A Review of Mental Health Issues in High-Performance and Elite-Level Cycling

Abstract

Despite the public health benefits of cycling in the general population, mental health issues may be evident in high-performance and elite-level competitive domains. With prominent riders disclosing their experiences with psychiatric symptoms, distinctive socioenvironmental factors could exacerbate psychopathological vulnerabilities. This suggests a need for greater mental health awareness amongst stakeholders, supplemented by actions from international and national federations and regulators. To synthesise relevant observations about psychiatric concerns in high-performance and elite-level cycling, we conducted a keyword search of articles in APA PsycINFO, PubMed, and Scopus based on specified exclusion criteria. Thirteen papers were identified that examined mental health issues in high-performance and/or elite-level cycling per classifications from the World Health Organization’s International Classification of Diseases 11th Revision. A large proportion of articles illustrated eating disorder symptomatology, but others discussed attention deficit/hyperactivity disorder, anxiety disorder, depression, sleep wake disorders, and substance use disorder. Existing literature underlines important considerations for all stakeholders within the cycling community around mental health initiatives and care provisions, which are currently lacking across the sport. Such programmes could incorporate consensus statements, psychiatric screening, psychoeducation, stigma-reducing policies, and athlete advocacy. These can help mitigate socioenvironmental risk factors and prioritise athlete wellbeing over performance-centred motivations.

Mental health resources and initiatives from European national cycling federations: Insights on policy and practice

“…Significantly, where resources and initiatives were identified, these were predominantly geared towards elite or high-performance riders (for 57% of ECFs who had relevant policies or initiatives (i.e., 4/7 ECFs), these were applicable for elite or high-performance contexts). Focussing on these target populations may be more viable owing to the psychiatric risk factors associated with high-performance cycling and the function of ECFs in supporting in-competition athletes at international events [16, 17, 18].…”

“…Conversely, the interconnections between cycling and mental health can be increasingly composite in elite and high-performance contexts. In these domains, athletes may derive an improved sense of wellbeing from elements of competition [15], yet riders can also experience psychopathological symptoms, shaped by socioenvironmental determinants and sport-specific risk factors [16]. This is demonstrated by results from the 2022 Cycling Alliance Survey in women’s cycling, where 22% of respondents identified deteriorating mental health as a consideration for early retirement [17].…”

“…Equally, researchers have contended that cycling should be extensively encouraged since it can augment life satisfaction and reduce psychological distress (e.g., [8]). Separately, in high-performance competitions, certain riders will likely require tailored psychiatric interventions, which have not been adequately documented in scientific publications [16, 21]. Nonetheless, in first-hand accounts, elite cyclists have attested to the efficacy of specialist therapeutic provisions and support [16, 22].…”

“…Separately, in high-performance competitions, certain riders will likely require tailored psychiatric interventions, which have not been adequately documented in scientific publications [16, 21]. Nonetheless, in first-hand accounts, elite cyclists have attested to the efficacy of specialist therapeutic provisions and support [16, 22].…”

“…Significantly, eating disorders can be a substantial issue for male and female riders, exacerbated by entrenched weight and body composition pressures, which can culminate in pathological behaviours (e.g., [18]). Additionally, symptoms of anxiety, depression, and substance use disorder can be apparent [16]. These academic findings are reinforced by primary narratives from high-performance cyclists discussing psychosocial concerns and psychopathological vulnerabilities (e.g., [10, 17]).…”