Millions of Americans are diagnosed with depression every year. A subpopulation that is particularly vulnerable to depression is athletes dealing with injuries, particularly those that require significant time away from competition.
Injuries and Mental Health
Unfortunately, in the world of sports and exercise injuries are inevitable. According to the Journal of Athletic Training, approximately 3 to 5 million athletic and recreational injuries occur annually in the United States. Although there are precautions that can be taken to decrease the likelihood of sustaining an injury, harm-free participation is never fully guaranteed.
The effects of athletic injuries often extend far beyond the physical impairments. The athlete’s mental and emotional states are often just as significant as their physical ailment. Emotional responses following an injury are normal and usually involve sadness, anger, frustration, and confusion, among other reactions.
However, when these initial emotions do not gradually subside or the recovery process is unusually slow, this can be a sign of poor adjustment and the athlete’s mental health can become a major concern.
Some common depressive symptoms include a persistent sad or empty mood, feelings of hopelessness, worthlessness or helplessness, irritability, decreased energy, restlessness, difficulty concentrating, difficulty remembering or making decisions, sleep disturbance, and possibly thoughts of death or suicide, or even suicide attempts.
Causes/Triggers of Depression
Injured athletes can become depressed for a number of reasons. One major reason is performance failure. When an athlete is not able to physically perform at the level that they are used to, they can become discouraged and frustrated.
The athlete may have to start from square one when it comes to performing basic actions that were previously second nature for them, such as running or throwing a ball. These types of sudden changes are difficult for anyone to adjust to but are particularly devastating for athletes, as they are typically accustomed to demanding and expecting a lot from their bodies.
Imagine being a pitcher who goes from throwing a 90-mile-per-hour fastball to struggling to play a light game of catch after undergoing shoulder surgery. Picture a basketball player with a 35-inch vertical leap who now struggles to simply bend their knee following knee surgery. Coming to terms with performing at a lower level than one is used to is a tough mental adjustment, even when the person knows that the condition is likely temporary.
Activities of daily living are also often greatly affected by some injuries. Depending on the severity of the injury, the athlete may now have to depend on others to help with previously effortless activities such as bathing/showering, getting dressed, using the restroom, driving, writing, or even sleeping. This decreases the athlete’s feelings of independence and can lead to frustration and even shame.
In addition, feelings of inadequacy may also arise if they begin to feel as though their role on the team or within the sport is now less significant than it once was. The possibility of getting one’s “spot taken” is often a significant concern for many athletes recovering from an injury.
Some athletes also fear that they will not fully recover from the injury and will not be as good when they return. Most injuries are followed by complete and timely recoveries. However, in some extreme cases such as with gruesome or repetitive injury experiences, the athlete may then be unable to recover mentally and as a result, ceases participation permanently. This mental block usually results from a constant fear of re-injury or the perception of an incomplete recovery.
Another major cause of athlete depression is simply emotional withdrawal. When athletes can no longer participate in the main activity that they love, a great deal of sadness and confusion may accompany that void, especially when the allotted period of rehabilitation is strenuous, lengthy or uncertain.
During this time, athletes often experience identity loss, meaning they lose the concept of who they truly are because such a greatly revered part of their life is now missing.
Another common cause of injury-related depression is detachment. Many times, injuries require athletes to spend a lot
of time away from their teammates and coaches. This is often due to factors such as rehabilitation scheduling and the athlete’s impaired physical ability to travel or maneuver in certain settings.
Traveling through an airport or on a bus to road games may not be feasible for an athlete that is physically restricted by an injury. Even leisure activities such as going out with teammates may have to be sacrificed. For example, it is difficult to move through a club while on crutches or risk being bumped into while wearing a sling.
This unintentional isolation can lead to loneliness and resentment within the athlete, and as a result, they may even begin to isolate themselves.
Another factor that may contribute to the depressive symptoms that often accompany injury is the physiological side of the matter. Research shows that exercise increases dopamine (neurotransmitter involved in pleasure and reward) levels in the brain. Therefore, the absence of regular physical activity may lead to a reduction in the individual’s normal dopamine production.
Prevention & Treatment
Regardless of which of the aforementioned mental struggles causes depression within a particular injured athlete, there is one clear commonality in all cases: the need for social support.
Athletes aren’t the only ones who need to be aware of the perils of injury to mental health. All athletic personnel are responsible for easing the burden of an athlete’s injury experience.
Coaches and teammates can make efforts to ensure that injured athletes continue to feel involved and a part of the team. As mentioned earlier, it is easy to unintentionally isolate injured athletes because their level of participation lessens. In addition, although coaching undoubtedly has a result-oriented “business side” to it, it is important to make sure that they do not ignore injured athletes or treat them as though they have no current impact on the team.
Athletic trainers play a huge role in providing support and keeping a close eye on the athlete’s post-injury responses, as they are usually the primary care providers. Much of the athlete’s time is spent in physical therapy with the athletic trainer and most of his/her communication with the coach involves the trainer as well.
Physicians are also a crucial piece to the puzzle. They should remain clear in their explanations, recovery timelines, and methods of treatment, and must also show sensitivity to the athlete’s natural emotional responses.
Additionally, university athletic administrations should invest in providing the necessary counseling or therapy care services for athletes in these difficult positions. Often times in sport, disclosure of emotions and seeking help are viewed as signs of weakness. Athletic personnel within high schools, colleges, universities, and professional team settings can work to eliminate the stigma of mental health by educating themselves and others on the psychological struggles associated with injury.
Families and friends also play a huge role in supporting these athletes and easing the mental and physical burdens of injury. Being there to listen and talk to the athlete is just as critical to their recovery as being there to help physically.
If any of these people notice the potential onset of depressive symptoms, they should start by simply taking the time to ask the athlete how they are feeling and what they are experiencing. Opening the door for disclosure of emotions is a small step that goes a long way in supporting and healing the athlete. Then, further steps to assist them may have to be taken such as referring the athlete to a counselor or psychologist to help them cope and recover.
The more resources that are made available for athletes dealing with injuries, the more they will begin to take initiative in addressing their own mental health as well.
For further information on athletic injuries and mental health, visit the following sites: