Mental Health Disorders in Ultra Endurance Athletes per ICD-11 Classifications: A Review of an Overlooked Community in Sports Psychiatry

Abstract

Introduction: Although research suggests that exercise benefits mental health, psychiatric disorders have been acknowledged in the ultra-endurance-athlete population. At present, the mental-health consequences of high-volume training associated with ultra-endurance sports are not well understood. Methods: We conducted a narrative review summarizing primary observations about mental disorders per ICD-11 criteria in ultra-endurance athletes using a keyword search in Scopus and PubMed. Results: We identified 25 papers discussing ICD-11-classified psychiatric disorders such as depression, anxiety, eating disorders, attention-deficit/hyperactivity disorder, and schizophrenia in ultra-endurance athletes. Discussion: Although evidence is limited, available papers indicate that there is a sizable incidence of mental-health issues and composite psychopathological vulnerabilities in this community. We contend that ultra-endurance athletes may represent a different, though similar, demographic than elite and/or professional athletes, as they often engage in high-volume training with similarly high motivation. This can have regulatory implications, which we also highlight. Conclusion: Mental illness in ultra-endurance athletes is an underrepresented topic in sports medicine, though psychiatric disorders may be especially prevalent in this population. Further inquiry is necessary to inform athletes and healthcare practitioners about the possible mental-health implications associated with participation in ultra-endurance sports.

A narrative review of sleep deprivation in ultra-endurance cycling

“…Moreover, sleep deprivation and disrupted circadian rhythms can exacerbate pre-existing psychiatric symptoms [9, 28] and may have causal relationships with mental health issues and increased symptomatology [29]. This is significant since ultra-endurance athletes might already be vulnerable to psychopathology and distinctive risk factors; prior psychiatric diagnoses were found to be more prevalent in this community compared to the general population [30]. Thus, in our view, periods of intensive exposure to deprived or extreme patterns of sleep in ultra-endurance cycling could lead to developing or recurring psychiatric disorders.…”

“…Moreover, improving comprehension about the psychopathological paradigms of sleep deprivation may influence individual decisions to join these events and could prevent psychiatrically vulnerable individuals from participating. That said, mental health stigma persists in competitive environments [30], as do negative conceptions about sleep in ultra-endurance cycling [18], which may undermine awareness campaigns. Akin to other sports, entrenched sociocultural perspectives are often difficult to modulate [37].…”

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

“…Moreover, as the articles we identified largely explore psychiatric disorders in track and road riders, it important to consider the diversity of UCI-regulated competitions and the variability of sportspecific determinants across cycling disciplines. This could involve ultra-distance or endurance competitions, since the psychological impact of these are not well understood, yet evidence indicates that there could be increased incidence of mental disorder amongst participants [80]. The relationship between mental health and transitions during a rider's career (e. g. professional retirement) could also be analysed since athletes can face unique stressors during these periods [45].…”

“…The latter group could form the basis for future reviews. Correspondingly, following a procedure for ultra-endurance athletes [80], we restricted our search to mental disorders within ICD-11 categories. Resultantly, we did not capture results around certain conditions, such as EXD or OTS.…”

Regulatory proposals to support athlete mental health in the Race Across America

“…Resultantly, since its introduction in 1982, RAAM has engendered a cultural “fascination” as “cycling’s hardest race” (e.g., [3, 8, 9]). Yet, correspondingly, RAAM’s distinctive parameters and intra-race conditions could have associated harms for the mental health of participants [10, 11]. To mitigate against these, we outline potential regulatory policies to help safeguard the wellbeing of competitors.…”