Top 3 Studies on Athletes’ Mental Health from Around the Globe: Insights from the Second Quarter of 2025

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SECTION EDITOR’S PICK

The second quarter of 2025 brought a diverse set of studies in sports psychiatry, spanning concussion recovery in collegiate athletes, the mental health impact of anti-doping systems in elite tennis, the protective role of competitive sports against youth suicidality, and even the emerging contributions of physiotherapists in suicide prevention. Together, they highlight the wide spectrum of factors influencing athlete mental health today.

1. Association of Premorbid Anxiety and Depression Symptoms in Concussion Recovery in Collegiate Student-Athletes

1. Study: Sawlani SP, Goldman JT, Babikian T, et al; CARE Consortium. Association of premorbid anxiety and depression symptoms in concussion recovery in collegiate student-athletes. Sports Health. 2025;17(3):497-503.
2. Summary: This NCAA–DoD CARE Consortium study analyzed 1329 athletes with 1352 concussions. Using the Brief Symptom Inventory, they categorized athletes into groups with elevated baseline anxiety, depression, both, or neither. Results: there was no difference in recovery time to asymptomatic status or return-to-play between groups. Importantly, none of the athletes reported a premorbid psychiatric diagnosis, so findings applied to self-reported symptoms, not clinical diagnoses. The authors conclude that mild premorbid symptoms should not be equated with diagnosed conditions when predicting recovery.
3. Why It Matters: Distinguishing between mild baseline symptoms and formal diagnoses helps clinicians provide accurate counseling on prognosis without over-pathologizing normal emotional variability.

4. Clinical Pearl: When counseling concussed athletes, clarify that mild self-reported mood or anxiety symptoms are not predictive of prolonged recovery unless associated with a clinical diagnosis.

2. Coercive Compliance? Anti-Doping Systems in Tennis and Athlete Mental Health

1. Study: Colangelo J, Smith A, Claussen MC, et al. Coercive compliance? Anti-doping systems in tennis and athlete mental health. Front Sports Act Living. 2025;7:1636161.
2. Summary: This perspective discusses ongoing litigation by professional tennis players regarding anti-doping enforcement. Players described procedures as “invasive” and “humiliating,” citing concerns over the stress of being tested with little privacy and under tight timelines. Specific grievances included the financial consequences of prolonged investigations, with athletes reporting that ongoing cases had led to the loss of endorsement deals, diminished sponsorship opportunities, and reduced income. In addition to financial strain, athletes highlighted mental health concerns including heightened anxiety, depressive symptoms, and sleep disturbances attributed to the stress of constant surveillance and uncertainty. The article highlights that while the integrity of anti-doping systems is essential, there must also be consideration of the psychological and financial toll such processes impose.The authors advocate for transparent communication, procedural fairness, and mental health support measures to mitigate these harms.
3. Why It Matters: This article underscores that anti-doping enforcement, while crucial, must also protect athlete dignity and mental health. Ensuring fairness and psychological support during investigations is key to maintaining both athlete well-being and trust in regulatory systems.
4. Clinical Pearl: When supporting athletes involved in anti-doping investigations, address the psychological impact of procedural stress, including anxiety, depression, and sleep disruption, along with financial uncertainty, while reinforcing the legitimacy and importance of anti-doping integrity.

3. The Protective Role of Competitive Sports in Reducing Suicidality Amongst Youth Athletes

1. Study: Sparagana PR, Clark VC, Herge W, et al. The protective role of competitive sports in reducing suicidality amongst youth athletes. Front Psychol. 2025;16:1591178.
2. Summary: This retrospective review examined 8599 youth athletes aged 10-18 who presented for care at sports medicine clinics affiliated with a large Midwestern US pediatric health system and its regional partner sites. The study focused on the 11 most common sports in these clinics, which included basketball, soccer, football, baseball/softball, track and field, swimming, wrestling, gymnastics, volleyball, tennis, and lacrosse. Results showed that higher competition levels correlated with lower rates of suicidality (P = 0.0162). Specifically, soccer and basketball were among the sports with the lowest suicidality rates, while wrestling and gymnastics reported relatively higher rates within the athlete population. Female sex predicted higher suicidality overall but not within the athlete subgroup. Notably, the authors acknowledge that other studies have found opposite trends, with higher levels of competitiveness linked to increased suicidality, highlighting the complexity of the relationship between sport participation and mental health.
3. Why It Matters: This study provides evidence that, in this setting, competitive sport may serve as a protective factor against suicidality in youth. It also underscores the importance of contextual and sport-specific differences and reminds clinicians that the protective effect is not universal and may vary by competitive level, sex, and sport type.
4. Clinical Pearl: Ask about competition level in youth athletes during mental health screenings. While it is essential to remain aware that some studies show risks at higher competition levels, this study supports that the benefits of participating in competitive sports generally outweigh the risks—particularly in fostering psychosocial factors such as belonging, structured activity, mentorship, and resilience.

Honorable Mention: The Untapped Role of Physiotherapists in Suicide Prevention

1. Study: Vancampfort D, McGrath RL, Stubbs B. The untapped role of physiotherapists in suicide prevention. J Physiother. 2025;71(2):143-145.
2. Summary: This editorial highlights physiotherapists’ unique role in suicide prevention. Many report disclosures of suicidal ideation during treatment but lack formal training. The authors emphasize the importance of physiotherapists receiving mental health and suicide prevention training so they can serve as the first line of protection by promptly notifying a mental health professional when an athlete is at risk. Concrete recommendations include: establishing referral pathways, integrating suicide prevention content into physiotherapy curricula, and encouraging collaboration with psychiatrists to ensure timely intervention.
3. Why It Matters: Broadening the suicide prevention workforce to include physiotherapists creates more entry points for identifying and supporting at-risk individuals and strengthens multidisciplinary athlete care.
4. Clinical Pearl: Psychiatrists and mental health professionals should actively engage physiotherapists as frontline partners by offering training, creating clear referral protocols, and fostering team-based approaches to athlete wellness. In US-based sports settings, this can include codeveloping emergency response plans, embedding physiotherapists in mental health workshops, and ensuring open communication channels between mental health and rehabilitation staff.

Closing Reflection

Across these studies, a clear theme emerges: athlete mental health is shaped not only by symptoms but also by systemic, cultural, and contextual factors. From concussion recovery and regulatory pressures to the protective role of competitive sports and the contributions of physiotherapists, proactive and culturally competent approaches remain essential. Tools that help athletes recognize their personal stress and resilience patterns will be increasingly valuable—setting the stage for more personalized, performance-supportive care moving forward.

As a sports psychiatrist and an advocate for equity, these findings highlight the dimension of social justice in our work. Access to care, fair treatment within regulatory systems, and culturally responsive approaches are not just clinical issues—they are equity issues.

• In the concussion study, the authors cautioned: “Our results highlight the need to distinguish between clinically diagnosed psychiatric conditions and elevated symptom reporting, to avoid over-pathologizing normal emotional experiences in athletes.” Thus, we are warned against labeling athletes unfairly, which can increase stigma and reduce access to fair treatment.
• In the anti-doping article, players described procedures as “invasive and humiliating” and reported that investigations caused “loss of endorsement deals, diminished sponsorship opportunities, and reduced income.” This perspective highlights the disproportionate impact these financial and reputational harms can have on athletes from less privileged backgrounds, for whom losing a sponsorship may end a career.
• The youth sport suicidality study noted: “Other studies have reported higher levels of competitiveness to be associated with increased suicidality, underscoring the complexity of contextual and sport-specific influences.” While competitive sport participation is on the whole a positive experience, athletes in resource-poor schools or communities may lack access. Even when sports are technically available, youth from disadvantaged backgrounds often shoulder additional responsibilities such as caregiving, employment, or household support, which limit or prevent participation. The literal cost to play is an additional barrier. A national survey underscores the scope of the problem:

Half of US adults who played youth sports or had children in youth sports reported struggling to afford participation costs.

• The burden was especially high among Latino/a families (66%), adults ages 35-49 (62%), those with high school educations (58%), lower-income adults (57%), and renters (56%). Additionally, over 4 in 5 Americans surveyed believe sports should be more accessible to underserved communities and athletes with physical disabilities.¹
• The physiotherapists’ editorial emphasized: “Physiotherapists are in a unique position to serve as the first line of protection by recognizing suicidality and promptly referring to mental health professionals… Suicide prevention content should be integrated into physiotherapy curricula.” In many low-income school districts, access to sports physiotherapists is severely limited, leaving a gap in the athlete safety net. A 2021 study found significant socioeconomic disparities in athletic trainer access: schools with full-time athletic trainers (ATs) had higher median household incomes ($56,026) compared with those with part-time ($52,719) or no ATs ($49,584). Similarly, the proportion of students eligible for free or reduced-price lunch was lowest at schools with full-time ATs (41.1%) and highest at schools with no ATs (52.9%).²

Whether it is ensuring that underserved youth or marginalized communities benefit from sport programs, safeguarding athletes from financial and psychological harm in compliance systems, or empowering physiotherapists to act as allies in suicide prevention, these studies remind us that the culture of sport and the culture of care must advance together.

Stay tuned each quarter for the latest insights shaping the future of sports psychiatry!

Dr Wilsa Charles Malveaux, MD, MA, FAPA,is a sports psychiatrist in Los Angeles, California, and the CEO & Founder of WCM Sports Psych. She is an advocate and educator on the intersection of mental health, sports, and racial and social justice. Dr Charles Malveaux lends her expertise as a psychiatric consultant to multiple national sport-related agencies, professional sports teams, and organizations. She served for over 4 years as the Western Regional Trustee (region 4) on the Board of Black Psychiatrists of America. Dr. Wilsa Charles Malveaux currently serves on the Board of Directors for the American Board of Sports and Performance Psychiatry (ABSPP), as well as on advisory boards for organizations serving the community.

References

1. Aspen Institute. State of play 2023: trends and developments in youth sports. Project Play. 2023. Accessed August 6, 2025. https://projectplay.org/state-of-play-2023/costs-to-play-trends

2. Barter EW, Rivera MJ, Post EG, et al. Differences in access to athletic trainers in public secondary schools based on socioeconomic status. J Athl Train. 2021;58(2):91-96.