1. Introduction
There are approximately a half-million collegiate student-athletes in the National Collegiate Athletic Association (NCAA), attending over 1000 colleges and universities in over 100 athletic conferences. According to the National Institute of Mental Health, approximately 8.4% of adults aged 18 or older experienced a depressive episode, and 19.1% had an anxiety disorder in the past year [
1]. More specifically, within college-age students ranging from 18–25, the prevalence was highest for depression at 17.0% and 22.3% for anxiety disorders [
1]. College is considered an at-risk period for the development of mental health illnesses. According to the American College Health Association, over 30% of students reported significant signs of depression [
1,
2,
3]. College student-athletes are a subset of the young adult population and may be at risk for stressors linked to mental health issues (e.g., disordered eating, substance or alcohol abuse). With many student-athletes participating in sport, it is reasonable to believe that numerous student-athletes participate in their sport while managing the signs, symptoms, and known risk factors of depression and anxiety. With an increase in mental health visibility, an updated examination on the prevalence of depression, anxiety, and low self-esteem for this population is warranted.
Depression is characterized by mood changes, loss of interest or pleasure in daily activities, and the associated symptoms of sleep and eating problems, low energy, lack of concentration and self-worth [
1]. With participation in sport, student-athletes are thought to be immune to mental health disorders like depression; however, research demonstrates that the general college student population and student-athletes are comparable [
4,
5]. Research directly investigating the prevalence and severity of depression symptoms in collegiate student-athletes varies by instruments used and by sports and sex examined. The prevalence of the risk of depression in collegiate student-athletes ranges from 15.6% to 33.2%, with first-year students and females typically reporting more symptoms [
4,
6,
7]. When examining the depression risk prevalence in specific sports including but not limited to football, baseball, wrestling, track and field, and lacrosse, the range was from 12.1% to 35.4%, with higher rates consistent with females [
8,
9,
10]. In the current literature, sports have been categorized as individual and team sports when examining risk of depression in collegiate student-athletes, indicating that individual sports may be at an increased risk over team sports [
10,
11]. With a younger population, a lower prevalence rate of 8% was found for depression and anxiety, and specifically 13% for individual sports and 7% for team sports, further supporting sport type as being associated with the risk of depression and anxiety in student-athletes [
11]. The previous research on prevalence rates for team versus individual sports is based on a younger population, and there are different validated measures used throughout the research to assess for the presence of the risk of depression.
Anxiety is commonly known as a reaction to a perceived stressful or dangerous situation that can have debilitating effects on daily activities and performance. State anxiety refers to a temporary response to a stressful advent and trait anxiety is defined as a personality feature or predisposition [
12]. Athletes often experience state anxiety during situations that create pressure, for example if a free throw determines the outcome of a basketball game. However, trait anxiety refers to characteristics of a person, where an individual is anxious about general unknown outcomes. Researchers have identified that high levels of trait anxiety may lead to an increase in state anxiety during performance [
13]. However, there is limited research focusing on the examination of state and trait anxiety prevalence in student-athletes. According to current literature by Li and colleagues [
14], one-third of student-athletes reported anxious symptoms prior to the season beginning with a significantly higher risk for sport injury. Furthermore, previous studies examining student-athletes primarily occurred during preseason training and did not find significance for gender, sport, or academic status differences and the state and trait anxiety scores [
8,
14]. However, both studies by Yang et. al. [
8] and Li et. al. [
14], indicated that the link between depression and anxiety is associated with higher levels of pain and injury incidence. Therefore, examining anxiety prevalence rates in student-athletes by sex, academic status, and sport type and determining additional risks for depression and anxiety is warranted to help clinicians prevent additional injury. Without further research on depression and anxiety prevalence, it is difficult to develop preventative mental health programs and interventions for current conditions.
Participation in sport facilitates positive mental health behaviors, including self-confidence, positive self-esteem, and social support [
15]. Individuals with positive mental health behaviors may be utilizing their social support systems to cope and manage stress in helpful ways to lower risks for depression and anxiety. However, student-athletes may be more susceptible to mental health issues due to the demands of sport participation (e.g., sports injury, coach expectations) [
9]. Student-athletes are thought to be protected from mental health issues because of increased self-esteem, a sense of connectedness, and social support from their teammates [
15]. There is an established relationship between self-esteem and depression, indicating that self-esteem is associated with depression. In those with lower self-esteem, depression rates tend to be higher, whereas in student-athletes with a higher self-esteem a lower rate of depression was found [
15]. However, this study is out of date, and updated research for student-athletes is needed.
Clinicians providing medical services within the collegiate sports setting should be mindful of comorbidities of mental illnesses and which student-athletes are at the highest risk. Additionally, being able to recognize the common mental health illnesses and risks among student-athletes can help guide clinicians to utilize validated patient-centered screenings to identify those who may need referral for psychotherapeutic intervention [
16]. Early screening, identification, and intervention can allow healthcare professionals to gain more information on their patients; furthermore, this allows providers to ask in-depth questions tailored to their patients’ needs, and to develop strategies (i.e., goal setting, coping mechanisms) to support their mental and physical needs [
17]. Student-athletes who have an individualized approach to their needs are more likely to communicate with their providers and trust the clinician providing healthcare [
18], and with a tailored approach to healthcare, specifically mental health care, student athletes are able to receive help before signs and symptoms begin to manifest. While all student-athletes have unique personal stressors and individual experiences, understanding the associations between depression, anxiety, self-esteem, sport type, and sex may help clinicians choose to use validated screenings and further develop interventions for managing symptoms for their patients. Therefore, the purpose of this study was to examine the overall prevalence of depression, anxiety, and self-esteem in NCAA Division I and II collegiate student-athletes, with a secondary purpose to examine differences between depression and anxiety risk, and low self-esteem with demographic variables such as sex, academic status (e.g., freshman, sophomore, etc.) and sport type (e.g., power, ball sports, technical, endurance, etc.); and lastly to identify associations for depression, anxiety, and low self-esteem.