Elite Taekwondo Athletes: The Relationship among Sport
Psychology, Mental Health, and the National Sport Organization

Nosworthy K and Telles-Langdon D

doi:10.23880/oajksm-16000115

Open Access Journal of Kinesiology and Sports Medicine Research Article 24 min read

Elite Taekwondo Athletes: The Relationship among Sport Psychology, Mental Health, and the National Sport Organization

Nosworthy K and Telles-Langdon D^*

^* Corresponding author

ISSN: 2995-0155 10.23880/oajksm-16000115 Received: July 05, 2024 Published: July 22, 2024

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Keywords

Taekwondo Mental-Health Qualitative Thematic Analysis Sport Psychology

Abstract

This study explored the perceptions of retired elite Canadian Taekwondo athletes regarding their National Sport Organization’s responsibilities for reporting, managing, and preventing athletes’ mental health issues. Using qualitative interviews and a situational analysis of the data, results show that the majority of those interviewed in this study struggled with a mental health issue while competing at an elite level, and all the participants reported seeing a teammate struggle, at one time or another, with a mental health issue. Participants in this study identified three major areas in which Taekwondo Canada can help athletes with mental health issues: 1) providing education to coaches and athletes; 2) providing a reporting structure that is independent and confidential, and 3) providing greater access to clinical psychologists on an ongoing basis.

Abbreviations

AAP: Athlete Assistance Program; NSO: National Sport Organization.

Introduction

With the rise of major national mental health campaigns, there is a push to remove the stigma attached to mental health disorders and treat mental health no differently than its physical counterparts. This increase in awareness extends into the realm of sport, and more specifically, elite sport, given the increased news coverage.

Often, research is focused on the beneficial links between sport and mental health, and studies [1] have found that involvement in sport can reduce mental health issues in the general population and be used at times as treatment Thesis as well. However, as Bär, et al. [2] argue, “more and more evidence has accumulated that high-performance athletes are not protected from mental disorders as previously thought”. These revelations may spark debate in society on many levels, and raise opposition to the widely-held belief that being involved in sport and physical activity acts as insulation from mental health challenges [3]. Prominent athletes challenging the narrative that participation in sport and exercise promotes mental health can be confusing to the public, particularly if people are unaware of the risks to mental health from involvement in elite sport. There is evidence that sport participation functions as both a preventative measure and, at the elite level, a potential cause of mental health issues.

Sport Canada administers the Athlete Assistance Program (AAP) and athletes who are funded through the AAP are governed by policies, including physical injury reporting enforced by National Sport Organization (NSO) such as Taekwondo Canada. In the sport of taekwondo, for example, if an athlete has a physical injury, it must be reported to Taekwondo Canada, often via the national team doctor. This reporting can lead to additional help from the NSO in receiving medical treatment, surgery, physiotherapy, diagnostic testing, and rehabilitation programming. The initial review of more than 60 publicly available policy documents, from various NSOs, did not yield a single document with information on how Canadian athletes could go about reporting mental health issues or voicing concerns about teammates.

Scholars have linked mental toughness to the success of elite athletes [4], there is often an assumption made that athletes must be mentally tough in order to compete at an elite level [5]. This toughness may be a contributing factor to the lack of research specifically on the causes of mental illness in elite athletes. It may perpetuate athletes, coaches and the public’s belief that mental toughness insulates athletes from mental illnesses. Despite this assumption, some researchers are finding that the prevalence of mental illnesses, such as depression, may be more common in elite athletes than previously thought [5]. The idea that these numbers are greater than presumed is leading to additional questions regarding the link between elite sport and the prevalence of mental health issues [2]. A systematic review recommended further study on the prevalence of mental health issues in elite athletes [6]. Research has been conducted in the areas of psychiatric diagnosis in elite athletes [7]. Specific concerns included, but were not limited to, anxiety and bipolar disorder [8], and enhancing mental health literacy with athletes and their support staff [9]. Researchers such as Newmanm, et al. [10] recommend that future studies focus strictly on how elite sports, and participation at that level, shapes the participants’ mental health.

Although research is emerging about the link between sport and mental health, several factors limit the ability to collect enough information to develop a deeper understanding of this complex issue [8]. The stigma attached to reporting mental health concerns makes it difficult to ascertain accurate numbers of athletes with mental health issues [11]. It is not only a sport issue, but a population-wide concern that reporting mental health issues can lead one to be labelled and have potentially negative consequences [10]. Not only does mental health usually come with a stigma, but the treatment of mental health issues can have its stigma as well [12]. Attitudes towards mental health and help-seeking tend to be more negative with younger adults and with elite athletes in particular [13]. Many people idolize elite athletes and hold them to standards that make them seem exceptional, not the norm [8]. This ideology regarding the athlete’s ability to be immune from such issues as mental health may also lead to behaviors from sports organizations which downplay the prevalence of these conditions and also serve as a barrier to seeking treatment [8]. Researchers such as Rice, et al. [6] continue to express concerns about the limited scope of the current research in both methodology and breadth and about the quality of the information being analyzed and used throughout organizations.

Potential causes for a negative link between being an elite athlete and the prevalence of mental illness have been identified. One study suggests that becoming an elite athlete limits the ability of the individual to acquire proper coping skills through their growth and development [14]. Additional research suggests that a root cause of mental illness in athletes may be the early specialization of these athletes and their intensive training programs [15]. Research delving into early sport specialization as a whole also suggests that further research needs to be done to determine if there is a direct link between this early foray into elite sport and psychosocial development [16]. There are conditions which exist within sport that are needed for sporting success but may be seen as unhealthy by the general public. The mental challenges that elite athletes face often present as overtraining in athletes [17]. It is possible that specific tools could help to properly identify the mental health concerns of elite athletes, which might differ from tools used with the general population.

Method

Situational analysis [18] is a data analysis method rooted in grounded theory [19]. Situational analysis involves the creation of “maps” which bring meaning to the data. In addition, situational analysis allowed the incorporation of lived experiences within Taekwondo into the research. The purpose of situational analysis is to further expand grounded theory into a process that can incorporate the observations and discourses into the mapping process of the analysis. Situational analysis is a method in which data is examined and evaluated through the mapping process within the textual analysis derived from the audio transcriptions [18].

Using a situational analysis [18] and an interpretive approach, the goal of this study was to identify themes from in-depth semi-structured interviews with retired elite taekwondo athletes, to create a foundation from which athletes’ mental health can be examined. To add to the existing research, which consists of mainly quantitative studies, this study gathers opinions and personal experiences to gain a broader and more complete picture of the situation as a whole. Specifically, this study examines retired Canadian elite taekwondo athletes’ perceptions of the ethical responsibilities of the NSO to develop, support, monitor, prevent and be involved in the treatment of mental health issues in athletes.

After obtaining human ethics research approval from the Education/Nursing Research Ethics Board (ENREB #E2018:067(HS22025)) participants were recruited using snowball sampling [20]. The primary point of contact was determined using the publicly available online listing of Canadian Olympic taekwondo athletes and recruitment of participants continued until data saturation was reached [21].

We conducted interviews with ten participants. Out of the ten participants, seven were female and three were male. Participants included athletes who had participated at multiple Olympic Games as well as participants who had only been considered elite for as few as two years. Participants are only identified by pseudonyms. This occurred when interviews were no longer yielding new information.

The Inclusion Criteria for this Study were: Elite Canadian Taekwondo Athletes who have Retired since 2008. The year 2008 was selected in order to ensure the experiences of being an athlete were still relatively current. As well, given the changes in sports over Olympic cycles, using elite athletes who would have been involved at an international level since 2008 ensures that they have participated in a recent Olympic cycle.

The first step was to create an abstract situational map. This is a map of ideas and thoughts that emerge from the analysis of the transcripts. Comments that were made by multiple participants were recorded on the map in bolder font. In addition, using field notes, comments and thoughts of the researcher were added that stood out during the interview process. Once this abstract map was completed, open coding was used to begin to create the ordered situational map. Open coding is “the analytic process through which concepts are identified and their properties and dimensions are discovered in data” [22]. Using open coding we were able to sort the data into tentative labels for the themes. Once the data was fully coded into the ordered situational map, we were able to create a relational situational map using axial coding. Axial coding is “an analytic tool devised to help analysts integrate structure and process” [22]. From this Axial Coding, the Three Themes that Emerged were:

prevalence of mental health issues,
responsibility for the athletes’ mental health, and,
what national sport organizations can do to help.

Once the three major themes had been identified and data coded into the ordered situational map, we selected terms and phrases which were prevalent in the interviews, to reconfigure the analysis [18] into the relational situational map while emphasizing phrases and words using selective coding. Words or themes that were said more often were labeled with bolder text, and words or phrases which had more emotional expression noted in field notes, taken during the interviews, were coded with capital letters. Following this process, we returned to the interview transcripts and selected the most poignant quotes from the participants in relation to the results of the analysis. Certain ideas overlapped from theme to theme. Those overlapping themes were recorded on the situational map and links were drawn between the themes.

Results and Discussion

Prevalence of Mental Health Issues

All the participants reported seeing mental health issues among their peers and teammates. All participants answered this question without delay. David was more specific than other participants about how often he had seen mental health issues and reported that “five people around (him) suffer (ed)… in a moment in their career.” Others were more generalized such as Rachel who shared: Well, you’re seeing your teammates, you see the struggles they go through in terms of how we all deal with the stress and anxiety, and life problems. Outside, everything looks super shiny and clean, but on the inside, once you really see the day-to-day of what is expected of us as an athlete, and competing at that high level, nobody sees what goes on, on the inside. Alice, was struck by the impact of the system in reporting the prevalence of these issues: I’ve seen a lot of athletes who were living under difficult conditions in their private lives and also with their coaches as well as their sports organizations. So, I’ve seen some athletes who were suicidal or had strange behaviors, which to go against the human instinct, so depriving themselves of food, training to a point of exhaustion, doing things that they were told that was dangerous for their physical and mental health. There were many recurring themes of the types of mental health issues the participants saw. These were most often described as depression, anxiety, stress, and eating disorders. Sam explained this concept well by summarizing; “there’s a lot of it (pause) so that’s like a constant thing; most athletes deal with (these).” One of the findings regarding the prevalence of mental health issues was the normalcy of these struggles. Participants repeatedly referred to mental health issues as being a part of elite sport and not an anomaly. Alice, who has been clinically diagnosed with mental health issues while competing, suggested: Unfortunately, it just seemed to be something that was quite normal if you wanted to make it to the Olympic teams. I’ve seen a lot of athletes, including myself, who just did absolutely everything that sometimes went against our health so that we can make it to the Olympic teams and keep competing. Given that current research [1, 23] has found such a positive link between mental health and sport, the participants in this study seem to suggest that there is more to it, and that perhaps the positive link is not always the case.

Six participants were all aware they had struggled with a mental health issue while actively competing. Dana, Shared that: More obvious issues came out after I was done competing because I had, you know, masked all my issues, or felt like I had a purpose while I was training. I had some issues with depression and anxiety that maybe weren’t in the forefront, or maybe that I wasn’t recognizing, per se, while I was competing. Often participants identified that someone else brought their mental health issue to their attention, such as a coach, friend, or family member, and that until then they had not seen it themselves. This was the case with Sarah whose coach and sport psychologist first noticed an issue and offered some help, which she accepted. This offer of help was not the norm for the rest of the participants, many of whom reported being told to suck it up as Jen comments, “we were basically told to get over it”. This statement by Sarah backs up previous research which looked at the stigma surrounding mental health reporting and help-seeking for these issues [17, 24].

Responsibility for the Athletes’ Mental Health

Participants consistently identified the same groups or individuals as responsible for athletes’ mental health. The personal coach was most commonly cited, followed by the NSO. Without exception, all participants acknowledged the NSO bears some responsibility for elite athletes’ mental health. They also believed that coaches play a crucial role in identifying issues and leading the way in acquiring treatment, despite recognizing that coaches generally lack the necessary training to deal with mental health issues affecting themselves or their teammates. Participants noted that individuals other than the athletes themselves such as teammates, parents, and friends also share responsibility for identifying mental health issues due to their proximity to the athlete. Specifically, Sam, Kari, Jen, and Sara emphasized the importance of their own family and friends in recognizing these issues. Sara, Kari, and Jen additionally highlighted the role of teammates in this regard. The participants unanimously agreed that the NSO and personal coaches bear primary responsibility for athletes’ mental health. David Explains Regarding the NSO that: They don’t have to know how the athletes feel but they have to help them. I mean when an athlete suffers from some mental health issue, they need to be taken charge of by someone and it’s easier for them to be taken charge closely and locally, but Taekwondo Canada has to support them by giving them the good staff to help them and if it’s possible to give fund money for that and to do prevention as well. This sentiment was echoed by all of the participants who responded in the affirmative when asked if Taekwondo Canada held responsibility for the athlete’s mental health. Although the participants all felt strongly about the NSO’s involvement with their athletes’ mental health, they were also quite clear in identifying the barriers the NSO faces in terms of how to go about this.

The primary barrier to the NSO’s involvement in the athletes’ mental health issues being reported and treated identified by the participants was the culture of the sport. This discussion almost always began with the identification that mental health struggles are perceived as normal within the sport. Kari Explains that: So sometimes there’s a shared inability to stop things before they get too bad because we assume that a certain level of angst is normal in the course of training and competing. On both sides (the athlete and the NSO), there’s probably a bit of confusion and boundary blurring when it comes to identifying those things because your first instinct as an athlete is to persevere rather than succumb and say, okay, I really need help, or something’s wrong, or I need to take a step back. This sentiment was echoed by many of the other participants, such as Rachel, who contributes: You are only as good as the racehorse that wins. After that, you’re considered garbage. And I don’t think they really look at it as wellbeing, the mental health of an athlete for the long term. It’s all about, oh, this Olympic cycle, who can get us the medals and the funding that we need? They [the NSO] are not looking at it from a four or eight or twelve year cycle of pure development. It’s purely about whoever gains in that four-year cycle, that’s where their focus is. The rest is irrelevant.

The culture of the sport is also identified by the participants when they were asked if they would have gone to Taekwondo Canada when they were, or if they were, struggling with a mental health issue while competing. None of the participants felt that is what they would have done. I asked Sarah if she felt that Taekwondo Canada would have had her back if she had gone to them when she was struggling. Her response was “no”. This was the same response given by six of the other participants as well. The remaining three participants did not feel that they knew enough to make a judgment call on how Taekwondo Canada would have responded. When asked if they believed Taekwondo Canada

would have ‘had their back’, John responded to that question with “I don’t know… why would they… I guess it’s because they just wouldn’t care.” Rachel felt the same way when she bluntly stated, “I don’t think they care.” Jen also echoed this when she lamented that, “I don’t think they would’ve really cared.”

What NSO’s can do to help

Participants identified a couple of subthemes in terms of what the NSOs can do to help with the prevention, identification, and management of athletes’ mental health issues. Their ideas can be broken down into subthemes of education, reporting options, and sport psychology. Across the interviews, perhaps the misunderstanding of the role of the sport psychology subtheme was the most significant.

Sport Psychology

The need for sport psychology and sport psychologists to help with identification and treatment of mental health issues in athletes is the second recommendation of what NSOs can do that came out of the participants’ interviews. It is necessary to clarify that the participants’ perceptions of the role of sport psychology seem to be more in line with the duties of a clinical psychologist. Participants were asked if they believed that sport psychologists were mental health practitioners. From the field notes taken during the interviews and the comments from the participants directly, it was apparent that they believed that a sport psychologist had the professional training to deal with mental health issues. When asked about who would be able to diagnose a mental health issue in a Taekwondo athlete, Diana replied “it has to be a sport psychologist that has done something like us.” This confirms the mentality that sport psychologists are assumed to have mental health training that they may not have had.

According to the participants interviewed for this research, none of them had ever travelled with any mental health staff, and that if there were any issues it was left to the medical staff to handle. Dana recalls that in her experience: Just about every trip I went on I had at least one meltdown, just, you know, anxiety, nervousness, stress that I wasn’t necessarily able to cope with at the time, and that fell a lot onto my personal coach to handle while I was on the trip. But my coach also had 10 other people that they were coaching at the time, right? Five of the athletes recalled that they did have some access to working with a sport psychologist through the Canadian Sport Centers/Institutes, but that it was up to them to seek this out, and at no time was there any encouragement from Taekwondo Canada to include the sport psychologist in their training plan.

The value of the sport psychologist is something six of the participants in this study were able to clearly articulate from their perspectives. This included Jen, whose friend and teammate was battling a mental health issue when Jen spoke with her. In this situation: I don’t remember who it was that told her, but I do know after it all happened, when it’s still fairly fresh, we were basically just told to get over it. Not super bluntly but just, it happened, let’s focus now on the next games and take it step by step, but it was someone who mentioned, I think, to her that she should maybe try and see a sport psychologist. This belief that seeing a sport psychologist would be a potentially helpful step for the athletes was echoed by Diana, Kari, Sara, Alice and Sam. The remaining four participants did not suggest that sport psychology had a role in athletes’ overall mental health, nor did they suggest that sport psychology did not play a role; they simply did not identify sport psychology at all as either helpful or not helpful to the elite athlete.

Conclusion

Overall, there was a large amount of consistency within the interview responses. The participants did all agree that the NSO should be providing some form of reporting structure and support for athletes who are struggling with mental health issues. All participants acknowledged that they have all either seen or experienced mental health issues during their athletic careers. The participants identified that they were often witnesses to anxiety, depression, eating disorders, stress and pressure.

It was also noteworthy that participants suggested that the primary responsibility for the athletes’ mental health is the personal coach. Given that participants also acknowledged that their coaches’ education was primarily through Taekwondo Canada, the participants’ perceptions that the coaches most likely lacked the training to identify mental health issues was important. This lack of formal education on mental health spurred the participants to be requesting further education be provided by the NSO to the athletes and coaches in the future. Along with the increased education, a confidential and third party driven reporting line, along with a year-round sport psychologist’s involvement, were seen to be paramount moving forward.

The findings of this study support some of the previous research but contradicts others. Although these results do identify some tangible options for future programming that may want to be implemented by Taekwondo Canada or other NSOs, it is perhaps more vital to look, in greater depth, at the disparities between previous studies and the results of this study.

Previous self-reporting research looking at the rates of mental health issues amongst elite athletes often found that between 20% and 40% of elite athletes struggled with mental health issues [25, 26, 27]. These rates were ultimately even higher than those found during the Rio 2016 Olympic Games of 15% [28]. Based on our research, the prevalence of mental health issues was much greater in the participants interviewed for this study. Without further research looking at the causes of the mental health issues the participants observed and experienced, or without a comparison between sports, we are unable to conclude if the higher rate of mental health issues reported is specific to taekwondo in general, taekwondo in Canada or simply the group of participants interviewed for this study. Previous research was often limited to specific mental health issues or disorders. Prinz, et al. [29] specifically looked for signs of depression. Other researchers looked specifically at anxiety [30] or stress [31]. Our research asked the participants which mental health issues they felt they had either dealt with themselves or seen within their teammates. Our participants’ responses echoed previous research that the most prevalent mental health issues are anxiety, stress, depression and eating disorders [31]. It was clear throughout this study that participants had strong feelings regarding not only their own mental health struggles but those of their former teammates and friends as well. This certainly leads to the need for more conversation, research, and programming in this area.

Throughout the interviews, participants referred to the role of the sport psychologist in terms of their ability to identify, diagnose, and treat mental health issues. This is concerning given the differences between a sport psychologist, or mental skills trainer and a clinical psychologist. The American Psychological Association recognizes sport psychologists as licensed psychologists who have specialized in sport psychology, and not individuals who have doctorates in sport psychology. The discrepancy between those with a sport psychology designation, and those with a clinical psychology designation who specialize in sport, is of great concern when examined in the context of this research. By studying these aspects, mental performance staff can help ensure clarity and optimize relationships within sports teams, ultimately enhancing both individual and collective performance. Perhaps there is a specific aspect of this relationship that warrants further study by sport psychology researchers to ensure clarity for all athletes involved.

References

Fenton L, White C, Gallant K, Hutchinson S, Hamilton- Hinch B (2016) Recreation for mental health recovery. Leisure Loisir 40(3): 345-365.
Bär KJ, Markser VZ (2010) Sport specificity of mental disorders: The issue of sport psychiatry. European Archives of Psychiatry and Clinical Neuroscience 263(S2): 205-210.
Ghiami Z, Khalaghi K, Soh KG, Roslan S (2015) Comparison of mental health components among athlete and non- athlete adolescents. International Journal of Kinesiology and Sports Science 3(3).
Nicholls AR, Morley D, Perry JL (2016) Mentally tough athletes are more aware of unsupportive coaching behaviours: Perceptions of coach behaviour, motivational climate, and mental toughness in sport. International Journal of Sports Science & Coaching 11(2): 172-181.
Hammond T, Gialloreto C, Kubas H, Davis H (2013) The prevalence of failure-based depression among elite athletes. Clinical Journal of Sport Medicine 23(4): 273- 277.
Rice SM, Purcell R, De Silva S, Mawren D, McGorry PD, et al. (2016) The mental health of elite athletes: A narrative systematic review. Sports Medicine 46(9): 1333-1353.
Glick ID, Horsfall JL (2005) Diagnosis and psychiatric treatment of athletes. Clinics in Sports Medicine 24(4): 771-781.
Reardon CL, Factor RM (2010) Sport psychiatry: A systematic review of diagnosis and medical treatment of mental Illness in athletes. Sports Medicine 40(11): 961- 980.
Sebbens J, Hassmén P, Crisp D, Wensley K (2016) Mental Health in Sport (MHS): Improving the early intervention knowledge and confidence of elite sport staff. Frontiers in Psychology 7(911): 1-9.
Newman HJH, Howells KL, Fletcher D (2016) The dark side of top level sport: An autobiographic study of depressive experiences in elite sport performers. Frontiers in Psychology 7(6): 1-12.
Born J (2017) National protection of student-athlete mental health: The case for federal regulation over the National Collegiate Athletic Association. Indiana Law Journal 92(3): 1221-1245.
Steinfeldt JA, Steinfeldt MC (2012) Profile of masculine norms and help-seeking stigma in college football. Sport, Exercise, and Performance Psychology 1(1): 58-71.
Gulliver A, Griffiths KM, Christensen H (2012) Barriers and facilitators to mental health help-seeking for young elite athletes: A qualitative study. BioMed Central Psychiatry 12(1): 157.
Bauman NJ (2016) The stigma of mental health in athletes: Are mental toughness and mental health seen as contradictory in elite sport. British Journal of Sports Medicine 50(3): 135-136.
Gould D (2010) Early sport specialization. Journal of Physical Education. Recreation & Dance 81(8): 33-37.
Baker J, Cobley S, Fraser-Thomas J (2009) What do we know about early sport specialization? Not much. High Ability Studies 20(1): 77-89.
Schwenk TL (2000) The stigmatisation and denial of mental illness in athletes. British Journal of Sports Medicine 34(1): 4-5.
Clarke A (2003) Situational Analysis: Grounded Theory After the Postmodern Turn. Symbolic Interaction 26(4): 553-576.
Glaser BG, Strauss AL (1967) The discovery of grounded theory: Strategies for qualitative research. In: 1st (Edn.), New York, NY: Routledge, Taylor and Francis Group pp: 1-8.
Markula P, Silk M (2011) Qualitative research for physical culture. New York, NY: Palgrave Macmillan.
Wachsmuth S, Jowett S, Harwood CG (2018) On understanding the nature of interpersonal conflict between coaches and athletes. Journal of Sports Sciences 12(1): 1-8.
Strauss A, Corbin J (1998) Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. In: 2nd (Edn.), Thousand Oaks, CA: Sage Publications.
Kiyani R, Mohammadi A, Sattarzadeh L (2011) The survey compares mental health and happiness of athlete and non-athlete employed people. Procedia - Social and Behavioral Sciences 30: 1894-1896.
Pedersen ER, Paves AP (2014) Comparing perceived public stigma and personal stigma of mental health treatment seeking in a young adult sample. Psychiatry Research 219(1): 143-150.
Gulliver A, Griffiths KM, Mackinnon A, Batterham PJ, Stanimirovic R (2015) The mental health of Australian elite athletes. Journal of Science and Medicine in Sport 18(3): 255-261.
Schaal K, Tafflet M, Nassif H, Thibault V, Pichard C, et al. (2011) Psychological balance in high level athletes: Gender-Based differences and sport-specific patterns. PLoS ONE 6(5): e19007.
Yang J, Peek-Asa C, Corlette JD, Cheng G, Foster DT, et al. (2007) Prevalence of and risk factors associated with symptoms of depression in competitive collegiate student athletes. Clinical Journal of Sport Medicine 17(6): 481-487.
Drew MK, Vlahovich N, Hughes D, Appaneal R, Peterson K, et al. (2017) A multifactorial evaluation of illness risk factors in athletes preparing for the Summer Olympic Games. Journal of Science and Medicine in Sport 20(8): 745-750.
Prinz B, Dvořák J, Junge A (2016) Symptoms and risk factors of depression during and after the football career of elite female players. British Medical Journal Open Sport & Exercise Medicine 2(1): 1-6.
Jensen SN, Ivarsson A, Fallby J, Dankers S, Elbe AM (2018) Depression in Danish and Swedish elite football players and its relation to perfectionism and anxiety. Psychology of Sport and Exercise 36: 147-155.
Hanton S, Fletcher D, Coughlan G (2005) Stress in elite sport performers: A comparative study of competitive and organizational stressors. Journal of Sports Sciences 23(10): 1129-1141.

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