anxiety and depression due mainly to oversight, injury and physical and mental stress (3). And this is a serious problem to be treated, since mental problems are associated with a greater risk of premature mortality (4). Unfortunately, as we have seen before, there are also cases of suicide among high performance athletes (5). These data are contributing to the mental health of athletes being receiving increasing attention from medical and scientific communities. Thus, several of the main world institutions in health and sports have published in recent years statements of consensus or recommendation guides for the management of mental health of elite athletes (6–8).

But how does mental illness affect life expectancy in elite athletes?

Not only moderate physical exercise regularly performed, but also high performance sport, is associated with a lower risk of death due to the main noncommunicable diseases: cardiovascular diseases and cancer (9). In fact, elite athletes live around 5 years more than the general population (10). And although high -performance athletes experience mental health disorders (eg, depressive symptoms) similar to those of the general population (11), athletes could also have a lower risk of mortality from mental illness than the general population . It is what determined a recent study that analyzed American former sportsmen who had participated in the Olympic Games between 1912 and 2012 (12). The data showed a risk of death due to mental and suicide disorders 32% less than that of the general population (12). Although there were some exceptions (eg, the shooters), the results were corroborated by analyzing by subgroups for individual sports such as athletics, rowing or swimming. In addition, this lower risk of death in athletes was obtained independently of whether they had been Olympic medalists or not, demonstrating that the success of these athletes in their respective disciplines did not affect their life expectancy (12).

The least risk demonstrated by athletes to die from mental illness or suicide could be explained in part through certain factors, genetic and non -genetic. Among the seconds, we would find: healthier living habits - which usually includes not smoking, not drinking and a healthy and balanced diet (13) - and some social conditions that, in turn, allow them more favorable lifestyles compared to comparison The population that we are not professional athletes. Thus, for example, elite athletes enjoy a better socioeconomic status and a higher educational level. For example, it is the case of the United States, since due to the outstanding role that the university system plays in American sport, Olympic athletes are more likely than the general population of attending universities and graduating in them (14). Both a better socioeconomic status and a better educational level have been associated with a lower suicide rate (15–17).

Conclusions

All cases that in recent years have appeared from athletes publicly recognizing that they suffer a mental disorder have contributed to the word "depression" begin to free themselves to lose their negative connotation. And just as if an athlete is injured by the shoulder or suffers a knee ligament injury, when he has a mental problem, it is necessary that this injury to the proper specialist is also treated (e.g., psychologists sports or psychiatrists). Mental disorders are a ballast too heavy to endure individually.  

Sport is an incredible escape route for many people for their multiple benefits on health in general and on mental in particular. These benefits seem to remain even when the exercise is carried out at the highest level of competition. However, linked to the current context that elite sport lives (perhaps never seen before), where many athletes suffer from the enormous pressure of social networks, sponsors and the load of training and competitions, it must be taken into account that They face a very complex reality and that can put their mental health in check. Work with sports psychologists should be a fundamental part of the preparation of elite athletes .

References:

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2. Gouttebarge V, Castaldelli-Maia JM, Gorczynski P, Hainline B, Hitchcock Me, Kerkhoffs GM, et al. Occurrence of Mental Health Symptoms and Disorders in Current and Former Elite Athlets: A Systematic Review and Meta-Analysis. BR J Sports Med. 2019; 53 (11): 700–6. 

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