Expert blog: How stress can increase risk of mental and physical ill-health among elite athletes

Stress – it is something we all encounter in our daily lives, shaping our health and wellbeing in ways that are both subtle and profound. Whether it's a looming work deadline, personal relationship problems, or missing a bus on the way to work, it is clear that stressors pervade all aspects of our lives.

One particular group of individuals who are exposed to stressors on a different level are elite-level athletes.

Athletes face a unique set of stressors that go beyond the typical day-to-day challenges. This can present itself in the form of a heated rivalry with your opponents during a big game, or navigating the complex dynamics of a coach-athlete relationship.

When it comes to competing, elite athletes do so in highly visible arenas characterized by narrow margins of victory.

The visibility has been further magnified and expanded with the advancement of technology, resulting in athletes’ lives being scrutinised like never before, often under the gaze of an unforgiving media and public.

But like the rest of us, athletes are still humans who experience stressors and worries associated with everything from mundane daily hassles to major life events, such as the loss of a loved one.

While it is common for us to view athletes as “super-humans” who repeatedly produce world-class performances without falter, it is important to remember that athletes are real people with real emotions.

This can be demonstrated by Victoria Azarenka who retired from the Miami Open in 2022 due to the stressors in her personal life. Indeed, she stated: “I shouldn't have gone on the court today… The last few weeks have been extremely stressful in my personal life… I always look forward to the challenge and pressure of competition but today it was too much.”

While it has historically been a rare occurrence to see athletes demonstrate their vulnerabilities publicly, we are seeing this more and more with several – including the likes of Emma Raducanu – prioritising their own health and well-being.

Because of these real-world examples, it is not surprising that there has been an increase in research conducted within this topic area. Research suggests that practitioners working with elite athletes should have a greater understanding of the psychological load experienced by sport performers.

As a result, research has recently begun to focus on the combined and cumulative effect of stressors over the entire lifespan, as well as examining how sporting and non-sporting stressors interact and accumulate over time. This is particularly important given that sport performers do not live in a vacuum. Rather, they function within highly complex environments which exerts major influences on them and their performances.

Recent research has shed light on the impact these stressors can have on athlete mental and physical health. It turns out, the stressors athletes encounter, both on (e.g., underperformance at a significant event) and off (e.g., financial problems) the field, can lead to significant health issues like depressive symptoms and physical illnesses such as respiratory infections.

But if we explore this further, the impact of these stressors isn't just about the number of stressful events; it's also about the nature of these events. Exposure to stressors which are chronic in nature (i.e., on-going for six months or more), for instance, tends to be more damaging than acute stressors (i.e., short-term exposures that have a clear beginning and end).

If these stressful experiences have happened more recently in adulthood as opposed to childhood, they also seem to have a stronger negative impact on health-related outcomes.

And, unsurprisingly, stressors that are more severe over a lifetime can be more harmful than those we encounter frequently but are less intense.

Recent studies have begun exploring this relationship further by identifying how stressor exposure impacts health and wellbeing among athletes. One key finding is that athletes who have faced more severe lifetime stressors, from either their personal lives or their sporting careers, tend to view stressful events as a threat (e.g., demands exceed personal coping resources) vs. a challenge (e.g., sufficient coping resources to meet demands of a stressful encounter).

This mindset can lead to poorer health outcomes, including increased risk of depression. On a biological level, research shows that exposure to a moderate number of stressors can lead to adaptive cardiovascular responses, like a temporary increase in heart rate that helps the body handle stress.

However, too few or too many stressors can have the opposite effect, resulting in maladaptive cardiovascular responses.

As an example, this could lead to elevated heart rate over a prolonged period which increases an individual’s susceptibility to cardiovascular disease. Delving deeper into the psychological, social, and behavioural impacts, recent qualitative research has shed light on how exposure to a high number of stressors can lead to maladaptive coping strategies, difficulties in forming relationships, and even risky behaviours.

In an ideal world, we would attempt to eliminate or at least reduce the stressors experienced by elite athletes to boost their long-term health and well-being. But, let's be real…that is not always possible or even desirable.

Instead of trying to eliminate stress, athletes can focus on how they respond to and manage stressors (e.g. viewing stressors as beneficial). By adopting this mindset, athletes can turn the inevitable stressors of their high-stakes careers into tools for enhancing performance.