Increases in rates of mental health concerns have been observed not only in the general population,1 but also among athletes in the United States.2 According to the National Institute on Mental Health nearly 60 million people in the United States were living with mental health problems.3 Athletes have experienced rates of common mental health disorders such as anxiety and depression at rates that are similar to non-athletes.2 While there are many protective factors for athletes who experience mental health challenges, athletes are continuing to report an increase in mental health related concerns.4 In this regard, organized sport may be a protective factor for mental wellness in children and adolescents.4 Organized sports, particularly team sports like soccer, provide settings for social interaction and inclusion, and contribute to physical health and psychosocial development.4 Participation in organized sports has been associated with lower rates of development of mental health related symptoms or difficulties, especially for those who participate in team sports from adolescence to adulthood.4

Participation in sport has also been associated with negative mental health indicators, including stress, anxiety, abuse, maltreatment, and burnout.5 Environments that primarily focus on winning or promote aggressive behaviors in athletes may contribute to negative mental health outcomes6 such as anxiety, stress, burnout, trauma from maltreatment and abuse, and an increased risk of alcohol abuse and eating disorders in adolescent.7 In the National Collegiate Athletic Association's8 Student-Athlete Wellbeing Study, student-athletes reported mental health concerns that consisted of increased rates of mental exhaustion, anxiety, and feelings of depression. The rates of mental health concerns were 1.5 to 2 times greater than were historically reported prior to the COVID-19 pandemic in 2020.8 The prevalence of mental health symptoms among elite (professional and Olympic) and collegiate athletes may be equivalent to or exceed the rate of mental health symptoms among non-athletes.9 The rates of mental health symptoms range from 15 to 35 % among athletes (collegiate, professional and Olympic/Paralympic). During the COVID-19 pandemic, rates of depression and anxiety among male and female professional soccer athletes doubled.9 For high school athletes in the United States, rates of moderate to severe depression increased more than three times during the COVID-19 pandemic.9 While the COVID-19 pandemic may have led to exacerbation of mental health related symptoms in athletes, it did bring to light the fact that athletes are a vulnerable population to the impact of life stressors.9

The impact of major life stressors could be seen beyond the effect of the COVID-19 pandemic in athletes who experienced a major life event, were forced to retire, or were injured and unable to participate in their sport.9–11 Other potential stressors that affect athletes, particularly youth athletes, that are not isolated to the COVID-19 pandemic include performance pressure, perfectionism, burnout, balancing academic and social responsibilities, conflict with others, abuse, injury, body image, and poor sleep.10,11 The increases in rates of mental health symptoms among athletes emphasized the growing need for discussion of mental health issues in sport to decrease stigma athletes may experience when dealing with mental health challenges, development of mental health support resources for athletes, and developing sport culture that is supportive of athletes who may be struggling with mental health symptoms.9

When mental health concerns in sports are evaluated, researchers have focused mainly on athletes; however, coaches, referees, and support staff members can also be affected by mental health symptoms.12,13 For example, researchers examined anxiety, stress, and depression among Turkish team medical and allied health staff and identified substantial rates of mental health symptoms.12 In another similar study that looked at the mental health of Turkish referees, participants revealed high rates of depression, anxiety, and stress that were associated with variables such as age, performance concerns, personal relationship status, and social support.14 Elite-level coaches and high-performance support staff also reported levels of psychological distress similar to elite athletes.13 Therefore, these findings could suggest that coaches and support staff may be also vulnerable to mental health related issues.12–14

A potential solution to the rates of mental health issues reported by athletes and staff is providing proper training and resources to help identify mental health concerns to allow staff to appropriately refer athletes and/or staff to support resources.9,13 Previous research explained that individuals who are stakeholders within sport who have a direct impact on athletes include not only the medical staff, but also coaches and administrators.9,13 Coaches and administrators also have day-to-day interactions with athletes and staff who may be vulnerable to mental health challenges.9,13 This fact emphasizes the importance of understanding the role of coaches in the mental health and wellness of their athletes and staff.15

Many coaches and administrators have encountered athletes and/or staff members who exhibited mental health concerns, and it is evident that the prevalence of mental health concerns among athletes and staff within a sporting environment warrant appropriate awareness and intervention.15 The ability of coaches and administrators to recognize and refer people in their sporting environment to support resources is vital to providing support to athletes and staff. By being aware of and able to recognize potential mental health related concerns, coaches can develop an inclusive and supportive sporting environment, where athletes and staff feel like they can perform at their best, be who they are, ask for help when they need it, and access support resources for themselves and their teammates.13,15 Therefore, the purpose of this study was to examine the experiences of participants in U.S. Soccer's coaching license courses who have supported individuals with mental health challenges and their exposure, interest, perceived value to mental health awareness training and access to resources.

Table 1 shows the profile characteristics of the participants. 51.81 % of participants were coaches and 37.31 % were academy or technical directors. The remainder consisted of coaching educators, talent identification managers, or scouting coordinators (10.88 %). The majority of participants typically worked with athletes (43.99 %) and coaches (29.75 %). Some of the participants also indicated working with referees, parents, and administrators (26.29 %).

98.71 % of participants (n = 153) felt that having training in the area of mental health was valuable for their role, but 1.29 % (n = 2) did not think that it was valuable. Also, 95.48 % of the sample (n = 148) were interested in having more training and information on mental health while 4.52 % (n = 7) of the participants did not express any interest in having more training and information on this topic.

When it comes to previous experiences supporting someone with mental health-related challenges (Fig. 1), 82.19 % (n = 180) of the sample supported their athletes or staff during challenges with their mental health. Specifically, 105 participants (n = 105, 67.74 %) who worked with youth and 75 participants (n = 75; 48.38 %) who worked with adults supported someone with challenges with their mental health.

However, Fig. 2 shows that 56.62 % of participants (n = 124) had no previous training in how to recognize and support someone with mental health related issues. Specifically, 77 (60.16 %) participants who worked with youth and 47 participants (51.65 %) who worked with adults had no previous training on this topic.

Fig. 2.

Participants’ previous training in how to recognize and support someone with mental health related issues.

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When it comes to resources that participants have utilized in the past, they mentioned the following resources: Psychology/Sport Psychology colleagues or resources at club/university/home environment (n = 28; 18.06 %), general public mental health resources, books, websites, or research articles (n = 17; 10.96 %) formal education such as degree in psychology, sport psychology, counseling, social work, or other related field (n = 10; 6.45 %), work required training (n = 9; 5.80 %), Safesport training and resources (n = 6; 3.87 %), and part of coaching course or training (n = 3; 1.93 %). A total of 89 participants (n = 89; 57.41 %) did not specify use of any resources or reported they did not have any access to resources.

The purpose of this study was to examine the experiences of participants in U.S. Soccer Coaching license courses (B-License, A-Youth, A-Senior, Academy Director and Coaching Educator Course) who have supported individuals with mental health challenges and the participant's exposure, interest and perceived value to mental health awareness training, and access to resources. The main findings of this study were: (a) a high prevalence of participants (82.19 %) have supported individuals with mental health challenges; (b) a majority of participants (56.62 %) had no previous training in recognition or management of mental health related issues; (c) a majority (60.16 %) of participants worked with youth athletes; (d) nearly all participants (98.71 %) felt that there was value in having training in mental health for their role as a coach or director.

The high prevalence of individuals who have supported people with mental health challenges in their sport setting is consistent with the growing data on the prevalence of mental health issues among athletes and staff.4,10,11,16 This is important because it highlights the need for more awareness and training resources for coaches, staff, and administrators who work with these athletes and staff so they can more effectively support individuals with these challenges.17 However, the present study does not differentiate between who the participants of this survey supported (e.g., athletes vs staff) and future research should take these specific groups into consideration.

When it comes to previous training, it is important to note that many of the participants in this study have had no previous training in how to recognize and support individuals experiencing mental health challenges. This is alarming knowing that a high prevalence of these participants (82.19 %) also have experienced supporting individuals with mental health challenges. Of those who have had access to training or resources, many of them utilize other professionals or general public resources for their training. However, training that is evidence-based in how to recognize and refer individuals to mental health support resources can be vital in effective access to treatment.15,18 Specifically, the results of this survey showed that only a few (6.45 %) had any formal training in the recognition and management of mental health concerns. This makes it clear that more effective training in the area of mental health awareness and access to supportive resources is fundamental to identifying and addressing mental health concerns.15,18

Another key finding of this study was that many of the participants (67.74 %) worked with youth athletes. This is important to note because we know sport can have both positive and negative effects on the mental health of youth athletes.4 Sport can provide a safe space for athletes, which is why coaches, directors, and team staff with proper training and access to resources can act as the front line in recognizing mental health challenges.10,15 If we can provide proper training for coaches and administrators who work with youth athletes, we can improve the youth sport environment and potentially counteract the negative impacts sport can have on mental health of athletes. Coaches and sport administrators have the potential to shape the culture within their teams that normalizes and destigmatizes mental health, and also supports mental health help-seeking behavior.15

Creating a supportive culture and environment where youth athletes can work through challenges, talk about their struggles, and ask for help can better support them off the field.17 Coaches play a significant role in the lives of young athletes. They are often mentors or positive adult figures who have great influence on their athletes and the culture of their teams.15 Coaches can monitor and respond to changes in athletes’ behaviors due to their regular interaction and relationships with athletes.15,18 In a narrative review by Bissett, et al., the results showed that coaches play a large role in building team culture and environments that support the mental health of athletes, and they play a pivotal role in supporting athletes who are currently seeking support for mental health challenges.15 Rice et al. concludes that coaches can have positive or negative effect on athletes’ levels of stress, anxiety, and ability to cope with challenges,10 by providing coaches with the tools to create an environment that destigmatizes and ultimately supports mental health will have positive effects on mental health of athletes at all levels.

Finally, nearly all participants (98.71 %) highlighted the value of having training in mental health for their role as a coach or director. Providing these tools may increase confidence in individuals, like coaches or directors, in being able to effectively support and provide resources when they notice an individual who is struggling.15 In Bisset et al.15 coaches who are aware of signs and symptoms associated in mental health concerns, play a significant role in secondary prevention. Secondary prevention includes effective management of athlete mental health through early detection and referral of individuals with potential concerns.15 Coaches and administrators should understand their limitations in their role. This can be achieved through proper education and understanding of resources. Proper training and education they will help them effectively understand when they need to refer individuals for help and how best to understand their role in supporting individuals with on-going mental health concerns.

In general, sport has not been inclusive to individuals who struggle with their mental health. Sport tends to celebrate the idea of mental toughness, which can be detrimental to individuals who are struggling and need help. Athletes are less likely to ask for help or report challenges with their mental health for fear of stigmatization.15 Early access to mental health resources can aid in the potential for reducing a mental health crisis or emergency.15,17 The knowledge gained in training in mental health awareness also helps to decrease the stigma surrounding mental health illness and provides a pathway for how to access appropriate resources.15 This is why it becomes vitally important that individuals who interact with athletes on a regular basis, like coaches, have training in how to create a safe environment where athletes can ask for help and where the coaches feel confident in helping their athletes access resources.

The survey was deployed following a free optional educational session that focused on awareness of mental health conditions that are common among athletes, why there is a stigma surrounding mental health illness in sports, and how to recognize and have conversations surrounding mental health concerns. In this regard, the timing of the survey may have resulted in participant bias regarding the importance of training about mental health due to the nature of the presentation and the timing when the survey was deployed.

In addition to identifying the important results identified in this study, it is also important to note the limitations. This study focused mainly on a limited number of coaches and administrators who were participating in licensing courses from the U.S. Soccer Federation, specifically the B-License, A-Youth License Course, A-Senior License Course, Academy Director Course, and Coaching Educator Course. These courses do not capture all coaches, directors, or staff who are actively coaching or supporting athletes in any given sport in the United States. It is not possible to fully understand the level of training or the prevalence of all coaches, team staff, or administrators in the United States soccer landscape who may be supporting athletes with mental health challenges with the limitations in the data obtained from this study. Moreover, the survey was deployed following a free optional educational session that focused on awareness of mental health conditions that are common among athletes, why there is a stigma surrounding mental health illness in sports, and how to recognize and have conversations surrounding mental health concerns. In this regard, the timing of the survey may have resulted in participant bias regarding the importance of training about mental health due to the nature of the presentation and the timing when the survey was deployed.

Future directions for this study should focus on coaches and administrators at all levels of soccer in the United States, from grassroots to elite level. Also, it is highly recommended to look at specific groups in soccer (i.e. athletes vs coaches vs referees), and the prevalence of mental health challenges to determine more accurate data on the prevalence and type of challenges individuals are facing. Continuing to assess the prevalence of mental health issues among athletes, coaches, and support staff in other sports or National Governing Body's may also be a direction to continue to evaluate. This can lead to an emphasis on the importance of mental health training for all stakeholders involved in sporting environments. Analyzing specific types of mental health training and resources to determine effectiveness in educating coaches and staff and identifying steps to provide support would be beneficial to determine the need and structure of future training. Future research could also look at awareness and access to resources at various levels of the sport throughout the United States in order to identify areas where more access to resources and training is needed. Finally, it would be interesting to look at confidence levels of participants in addressing mental health concerns prior to and following training to fully understand the effectiveness and value that training provides.

Based on the results of this study, it is clearly evident that coaches and administrators working with soccer athletes desire more training in the area of mental health, and the prevalence to which they are supporting individuals with these challenges emphasizes the continued need for training and access to resources in this area. Clubs and teams need more access to mental health resources, whether that is through more access to education, to licensed mental health professionals hired at the club level to provide mental health and wellness services and who can help assess and direct care of individuals with mental health related concerns.

For coaches, it is important to understand the unique position and responsibility that they have related to player welfare. Understand that changes in the behavior of athletes can be early signs that they may be dealing with a mental health related issue. Being able to recognize and refer that individual to the appropriate resources can have great implications in the long-term welfare of that athlete. Coaches also have a significant responsibility in creating culture within their team environment. By creating environments that are free from stigma surrounding mental health issues, coaches create a positive and inclusive space where athletes may feel more comfortable asking for help when they need it and feel supported when they do struggle. However, training and awareness raising measures can extend beyond coaches and administrators to parents, athletes, and other team staff. More education surrounding mental health may help to decrease the stigma and improve help seeking behavior. This can also help reinforce the idea of a positive, inclusive team environment where everyone involved is able to recognize when other people may be struggling and be able to assist in gaining access to help.

It is important that sport leagues, governing bodies and federations take the lead in areas related to athlete safety and welfare, including mental health, to create healthy and safe environments for athletes at all levels of sport. By incorporating courses that promote safe and healthy playing environments, like the free mental health awareness course created by the U.S. Soccer Federation Mental Health Task Force, a sustained positive impact on participants within soccer can continue. It is important to find ways to incorporate training into all levels of coaching licenses. For instance, adding mental health training to requirements for coaching licenses could be vital in better supporting and helping athletes and staff perform on and off the field. Training and awareness about mental health can counteract the stigma that is prevalent in sport and create a more inclusive environment that promotes continued lifelong participation in soccer.

No funding has been received for this work.