Post-traumatic stress disorder and related disorders in elite athletes: a narrative review

This narrative review examines post-traumatic stress disorder (PTSD) and other trauma- and stressor-related mental health disorders in elite athletes. Elite athletes may experience these disorders at higher rates than the general population owing to disproportionate exposure to traumas and stressors, which can be experienced at individual and collective levels. These disorders can be difficult to detect due to complex symptom presentations and coping strategies that may mask symptoms. They can have both psychological and somatic components, and this dual nature has significant relevance for elite athletes given sport demands. Early identification of elite athletes suffering from trauma- and stressor-related symptoms may prevent progression to PTSD and other chronic mental health disorders. Cultural considerations specific to trauma require attention, as athletes' diverse cultural backgrounds shape help-seeking behaviours, symptom expression, stigma and access to care. Within a framework of trauma-informed care, first-line psychotherapies are generally cognitive-behavioural therapy-based, and first-line pharmacological treatments are generally serotonergic antidepressants. Team-based interventions may be necessary if there is a vicarious aspect to traumas or stressors. Future needs for the field include study and implementation of coordinated approaches to trauma screening and trauma- and stressor-related symptom screening for elite athletes. Healthcare providers and other entourage members for elite athletes should receive education on trauma-informed approaches. Organisational supports should facilitate implementation of trauma-informed care. Further research is needed on all types of traumas and stressors and particularly on institutional and systemic maltreatment as well as on established and emerging therapies as uniquely applied to elite athletes.