Sport Medicine Mental Health Podcast with Dr. Carla Edwards and Dr. Janice Harvey
Dr. Janice Harvey talks with Dr. Carla Edwards, MD, Sport Psychiatrist, about the mental health aspects of sport, covering a few topics including athlete harassment and bullying.
Dr. Harvey: What got you interested in sport as an aspect of psychiatry?
Dr. Edwards: I think it goes back to the fact that I’ve been an athlete all of my life, long before I was a psychiatrist and played at a high level in a number of different ways. I was able to certainly live the life of an athlete and can certainly understand the challenges that can come from that high level of demand.
Dr. Harvey: When you were a varsity athlete did you recognize at that time the issues that you would have considered concerning as far as a mental health aspect or even factors around harassment or bullying?
Dr. Edwards: I remember as far back as playing high school volleyball and one of my teammates was hospitalized in the psychiatric unit at that point but of course I was too young to really understand what was happening then but I remember it happening. Then throughout university a number of my teammates experiencing adversity both as a result of hazing and other unfortunate life events like rape and major depression, so there was certainly very serious things happening to athletes at all levels and they didn’t always have the resources available to help them.
Dr. Harvey: What about the actual direct sport related stresses of being a varsity athlete? Some of the things you’ve mentioned may not have been directly related to the sport but what about the aspects that are actually directly related to sport itself, what are some of those factors that may put an athlete at risk?
Dr. Edwards: There are so many factors that can contribute to that form the sport itself. From the varsity point of view, in my experience, working with a number of universities in the last decade or so I’ve seen a lot of psychopathology and mental illness arising from dynamics within teams. Whether it’s bullying and harassment between teammates or intimidation form coaches, poor performance or response to injury that can be very disruptive for an athlete’s life and sense of identity. Even in the more elite groups when you have such young athletes in their mid to late teens suddenly becoming world champions and gold medalists and their lives changing instantly and then trying to go back and settle to a normal life it just creates challenges that we can’t even begin to appreciate
Dr. Harvey: I can well appreciate anyone who is going through the stages of development and growth towards being an elite athlete at the high levels and you have those kind of stresses and then something happens in their other life, in their life with their family or in a relationship or financially, that those things can just potentially increase their risk and they might develop other conditions that just put them at risk as well, like eating disorders or those kinds of things, is that fair to say?
Dr. Edwards: Absolutely, I work with Swimming Canada and I speak with their athletes quite frequently and sometimes I hear when I ask them what they’re struggling with and they say ‘everything’ and really trying to distill down what ‘everything’ means. You look at every corner of their lives and they’re still trying to finish school, they have typical teenage friend drama, they can’t go out in society without being recognized and they still have to train incredible hours and try to maintain their incredible levels of performance on a daily basis. I think they have their plates full and it’s really difficult for them to manage that at times.
Dr. Harvey: I can also imagine that it might be difficult to understand from a coach’s perspective or a therapist’s perspective regarding the signs and symptoms that might be indicating that someone’s is getting into trouble because some athletes may just keep to themselves and wouldn’t want to share just out of sheer embarrassment or for fear that it might get back to the coach and they might lose their position on the team. So what kind of factors should allied healthcare professionals who are related to the athlete and the team, watch for?
Dr. Edwards: I think that one of the challenges when someone is struggling with mental illness and don’t feel comfortable seeking help is that it can manifest as behavioural changes. If they’re unable to attend practices or their performance starts to change or they become more stand offish or irritable with their teammates or reactive, then they can be punished for that and it can be misinterpreted that they’re being a bad teammate and coaches can be very reactive to that whereas in reality they can be struggling with a lot of things.
On that note, any significant change from baseline should be really paid attention to whether its the way they’re reacting to things; if they’re more irritable that usual, if they’re missing practices or they seem to be giving a different level of effort when they’re in practice. If they’re dressing differently, for example if their typical uniforms are sleeveless and but suddenly they’re wearing sleeves, maybe they’re trying to hide something. If they’re being resistant to examination by the athletic therapist or sport med physician there may a reason for that as well. In addition to changes to things like their weight, their appetite, the amount of sleep that they’re getting, their grades, the amount of substances that they’re using and their socialization, those are all very clear indicators that something may be going on if there are significant changes.
Dr. Harvey: What about the aspect of injury? I know that injuries can be highly impactful to how athletes cope with other things like school or relationships and sometimes I’ve seen athletes that spend an extraordinary amount of time having physiotherapy and repeatedly getting injured. Is that a warning sign as well?
Dr. Edwards: Psychological response to injury has actually been well studied and well published about. Studies tend to indicate that the more profound the injury which results in a longer loss of training or competition time tends to have the most severe psychological impact in the athlete and can quite honestly lead to severe depression and risk of suicide. So those are very big risk factors that we need to be aware of but in general in any active athlete the sport is usually their portal of catharsis and release and any interruption in that can be quite a blow to them with their coping styles. Any changes in their performance as a result of concussion or surgery can even compromise their identities or sense of worth so it can be quite catastrophic, and we need to be aware of that.
In addition to that just returning from any sort of injury to the field of play can be co-existent with anxiety with re-injury which would be quite normal but it should be addressed because if a person does have any trepidation or anxiety about returning to the field and therefore they change their style of play because they’re anxious about being re-injured they’re actually placing themselves at a higher risk of re-injury which should be addressed.
Dr. Harvey: Let’s talk a little bit about harassment and bullying. You mentioned hazing but now I think the terms we’re hearing more about, certainly in the media and the athletic world, is harassment and bullying. How prevalent is that and what should we be looking for?
Dr. Edwards: Harassment and abuse is being recognized as being more prevalent than previously known. The IOC in 2016 released a consensus statement on non-violent harm to athletes in the form of various types of harassment and abuse to bring awareness of the various types of maltreatment that athletes can undergo with the goal of trying to establish a safe and respectful place for an athlete to be able to pursue their goals and dreams without the risk of being mistreated.
Prevalence data shows that up to 75% of athletes can experience psychological harassment and abuse which can be in the forms of shouting, belittling, being made fun of, taunting and being threatened and this happens quite frequently. Other forms of abuse are sexual harassment and abuse of course, which can have rate of up to 92% with respect of sexual harassment, and up to 49% of sexual abuse. It can also come in the form of physical abuse either on or off the field where an athlete can be made to do excessive amounts of unreasonable workload in a punitive fashion without appropriate supports and then going through to neglect where they’re not permitted to access timely medical care or they’re being made to train on injuries or they’re not permitted to access water or nutrition appropriately, so it can exist in multiple forms and it’s quite concerning.
Dr. Harvey: You mentioned the IOC and the position statement, what other steps could be taken at the higher level stakeholder organizations?
Dr. Edwards: I think more and more attention is being drawn to the mental health aspect of sport. Some national sport organizations are taking more formal roles in having individuals in their organizations who are addressing the specific mental health needs of the athletes and the coaches and everyone else that works with the organization and they actually create pathways to create healthy work places and policies in place for safe sport. I don’t think that exists in all national sport organizations so I think the rest should take some hints from those who have done it already and try to incorporate it because it is so important.
Dr. Harvey: What’s out there in the horizon in terms of research, what should we be looking at as far research in this area?
Dr. Edwards: I think there’s a lot of research going on with respect to prevalence data, mostly in other countries, unfortunately there’s not a lot of Canadian data and we’re trying to work to increase that. There are some studies that are being developed that are looking at mental health literacy within the university settings, within the athletes and the athlete entourage, as they call it, including all of the support people that help with their heath care and the physicians and the coaches. Then trying to create a program to enhance that mental health literacy and understanding and try to follow up and ensure that the pathways are being followed. I think we need to create the steps, create the resources and then help the organizations across the country to implement it in the best way they can.
To learn more about mental health and sports medicine, CASEM is offering talks covering related issues at:
- Medicine Through Movement – April 6, 2019 in Ottawa
- Vancouver 2019 Annual Symposium – May 18-19, 2019 in Vancouver