American gymnast and four-time Olympic gold medallist Simone Biles is the latest high profile athlete to withdraw from a major tournament citing mental health reasons.

Biles's decision was heralded as brave and empowering for other athletes who may be hesitant to put their well-being first, but she nevertheless faced attacks from those suggested she was using mental health as an excuse for poor performance.

Yet, a new study by University of Toronto research suggests that elite athletes experience mental health challenges such as depression, anxiety and eating disorders far more frequently than most people realize.

"Athletes face a huge amount of stress and pressure, and have to manage lots of different expectations—especially at the Olympics," says Zoe Poucher, a graduate student in the Faculty of Kineisology & Physical Education (KPE).

"This can have a very negative impact on their well-being."

Poucher recently published a paper in the journal Psychology of Sport and Exercise that explores the prevalence of symptoms of common mental disorders among elite Canadian athletes.

She found that as many as 41.4% of Canadian national team athletes—those training for Tokyo 2020—met the cut-off criteria as proposed by the Diagnostic and Statistical Manual of Mental Disorders (DSM–5) for depression, anxiety and/or an eating disorder. That's compared to an estimated 10% of Canadians in general who report a mental disorder in a given 12 month period, according to the study.

Specifically, 31.7% of athletes reported symptoms of depression, 18.8% reported symptoms of moderate (12.9%) to severe (5.9%) general anxiety and 8.6% reported scores indicating a high risk of an eating disorder.

"We found a significant positive correlation between stress and the three different mental disorders we measured, so I think that is one important piece of the puzzle," says Poucher, who collaborated on the study with KPE Associate Professor Katherine Tamminen, Professors Catherine Sabiston and Gretchen Kerr, as well as Professor John Cairney from the University of Queensland.

The study also revealed that having competed in a previous Olympic/Paralympic Games was negatively correlated with symptoms of an eating disorder, and that having been selected to attend the 2020 Games at the time of the survey in late 2019 was positively correlated with symptoms of depression.

"I was really surprised by the high percentage of Canadian elite athletes experiencing mental disorders, but in hindsight I probably shouldn't have been since this number is very similar to what we have seen in research that has been done with athletes from other countries," says Poucher.

Another unexpected finding, according to Poucher, was that athletes who had made the Olympic team had more symptoms of depression prior to the Games.

"We hear a lot about post-Olympic depression, but I have not seen any research on mental health prior to the Olympics," she says. "I think the assumption is that people are happy they made the team."

Stress, social support, coping skills and self-esteem were all found to have an impact on the athletes' mental health.

"Mental health is obviously impacting a large portion of elite athletes, but it is still not getting the attention it deserves and athletes are made to feel bad about it," says Poucher. "If we can demonstrate that this is a large problem, I am hopeful that it will help to shift the conversation around mental health, increase awareness of the issue and help inform policy-level change.

"Having world renowned athletes like Simone Biles and Naomi Osaka [who pulled out of the French Open, citing her mental health] speak openly about their mental health is helping change the stigma many athletes still face."