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Q&A: Dr. Stephen Nickell on the Role of Athletic Trainers in Mental Health

When considering an athlete’s health, most people tend to think about physical characteristics such as height, weight, speed, strength and endurance; however, mental wellness is every bit as important to an athlete’s ability to perform.

According to the American College of Sports Medicine, 30 percent of women and 25 percent of men who are student athletes struggle with a mental health issue while 35 percent of professional athletes suffer from conditions such as disordered eating, burnout, depression and anxiety.

We sat down with Stephen Nickell, EdD, MA, ATC, program director for Logan University’s Master’s in Athletic Training (MAT) and Sports and Exercise Science department chair to learn more about the significant role athletic trainers play in supporting and promoting athletes’ mental health.

Why is athletes’ mental health an important consideration for athletic trainers?

Athletic trainers are in a unique position in health care. We observe athletes’ behavior before they get hurt or fall ill, so we can serve as gatekeepers by helping to determine if they need assistance with mental health issues. We may be the first provider they speak to about their concerns because they are familiar and comfortable with us. However, because we aren’t psychologists or psychiatrists, it’s important for us to be able to recognize the signs and symptoms of mental health issues in order to refer athletes to the right physicians when needed.

What sorts of mental health problems can athletes face?

Like the general population, athletes can experience a wide range of mental health issues, including mood disorders like depression, anxiety disorders, attention deficit hyperactivity disorder (ADHD) and eating disorders such as anorexia and bulimia. Many of these conditions can arise after physical injuries, especially those that end an athlete’s season or career.

What are some symptoms athletes might show if they’re experiencing a mental health problem?

It depends on the individual and mental health issue, but some general signs an athlete may be struggling include a sudden drop in grades, disinterest in their sport, a negative attitude, abnormal aggression, sleeping problems and debilitating pre-performance anxiety. Athletes with eating disorders show specific symptoms such as an obsession with their weight and appearance and may be hypercritical of themselves. Overall, any behavior that is out of the ordinary could be a warning sign that an athlete may be grappling with a mental health concern.

How has the COVID-19 pandemic impacted athletes’ mental health?

For many athletes, a large part of their identities revolves around their ability to go to the gym, interact with teammates and compete. Not being able to do those things has resulted in significant mental health consequences.

The pandemic has also affected athletic trainers. Many lost their jobs or entered different professions because they were overworked or burned out. Just like athletes, it’s important for us to practice self-care to achieve a healthy work-life balance. Sometimes we spend so much time taking care of others that we neglect our own needs.

For so long, mental health has been a taboo topic, especially among athletes. Why is that?

This mentality was exemplified during the 2020 Summer Olympics when Simone Biles received criticism after withdrawing from multiple events due to mental health struggles. Many athletes feel they have to walk it off, tough it out and put the team first, but a mental health issue is like any other physical injury or illness. It can impact your ability to perform and put you and your teammates at risk. If you had asthma, you’d seek treatment so you could play your best. You should have the same attitude when it comes to mental health concerns, which can be every bit as debilitating. Just because you can’t see it on an X-ray or MRI doesn’t mean it’s not there and shouldn’t be addressed.

How can athletic trainers help athletes address their mental health concerns?An athletic trainer wraps a bandage around an athlete's foot

Professional development for athletic trainers should include intervention strategies for mental health issues and how to make proper referrals. Additionally, mental health professionals should be on every sports medicine team. Just like an orthopedist would be on hand to help treat muscle, joint or bone injuries, a trusted psychologist or psychiatrist should be available to attend to athletes’ mental health.

As far as specific intervention strategies go, listening is the most important. If an athlete confides in you, be attentive, be understanding and offer what assistance you can in the form of a referral. Remember that athletes have a lot going on in their lives, both on and off the field. Whether it’s a family, financial or academic issue, make sure the individual feels heard, and then determine if additional intervention is needed. Since you are not a mental health provider, you may not be able to solve their problems, but you can help guide them in the right direction.