Mental health in elite and youth athletes: emerging strategies and evidence-based trends: a narrative review

Abstract

The significance of mental health in athletes is acknowledged and valued. This review explores psychosocial triggers, evolving screening approaches, digital mood-tracking tools, and embedded mental health professionals in performance programs. Numerous studies have shown that the occurrence of depressive symptoms and anxiety is common among high performance athletes. Recent systematic reviews confirm anxiety, depression, and distress rates of 20–35%, especially around injury, deselection, or career change. In this article, we aim to focus on psychiatric issues faced by athletes and propose strategies that would help in improving mental health. Several reasons that affect the mental health of this population have been highlighted. The lack of proper mental health support, no access to sports psychologists in the training programs need urgent attention. A key point is that team support and self-confidence can also help buffer the negative effects of perfectionism on anxiety and performance.

Introduction

High-performance sports is well known for its discipline. Athletes are known for their resilience and peak physical prowess. However, various psychological problems are more common among athletes than in the general population, and they also vary based on gender and age[1]. The intense pressure on them to pursue excellence can lead to many psychological problems. There is comparatively less research on the psychological well-being of the athletes and psychiatric issues faced by this population.

A study in 2020 shows that the prevalence of depression and its symptoms in high-performance athletes ranges from 6.7 to 34%[2]. A recent systematic review and meta-analysis in 2024 shows that the prevalence of depressive symptoms and anxiety in athletes is twice that of the public, and among these former athletes, 2% were females[3]. Research shows that this population faces many mental health problems, which might be influenced by sports or any other factor not related to sports. However, intervention-based research in this field is scarce to explore the cause of this issue[4].

HIGHLIGHTS

• 20–35% of elite athletes experience anxiety, depression, or distress.

• Youth athletes face added risks from academics, peers, and early specialization.

• Concussions and injuries strongly link with anxiety, depression, and recovery delay.

• Digital mood-tracking tools support early detection of mental health issues.

• Embedding psychologists in teams reduces stigma and improves athlete resilience.

There are several factors that can have negative implications on athletes’ mental health, which include a competitive environment, constant pressure, fear of rejection, and sports injury, which can lead to athletic career termination. The constant stress can also alter their decision-making capabilities, leaving them vulnerable to injury[5]. A study demonstrates the effect of career-ending injuries on the biopsychosocial health of athletes as they face many challenges during this transitional phase of their life, stressing the counselling and education of them to be mentally prepared for the unexpected retirement[6]. A review article reported that disordered eating, anxiety, and depression are common among young athletes[7]. High expectations, overtraining, and perfectionism expected from them can cause burnout and exhaustion. Hence, early intervention and preventive measures are the need of the hour to protect and promote sound mental health among elite young athletes[8].

In accordance with the TITAN 2025 guidelines governing the declaration of AI usage in the research and manuscript development, we confirm that no generative AI tools were utilized in the conceptualization, writing, or editing of this manuscript[9].

Aim of the study

This narrative review intends to critically examine existing therapies and preventive approaches while also combining pertinent prevalence data to better comprehend the burden of mental health in sports communities.

Research questions

1. what are the fundamental mental and psychological concerns for elite and youth athletes?

2. What evidence-based screening and intervention techniques are currently available to promote mental health in this population?

3. How do innovative strategies, such as digital monitoring technologies, fit into competitive performance schemes?

Primary outcomes

To assess and organize preventative and intervention methods that improve elite and young athletes’ mental wellness and psychological endurance.

Secondary outcomes

To highlight the determinants of typical psychiatric disorders witnessed in young athletes of high performing sports.

Methodology

Search strategy

The review was conducted as a narrative synthesis through a comprehensive literature search across MEDLINE/PubMed from January 2000 to July 2025. An assortment of pertinent keywords was used in the search strategy such as “youth sport,” “elite sport,” “elite athletes,” “mental health,” “adolescence,” and “psychology.” The full text of potentially relevant articles was thoroughly assessed, and their bibliographies were reviewed to identify additional relevant studies.

Inclusion criteria

1. Original research articles, clinical trials, and review papers discussing mental health issues in elite athletes.

2. Studies reporting evidence-based interventions and emerging innovations to protect the mental health of young, elite athletes.

Exclusion criteria

1. Articles published before 2000 to ensure the omission of outdated data.

2. Non–peer-reviewed literature without substantial scientific evidence.

3. Articles written in languages other than English.

Conceptual framework

Mental health disorders among high-performance athletes and those who strive to be one arise from an interaction of multiple stressors and vulnerabilities, especially in the face of transition (i.e., onset or exacerbation of symptoms) and significant life stress (injury, transitioning out of sport, and times of intense performance demand). Cognitive concussion etiology, treatment, and outcome are highly consequential. Disabling injuries, such as concussions, impair training and induce psychological stress, with 17–46% of athletes suffering from anxiety and/or depression following the injury^[4,10^]. Career transition (i.e., from junior to senior and from the end of a career) is recognized as a struggle of identity for athletes, which is expressed by stress, and this sometimes results in subclinical symptoms such as low self-esteem^[10,11^]. Increased pressure to perform, in addition to over 600 sport-specific stressors (e.g., competition demands and maladaptive perfectionism), has been found to elevate anxiety levels, particularly during peak competitive years (15–25 years old) that are established to have parallel developmental changes in youth athletes^[4,11,12^]. For adolescent athletes, younger age groups add stressors, such as academic-sport conflicts and peer comparisons to age-specific cohorts and susceptibility to mental health[13]. These issues are most appropriately considered from a biopsychosocial perspective, in which biological elements (e.g., concussion or pubertal changes) converge with psychological characteristics (e.g., perfectionism) and social pressures (e.g., coaching styles and parental expectations)^[10,11,13^]. Overtraining (e.g., SGMs testing is compared to regular training), for example, can create depressive symptomatology with performance-oriented environments, worsening stress (with immoral family members’ collusion) and causing the at-risk young to navigate their stress-visiting confusions^[4,12^]. Youth athletes are under more far-reaching external social pressure from peers and parents, which may increase anxiety and body dissatisfaction, especially in appearance-related sports^[4,13^]. This biopsychosocial model emphasizes the importance of targeted interventions addressing physical recovery, cognitive coping, and supportive social systems, with special emphasis on developmental periods in youth athletes to enhance resilience and reduce the likelihood of clinical syndromes^[10,11,13^].

Evidence synthesis

Elite and young athletes have alarmingly high susceptibility for mental health issues, exceeding that of the general population, and the prevalence has been reported to be related to sport-specific and developmental factors. Studies have shown that 19–34% of elite athletes still in competition suffer from symptoms such as alcohol misuse, stress, sleep disturbances, or anxiety/depression, and that former elite athletes report 16–26%[12]. Other studies emphasize 20–46% anxiety, depression, or eating disorder prevalence among elite athletes, specifically 27% for depression and 23% for eating disorders[4]. In team sports, its prevalence varies from 5 to 45%^[11,12^]; at the same time, college athletes, who are in youth ages, have 10–25% for depression[11]. For example, up to 68% of world-class swimmers satisfy the criteria for depression prior to competitions[10]. A similar risk applies to youth athletes, with 15–30% presenting with symptoms of anxiety or depression, motivated by academic stressors and developmental issues[13]. Female and young athletes participating in aesthetic sports are especially at risk.

The association between mental health and injury is reciprocal, ultimately impacting athlete health and well-being. Psychological distress, including anxiety, influences concentration and higher rates of injury, with trait anxiety a correlate of injury in soccer players^[4,10,12^]. Conversely, serious injuries such as concussions exacerbate mental health, as 17–46% of athletes report at least one symptom of post-concussive depression (PCD) or post-concussive anxiety (PCA), which are associated with recovery delay^[10,11^]. Athletes with sports injuries tend to have higher depression scores; serious musculoskeletal injuries increase the risk of mental health issues^[4,11^]. Young athletes are at special risk for overuse injuries, which have been linked to excess pressure and anxiety from longer recovery processes[14]. This cycle can only be addressed by combined physical and psychological rehabilitation approaches^[4,10,11^].

Interventions for athletes’ mental health are advancing, but youth-tailored strategies lag behind. Cognitive behavioral therapy (CBT) and family therapy work well for depression and anxiety and are adapted to fit around the busy schedules of athletes[11]. Mindfulness-based interventions can alleviate burnout, and the evaluations for them are available, including the Profile of Mood States (POMS) or the Brunel Mood Scale (BRUMS) for mood assessment[10]. Multidisciplinary teams are essential for timely identification and treatment; however, mental health literacy programs, although increasing awareness, have proven difficult to promote seeking help, given the ongoing stigma associated^[4,11^]. School-based approaches combining mindfulness and peer support appear promising for youth athletes, with 60% of such participants reporting reduced anxiety[14]. Digital systems such as Smartabase monitor both mood and training load to detect overtraining early[11]. The integration of psychologists into teams facilitates recognition, yet age confines stigma as a barrier^[10–12^].

Workplaces related to sports are currently focusing on mental health and implementing well-organized policies. The International Olympic Committee (IOC) dictates screenings at high-risk times, such as injury or retirement, to catch cases early[11]. “Exit health examinations” for post-professional career mental health, modeled on professional football, are also concerned with the problems of former players[12]. Mental health literacy programs, effective in junior sport clubs, are one way to reduce stigma and facilitate help-seeking[10]. Cooperation models among coaches, psychologists, and medical staff reinforce early intervention[4]. For adolescents, NCAA regulations require mental health screening and counselor access, thereby reducing stigma in the college environment[15]. The National Athletic Trainers’ Association (NATA) promotes required screenings and the establishment of autonomy-supporting environments that support athlete mental health in athlete welfare, in elite and age-group sports environments alike^[9–11].

Epidemiology and risk factors

Mental health prevalence

Mental health challenges are increasingly recognized among both elite and youth athletes, with emerging research refining our understanding of their prevalence and presentation. Recent systematic reviews (2023–2025) estimate that approximately 25% of elite athletes experience anxiety symptoms, 20% experience depressive symptoms, and up to 35% report high levels of general psychological distress[4]. Notably, sport-specific trends have emerged, athletes competing in individual sports consistently report higher levels of distress than those in team settings, likely due to the increased personal accountability and isolation inherent in such disciplines[16]. In youth athletes, while the prevalence of clinical diagnoses may be lower, screening studies frequently reveal elevated subclinical distress. These athletes often show signs of emotional strain that do not meet diagnostic thresholds but may still impair performance, well-being, and development. The convergence of high performance demands with limited emotional maturity and coping skills leaves this population particularly vulnerable. Moreover, early exposure to high-stakes competition and external pressures may heighten susceptibility to stress-related conditions[17]. Figure 1 explains the epidemiology and risk variables for mental wellness in elite and young athletes.

Figure 1.

Illustrates the epidemiology and risk factors of mental health in elite and youth athletes.

Individual-level drivers

Several individual-level factors contribute to mental health risks in athletic populations. Athletic identity, the degree to which an individual identifies with the athlete role, can act as both a protective and a risk factor. While strong athletic identity can foster motivation and resilience, identity foreclosure (i.e., when identity becomes overly dependent on sport) is associated with burnout, emotional dysregulation, and difficulties during transitions[18]. Early sport specialization, intensive focus on a single sport at a young age, has been linked with increased rates of anxiety, depression, and burnout. Overtraining and injury are further risk amplifiers, often leading to psychological distress, particularly when athletes face prolonged rehabilitation periods. During injury and rehabilitation, athletes may experience identity loss, social isolation, and fear about performance upon return, creating a high-risk window for mental health deterioration[19]. Performance-related pressures, including perfectionism, social media scrutiny, and national expectations, contribute to chronic stress and anxiety, especially in elite settings. For youth, the lack of emotional maturity and developing self-concept limit their ability to navigate failure or public criticism effectively, amplifying mental health vulnerabilities[20].

Interpersonal factors

The quality of interpersonal relationships significantly influences athletes’ psychological well-being. The coach-athlete relationship is particularly critical; while a supportive coach can buffer against stress and promote mental health, abusive or overly controlling dynamics can lead to psychological harm. Maltreatment, ranging from emotional neglect to verbal abuse, has been documented across multiple sports and levels of competition[21].

Beyond coaches, the influence of parents and peers plays a central role in shaping athletes’ self-worth and stress response. Unrealistic expectations or critical feedback from close relations can exacerbate feelings of inadequacy, while environments characterized by emotional support and autonomy-granting behaviors tend to promote resilience[22].

Organizational and societal influence

At the broader level, systemic and cultural factors shape mental health outcomes. “Win-at-all-costs” cultures, often perpetuated by performance-driven institutions, tend to deprioritize athlete welfare and discourage open dialogue about mental health. These environments can normalize overtraining, stigmatize vulnerability, and hinder help-seeking behaviors[23]. In contrast, a growing number of organizations have begun implementing proactive mental health strategies that emphasize psychological safety alongside performance. Examples include federations embedding mental health professionals within teams, promoting mental health literacy, and revising protocols to include rest, recovery, and psychological monitoring. These proactive cultures offer valuable models for broader systemic change[24].

Figure 1 shows a summarized diagram illustrating the epidemiology and risk factors of mental health associated with elite and youth athletes.

Evidence-based interventions

Preventive interventions

Prevention is increasingly emphasized as a cornerstone of athlete mental health strategy. Key approaches include mental health literacy programs targeting athletes, coaches, and support staff, which aim to normalize mental health dialogue and increase early recognition of symptoms. Studies show these programs improve attitudes toward mental health, reduce stigma, and enhance help-seeking behavior[25]. Psychoeducation for parents, especially in youth settings, provides essential context about performance stress, emotional development, and appropriate support. Well-informed parents are better equipped to create psychologically safe environments that buffer against overpressure and emotional burnout[26]. Screening initiatives are also expanding in both elite and developmental systems. Tools like the Sport Mental Health Assessment Tool 1 (SMHAT-1) allow for early identification of subclinical distress, especially in high-risk periods like injury, selection, or transition phases. These screenings are most effective when embedded in regular care cycles, rather than used as reactive assessments[27].

Psychological Skills Training

Psychological Skills Training (PST), often rooted in cognitive-behavioral principles, includes goal setting, self-talk, imagery, and arousal regulation. While traditionally linked to performance enhancement, PST also shows utility in improving coping and reducing anxiety[28]. However, evidence on PST’s impact on mental health is mixed, particularly for subclinical populations. The benefits appear strongest when PST is integrated into everyday training rather than delivered in isolation. Moreover, for elite youth athletes, traditional PST may lack the developmental sensitivity needed to address emotional regulation and identity concerns[29].

Acceptance-based training

Third-wave psychological interventions, especially those grounded in Acceptance and Commitment Therapy (ACT) and mindfulness, are gaining momentum in sport psychology. Programs such as Mindfulness-Acceptance-Insight-Commitment (MAIC), Mindfulness-Acceptance-Commitment (MAC), and Mindful Sport Performance Enhancement (MSPE) have demonstrated moderate efficacy (standardized mean differences ~ 0.32–0.78) in reducing anxiety, improving focus, and enhancing emotional regulation among both elite and developing athletes[30]. These programs cultivate present-moment awareness, reduce experiential avoidance, and support values-based action, core psychological flexibilities vital in high-stakes sport. Importantly, elite youth athletes appear especially responsive to mindfulness frameworks, perhaps due to their intuitive alignment with growth-oriented mindsets and non-judgmental reflection[31]. Figure 2 demonstrates various evidence-based interventions.

Figure 2.

Illustrates evidence-based interventions that include preventive interventions, PST, acceptance-based training and others.

Multi-modal and resilience programs

Given the complexity of athlete stress environments, multi-modal interventions are emerging as best practice. Programs such as FRIENDS, an evidence-based cognitive-behavioral protocol originally developed for school-aged populations, have been successfully adapted for sport settings to prevent anxiety and depression. FRIENDS targets cognitive restructuring, relaxation, and problem-solving skills directly transferable to athletic stressors[32]. Combined athlete–parent educational interventions show promise, particularly in youth development academies. These packages focus on shared resilience building, aligning expectations, and enhancing emotional literacy within the athlete’s support ecosystem. Resilience programs that blend PST, mindfulness, psychoeducation, and behavioral rehearsal tend to yield the most sustained mental health outcomes. When these are embedded into sport curricula and reinforced by coaching staff, long-term effects on emotional regulation and stress tolerance are more likely[33].

Psychiatric care

While most mental health strategies in sport remain preventive or performance-oriented, the need for integrated psychiatric care is gaining urgency. The traditional model – ad hoc referrals to external psychologists, often results in poor continuity of care and delayed intervention. In response, elite teams are increasingly embedding sport-trained psychologists and psychiatrists into daily operations[4]. This proactive model includes weekly mental skills sessions, confidential open-door policies, and crisis response protocols, creating an environment where mental health support is not only available but normalized. Data suggests that athletes are more likely to seek help when psychological care is part of the sport infrastructure rather than an external add-on.

Digital mood-tracking tools

Technology is now central to proactive mental health monitoring. Platforms such as Smartabase, AthleteMonitoring, and integrations with WHOOP or Oura allow athletes and staff to input and visualize daily mood trends, stress levels, and sleep data. These digital tools facilitate early detection of mood dysregulation and can flag pre-clinical warning signs, especially useful in environments where stigma or travel logistics may otherwise inhibit frequent psychological check-ins. Some platforms include algorithmic alerts to trigger follow-up assessments when mood data crosses predefined risk thresholds[34]. Though promising, challenges remain around data privacy, interpretation, and sustained engagement, highlighting the need for careful implementation with athlete consent and education.

Figure 2 summarizes evidence-based interventions that include preventive interventions, PST, acceptance-based training and others.

System level innovations

Coaching education initiatives

The general public can now use digital mood tracking tools to monitor their moods thanks to the ongoing rise in smartphone usage. Consequently, it was essential that comparable advancements be made in the area of fitness and coaching athletes. The Million Coaches Challenge is a program based in the US that trains coaches to improve the mental health status of their athletes. It focuses on enhancing coaches’ understanding of psychological well-being, teaching them to recognize signs of mental distress, and fostering open communication about mental health[35].

Digital innovation

The Sport Mental Health Assessment Tool 1 (SMHAT-1) is used by AMS, previously Smartabase, to identify athletes who may be at risk for mental health issues and to give information about an athlete’s emotional state to the coach or mental health professional[36].

WHOOP’s Stress Monitor can measure an athlete’s stress level in real time and offer breathing exercises supported by research to help manage it[37]. Athlete Monitoring is an additional application that provides real-time tracking of workload, performance management, injury information, and mental health wellness[38]. A literature review recommends that a hybrid model should be adopted which would be a combination of face to face and digital and Artificial Intelligence based interventions in athletes with prevalent mental health issues[39].

Organizational policies and federations

The International Olympic Committee (IOC) has published a toolkit on mental health in elite athletes to help in the implementation of policies for the preservation and advancement of elite athletes’ mental health and wellbeing. The Toolkit is available for use by clubs, teams, governing authorities, athletes’ entourage, medical professionals, and other sport stakeholders. It provides an overview of mental health symptoms and disorders among elite athletes and the responsibilities of key organizations in creating psychologically safe athletic environments, in addition to other IOC resources, information, and educational initiatives[40].

The National Athletic Trainers’ Association (NATA) targets an improvement in an athlete’s mental health by educating coaches and trainers through specialized programs and peer-support initiatives. This leads to early detection of mental health problems and increases the awareness of mental health in the sporting fraternity. By positioning trainers as frontline mental health allies, NATA integrates psychological care into sports medicine[41]. This is also shown in Figure 3.

Figure 3.

Illustrates various system level innovations.

The National Collegiate Athletic Association (NCAA) has made it mandatory to conduct annual mental health screenings for student-athletes, including during preseason and post-injury phases. According to the NCAA’s 2024 Mental Health Best Practices, institutions must use already validated tools like CCAPS-Screen to screen for psychological stress at least once per year, and at key points like return-to-play after injury[42].

Figure 3 illustrates various system level innovations including NCAA and NATA guidelines, athlete monitoring and Million Coaches Challenge.

Discussion

Shift in mental health philosophy

Earlier research shows that seeking mental health support was heavily stigmatized in the world of elite sports. For many athletes, validating psychological suffering came with multiple emotional challenges like fear of criticism, humiliation and confidentiality issues. This hesitation was significant among young athletes as they face additional obstacles like managing finances, academics, relationships and peer pressure^[43,44^]. While physical fitness has always been seen as key to athletic success, an increasing amount of evidence shows that mental health is equally crucial for elite athletes. In 2019, the International Olympic Committee acknowledged the unique challenges faced by elite athletes, as reported 49% of Olympic athletes are poor sleepers, and over 50% of NCAA athletes report less than 7 hours of sleep in-season. Psychological problems like overtraining syndrome, vanity and presumptuousness can further complicate diagnosis and treatment[11]. Extreme training at an elite level may further increase depression and anxiety due to overthinking, burnout and injury[4]. Systematic research in physical injury management surpasses mental health studies, although the latter significantly impact performance and long-term well-being. In an interview at Sports Illustrated, published in 2018, Michael Phelps opened up about his struggles with suicidal thoughts and post-retirement psychological distress. Through his own organization, he became an advocate and promoted communication as a vital, life-saving tool[45]. This cultural shift in the world of sports was reinforced at the Tokyo 2021 Olympics, when Simone Biles decided to withdraw due to mental health concerns. Her decision not only challenged long-standing stigma, but it also normalized vulnerability[46]. Figure 4 summarizes numerous facets of mental health in young people and elite sports.

Figure 4.

Summarizing various aspects of mental health in youth and elite athletes.

Limitations of current practices

A 2022 study revealed that only 25.7% of NCAA Division athletic departments provide mental health or performance services, that is, 99 professionals for over 187 000 athletes. This evidence shows how endangered long-term athlete development and well-being are[47]. The traditional 5 Cs of performance have expanded to 6 Cs, including character, confidence, connection, competence, caring, and contribution; the implementation of mental health support still lacks. Many academies, for instance, still do not have access to sports psychologists due to a shortage of staff, financial limitations and ongoing resistance from both coaches and players[48]. According to a prospective cohort study, athletes underreported concussion symptoms by over 50% compared to confidential interviews, particularly psychiatric symptoms, even 9 days post-concussion. This highlights the need for analysis tools in managing athlete mental health after injury[49]. Current Athlete Self-Report Measures (ASRM) are limited by social and organizational elements that impact accurate reporting. Without education and supportive structures, athletes may downplay symptoms, reducing screening accuracy and efficacy. A complex, athlete-centered approach is essential for reliable mental health monitoring[50]. Coaches influence both risk and help-seeking behaviors, yet unclear coaching roles and lack of integrated coordination hinder effective support. The absence of integrated care among medical, coaching, and psychological staff, coupled with conflicts of interest and power dynamics, worsens the problem. A model suggesting onsite sports psychiatrists and regulatory oversight is proposed to ensure comprehensive and better care for all team members[51].

Research gaps

Limited cross-sectional findings show widespread prevalence of mental disorders. Self-reported symptoms include 6.7% for anxiety and 9.5% for depression and 23% for multiple symptoms. Despite growing awareness, mental health of youth elite athletes, specially aged 12–18, remains insufficiently explored. Unique developmental challenges such as identity formation, social media use, and performance pressure need to be explored more[52]. Beyond stigma, barriers like insufficient treatment awareness, regional differences and poor multi-sector coordination limit access to psychotherapy. E-mental health technologies including self-help tools, computer-assisted programs and remote healthcare offer viable alternatives[52]. A study involving therapists compared human-human and human-AI therapy and found that therapists could not reliably distinguish between both, giving 53.9% accuracy. These findings suggest that chatbots may serve as effective support tools for individuals with mild to moderate psychological issues especially when human therapists are unavailable, however humans remain essential for more complex therapeutic need[53]. The International Olympic Committee recognizes transgender athletes as highly susceptible to bullying and abuse in sports, often facing homophobic language and threats. Team support may help reduce mental health risks, but evidence of true inclusivity in sports remains limited. To create safer environments, educational institutions and athletic departments should integrate non-discriminatory curricula, act against prejudice, provide sensitivity training for coaches[54]. While some trainers provide competent care, unreliable practices reveal the need for harmonized education to combat bullying and redefine norms for gender minorities[55].

Figure 4 summarizes the stigma, awareness, current limitations, research gaps and future directions in the landscape of mental health in youth and elite athletes.

Strengths and limitations

The mental wellness of elite athletes in high-performance sports has traditionally received little attention. This review identifies the risk factors that negatively impact mental health, with an emphasis on anxiety and depression. Furthermore, the inclusion of recent research on system-level integrations along with the usage of modern digital mood-tracking tools effectively conveys the timely application of technology. Our article thoroughly evaluates current developments in this field and provides a credible discussion based on the most recent trials and systemic reviews.

Several limitations must be considered. As this review was designed as a narrative rather than a systematic review or meta-analysis, potential drawbacks include the possibility of publication bias, selective reporting, and incomplete capture of available evidence. A key challenge is the scarcity of large-scale studies reporting evidence-based strategies for mental health of elite athletes, which limits the generalizability of observations. Existing literature frequently lacks substantial data on intervention-based research in this field.

Recommendations and future directions

Future AI directions in sports include enhancing athlete well-being through personalized mental health monitoring. Hybrid models like BERT-XGBoost have potential in predicting stress and anxiety, while integrating biometric verification, voice, and facial analysis can support AI-based solutions^[56,57^]. Peer guidance promotes communication and teamwork, especially when coaches match athletes well, set clear roles and support their development[58]. Freshly qualified athletic trainers value accessible mentors who provide honest, constructive feedback and emotional support to boost confidence. Mentorship guides the adjustment to practice, mainly in patient care and communication. Future research should explore its impact on job performance, turnover, and satisfaction[59]. Coaches at the grassroots level should build FMS and nurture confidence in 7–12-year-olds in order to highlight the importance of early sports development[60]. Based on a study that showed self-confidence can buffer the negative effects of perfectionism on anxiety and performance, it is proven that incorporating mental skills training builds confidence and addresses perfectionism to support athletes’ psychological resilience and improve their sporting outcomes[61].

Conclusion

Mental health in elite and youth athletes remains critically overlooked despite its profound impact on performance and long-term well-being. Psychological distress tends to heighten during high-risk periods such as career transitions or prolonged phases of underperformance. Challenging phases like these question sportsmanship often leading to depression, distress and emotional exhaustion. Holistic, athlete-centered care including mental, physical, and social dimensions is essential for sustainable high performance.

Federations and sports institutions must shift from acknowledgement to implementation and integrate structured, evidence-based mental health frameworks into the athletic ecosystem.

Stereotypes, systemic barriers and inconsistent support networks continue to compromise timely action, particularly in adolescent athletes handling psychosocial transformation. Coaches, parents, and medical staff must collaborate across disciplines to recognize early signs and offer immediate assistance. Digital platforms, such as mood tracking apps and AI-based monitoring tools, reinforce clinical care and help in identifying early symptoms, yet human supervision remains essential.

To conclude, mental fitness must be valued on par with physical conditioning. Developing emotional endurance and promoting therapy among the athletic community are key to sustaining long-term performance. A multidisciplinary, preventative model will not only improve outcomes but also ensure athletes thrive both within and beyond the arena.

Declaration of AI content

This case study was not generated by AI tools. While AI was utilized to enhance the professionalism and readability of the content, it was not used extensively to the extent that the work appears AI-generated. The primary content, analysis, and conclusions are the result of the authors’ original work.

Ethical approval

Ethics approval was not required for this narrative review.

Consent

Not applicable.

Conflicts of interest disclosure

Not applicable.

Sources of funding

No funding was received during this research.

Author contributions

I.K. and Z.A.D.: conceptualization; F.S., H.U.R., T.R., F.I., A.A., T.M., and E.A.: writing – original draft; Z.A.D., M.A., and E.A.: writing – review and editing.

Research registration unique identification number (UIN)

Not applicable.

Guarantor

Iftikhar Khan.

Provenance and peer review

Not applicable.

Data availability statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Patient and public involvement (PPI)

Patients and/or the public were not involved in the design, conduct, reporting, or dissemination plans of this research.

Acknowledgements

None.