There is limited research offering experiential knowledge of severe mental illness in elite athletes. Adopting a narrative approach, this study explored how an Olympic athlete constructed his illness identity and how this construction shaped his experience of living with bipolar disorder. We conducted five semi-structured interviews with Darrel, a male Olympic athlete diagnosed with bipolar disorder, over a ten-month period in the lead-up to the Paris 2024 Olympic Games. 10 hours of data were collected, with interviews an average of 90 minutes in duration. Interviews were transcribed verbatim and analysed using dialogical narrative analysis, attending to both the content of Darrel's stories and the ways in which he told them. Through various storytelling strategies, Darrel constructed a de-stigmatised illness identity that reinforced his sense of self as an athlete. His narratives emphasised athletic accomplishment despite - and sometimes because of - his bipolar disorder. He distanced himself from the stigmatised stereotypes of severe mental illness by telling stories of his high functioning. Emotionally difficult moments were laced with humour, while manic episodes were portrayed in a glamourised way. These narrative strategies appeared to manage self-stigma and resist the potentially marginalising meanings associated with mental illness in elite sport. However, such storytelling also has implications for how others perceive and respond to athlete distress. For example, the glamourisation of mania may lead staff to underestimate the severity of the athlete's mental illness. This study demonstrates the value of narrative methods for exploring how athletes make sense of severe mental illness and construct identities within the cultural context of elite sport.

BACKGROUND:Due to a range of pressures associated with high-performance environments, elite athletes are at increased risk of eating disorders and disordered eating. Most prevalence studies focus on female athletes in lean or esthetic sports, with males, particularly those competing in power sports, seldom considered. This study addresses this gap by exploring disordered eating in elite male adolescent rugby union players. METHODS:We distributed an online survey to male rugby players aged 16-18 through RFU-affiliated academies. The survey contained three sections: general demographics; the Eating Disorder Examination Questionnaire (EDE-Q); and knowledge of eating disorders. RESULTS:From 107 responses, 14% had a global EDE-Q score that met the clinical cut off of 1.68 for males displaying symptoms of an eating disorder. An increased Body Mass Index (BMI) was statistically significantly associated with a positive increase in global EDE-Q score. Props demonstrated the highest global EDE-Q scores. The desire to change body size was also statistically associated with increased global EDE-Q scores. Most participants admitted poor knowledge of eating disorders and where to access help to manage them by giving a score of 2 on a 1-5 Likert scale ranging from no knowledge to very knowledgeable. CONCLUSIONS:Overall, 14% of the elite adolescent male rugby participants in this study met the clinical cut off EDE-Q global score, suggesting that there may be a higher prevalence of disordered eating behaviors and attitudes compared to the general population. Increased BMI and certain positions are associated with more disordered eating behaviors and attitudes. There is also a lack of confidence in knowledge about EDs and where to access help, therefore greater education and awareness about this issue is warranted. More research is required to further explore the reasons for the increase in disordered eating behaviors and attitudes.

This essay provides a reflective commentary on Smith et al.'s "25 years of qualitative research in sport and exercise psychology" piece. Alongside summarizing the primary insights of their review, I seek to situate current qualitative sport and exercise work within psychology's long-standing quest for scientific legitimacy. Including a whistle-stop tour of the history of psychology, I argue that a form of disciplinary imposter syndrome has shaped psychological science and continues to influence contemporary qualitative research. The consequences of this scientism are a trend towards formulaic, risk-averse, qualitative inquiry-by-numbers. Extending Brinkmann's (2015) McDonaldization metaphor, I propose McDowellization; which positions qualitative methodolatry as motivated by a quest to appear more objective, more scientific, and ultimately more like our "real science" quantitative cousins. The danger is that the field of qualitative research foregoes the very qualities that inspired its rise. My optimistic conclusion is to follow the lead of those scholars that have rejected rigid fast-food processes in favour or rigorous, reflexive, interpretive work across a broad range of methodologies.

A multi-disciplinary approach is considered best practice when supporting athlete mental health and illness within elite sport. However, research is yet to explore how multi-disciplinary teams operate in this area. This study explores how multi-disciplinary team staff understand mental health and illness and how they negotiate the interpersonal dynamics and tensions of a multi-disciplinary approach to supporting athletes. We conducted five focus groups with a total of 19 participants across a range of professions, including: sport psychologists (n = 6); coaches (n = 4); physiotherapists (n = 2); performance lifestyle advisors (n = 2); clinical psychologists (n = 2); player care managers (n = 2); and a doctor (n = 1). Eight hours of data were collected, transcribed verbatim, and analysed using reflexive thematic analysis. We constructed three primary themes: 1) an (over)medicalised understanding of athlete mental health concerns; 2) division within multi-disciplinary teams; and 3) tensions when negotiating confidentiality. Staff showed an over-medicalised understanding of mental health and illness and expressed uncertainty in recognising and supporting sub-clinical mental health concerns. Participants spoke of the divide between coaching staff and science and medicine staff and suggested diverging priorities surrounding mental health and performance. Negotiating confidentiality was a challenge for multi-disciplinary teams, with mental health information guarded by some staff, leaving other staff feeling isolated. However, it was acknowledged that some mental health information must be withheld from coaches due to mental illness stigma. Guidance regarding sub-clinical concerns and the handling of confidential mental health information within multi-disciplinary teams should be developed to encourage effective collaboration within sporting organisations.

BACKGROUND:Healthcare assistants (HCAs) are well placed to promote physical activity (PA) in secure hospitals, though multiple barriers limit these opportunities. Using a Medical Research Council (MRC) commissioned framework, this study aimed to develop a self-determination theory (SDT) informed e-learning module for HCA's. METHODS:The development process included three phases. (1) a preparatory phase involved a scoping review, immersive fieldwork and 15 patient interviews. (2), a development phase involved establishing an intervention development team, selecting appropriate theory (SDT) and collecting pilot data (3) a user testing phase exploring intervention acceptability through a staff survey. RESULTS:The outputs from each phase informed the production of an e-learning educational module. The first section of the module incorporated information on: the importance of PA and consequences of prolonged inactivity in inpatient settings, benefits of PA in secure settings and the role of ward staff in PA promotion. The second section, underpinned by the tenets of SDT, outlined the three basic needs, highlighted the importance of these needs in motivating behaviour change and provided specific practical examples of how HCAs can adopt need supportive behaviours. The final section provided interactive case studies where HCAs identified strategies to meet patients individualised needs regarding PA engagement. Following preliminary testing, 71 % of staff reported changing PA promotion practices after the training. CONCLUSIONS:Following MRC guidelines on the development phase of an intervention allowed for exploration of both population and environmental considerations and provided a strategy to develop an intervention that can be integrated into routine care.

There has been limited research into the impact of community-based running mental health peer support groups. This study explored participants' experiences of Run Talk Run; a group which combines exercise with talking about mental health. We recruited 15 participants from three Run Talk Run groups. To support a more immersive data collection process, we combined video recordings of runs with follow-up interviews. Through a reflexive thematic analysis, we generated two themes: 'Nobody left behind: on and beyond the run', which described how the sense of community in the group forms and the processes underlying this; and 'It's not therapy: navigating shared spaces and negotiating personal boundaries', which highlighted difficulties that can arise in peer support and how these are navigated. Our interpretive insights suggest that although there are psychosocial benefits to running-based mental health groups, the distinction between peer support and formal therapy can lead to tensions, insecurities, and dilemmas. It is important to be explicit about the remit of mental health peer support running groups so that people are clear about their purpose.

Sport and Exercise Psychologists are increasingly called upon to support athlete mental health. This study explores sport psychologists' perceptions of their role in relation to athlete mental health and illness and their experiences of offering mental health support. We conducted in-depth, semi-structured interviews with 12 sport psychologists, gathering more than 19 hours of data. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. We constructed three themes: 1) A lack of consensus on remit and role 2) Organization-practitioner misaligned expectations and 3) The emotional toll of supporting athlete mental health. Some practitioners considered their role to be exclusively performance enhancement, whereas others placed mental health at the center of their practice. Challenges arose when practitioners and sporting organizations held conflicting perceptions of the sport psychologist role in relation to athlete mental health. Practitioners shared the emotional toll of responding to athlete mental health concerns sensitively, appropriately, and swiftly. Education and training for aspiring Sport and Exercise Psychologists should be reviewed to reflect the increasing role that practitioners are expected to play in supporting athlete mental health. We discuss strategies to reduce potential misalignment between sporting organizations' and practitioners' expectations of the sport psychologist role in relation to mental health. Sport psychologists are encouraged to engage with ongoing supervision and self-care strategies to manage the emotional toll of their practice.

Performance directors lead high-performance programmes within elite sport and where they opt to invest resources has implications for athletes. This study explores performance directors' perspectives on mental health and illness and their experiences of managing these within elite sport. We conducted semi-structured interviews with 11 performance directors, resulting in 18 h of data. Interviews were transcribed verbatim and analysed using reflexive thematic analysis. We constructed three themes: 1) making sense of mental health: legitimacy vs. scepticism; 2) mental health as athlete responsibility; and 3) simplifying and sanitising mental health. Performance directors used physical health analogies to make sense of mental health, sometimes describing unrealistic expectations regarding mental health management. They also positioned athletes as responsible for finding solutions to their mental health concerns, at times overlooking the impact of the elite sport environment. Some performance directors shared over-simplified perceptions of mental health, often focusing on 'the positive' and neglecting to talk about the more challenging aspects of mental health and illness. Educating performance directors, as well as others in leadership positions, on the complexities of mental health and illness is recommended. This should include how mental illness differs from physical illness and injury, how to respond when athletes disclose mental health concerns, and how mental illness recovery is often nonlinear and subjectively defined.

This meta-study systematically appraises and synthesizes research into athletes' experiences of mental illness. Our critical review of 37 studies conformed to the meta-study structure of meta-theory, meta-method, and meta-data analysis. We also produced a meta-synthesis of findings to deliver new insights into athlete mental illness. Athlete accounts of mental illness pertained to experience of the following: depression, eating disorders, gambling addiction and substance-related disorders (alcohol and drugs). Following a critical interrogation of original articles' theory, method, and findings, we noted a general lack of methodological coherence (congruence between philosophical stance, theoretical position, and methodology). Through the process of a thematic synthesis, we developed 4 new themes: origins of certainty and ambiguity, a gradual sense of decline, mental illness as a threat to identity, and constructing recovery stories. Athletes drew upon dominant illness discourses to construct mental illness and recovery experiences. Our results provide us with an understanding of how mental illness and recovery were experienced within an elite sport involvement. We recommend future research embraces more diverse methodologies and authors ensure a strong alignment between guiding philosophies and methodological approach.

Athlete body dissatisfaction is prevalent across sports and can lead to disordered eating, negative affect, and poor mental health. Whether body image concerns persist into athletic retirement is a focus of research, predominately involving survey-based data in usually sub-elite athletic samples. This study is the first to focus on the meanings elite athletes ascribe to their bodies in retirement. We recruited 31 retired elite athletes, including 23 former Olympians, to participate in a semi-structured interview. More than 25 h of interview data was transcribed verbatim and subject to a reflexive thematic analysis. We constructed 4 major themes to describe athlete experiences: 1) A legacy of body-conscious culture 2) The struggle for "normal", 3) Loss of body as loss of self, 4) Towards new meanings and identities. Athletes explained how the body surveillance culture of elite sport echoed into their post-sport lives. An Olympian identity was considered an embodied identity, so body changes represented a loss of the self. Adjusting to regular eating and exercise routines was deemed challenging, with minimal access to guidance and support. Accepting the inevitability of physical changes in retirement and finding new meanings and identities, were deemed effective coping strategies. Athletes' insights can support sport psychologists and elite sport organisations to devise strategies and policies to facilitate adaptation to body changes post-retirement from sport.

Introduction: Physical activity (PA) is effective in improving physical and mental health outcomes of individuals within secure psychiatric care. However, psychiatric inpatients remain a seldomly heard population in research involving their care. This project reports on the co-development of a theoretically informed PA toolkit to promote physical activity within an inpatient setting. Methods: A behavioural analysis was conducted with 10 patients and 11 staff within a secure psychiatric hospital. Qualitative interviews and group discussions guided by the COM-B model were conducted to identify barriers to physical activity. Based on identified barriers, participant led solutions and suggestions for toolkit content were identified. The academic team selected intervention functions and behaviour change techniques from the behaviour change wheel (BCW) which were subsequently aligned with toolkit content. A final toolkit titled the ‘Move More’ toolkit was developed and produced. Results: Applying the COM-B model to interview transcripts, we identified six key subthemes reflecting the capability, opportunity and motivation components of the model. Using the BCW, we selected three intervention functions (education, training and enablement) and six behaviour change techniques ( restructing the social environment, instructions on performing behaviour, social support, demonstration of behaviour, self-monitoring of behaviour and information about health consequences). Incorporating these components, the final toolkit consisted of four sections: education on the benefits of physical activity engagement, ways to prepare for physical activity (e.g., selecting appropriate clothing), examples of activities that patients could engage in within a ward environment, and self-monitoring tools including a PA planner. Significance: The toolkit was developed using principles of co-production and guided by the BCW. This approach presents a key contribution to literature by demonstrating how principles of co-production can be employed with the BCW in a complex, often hard to reach population. This may represent a valuable approach to develop targeted and effective health interventions within psychiatric populations.

Mental illness identities are personally and socially constructed and impact psychological wellbeing. This study explored how athletes diagnosed with a personality disorder construct their illness identity and the various ways this impacted experience. Guided by an interpretivist paradigm, we recruited two powerlifters, Samantha and Alex, who engaged in a series of one-to-one interviews. In total, 11 hours of data was collected and analysed using dialogical narrative analysis. The personality disorder diagnosis had significant but divergent influences on each athlete. Samantha accepted the diagnosis, aligning to dominant medical understandings of mental illness and using these to construct renewed understandings of the self. In contrast, Alex told a counternarrative to dominant medical discourses of mental illness, which was characterised by stories of activism. Alex sought an alternate diagnosis, autism spectrum disorder (ASD), which better validated their experience. We discuss implications of this work for those operating in sport, such as the importance of allowing athletes to develop their own understandings of mental illness to allow for the construction of an authentic self.

In this article, we utilise the social dynamics of concussion in professional wrestling to examine and critique calls for cultural change as a solution to the crisis of concussion in sport. Drawing on interview data from wrestlers, promoters, referees and healthcare providers in UK professional wrestling, we illustrate the experiences, attitudes and subcultural norms exhibited in relation to concussion. Despite increasing concerns that brain injuries present unique risks to long-term health, wrestlers continue to embody a culture in which pain is ignored, and 'playing' with brain injury is linked to notions of masculinity and wrestling identity. We further explore the organisational features of wrestling, which facilitate and compound these risk-taking behaviours, and conclude by identifying the structural-cultural causes of concussion in wrestling. In sum, economic precarity encouraged risk-taking behaviours, while the 'free agent' status of many wrestlers obviated the potential for any continuity of healthcare or paternalistic protection. Moreover, changes to the dominant performative character of wrestling led many to undertake increasingly risky moves, and the serial nature of character development and the centrality of interpersonal negotiations in workplace practice threw precautionary attitudes into conflict with self-identity and social reputational concerns. We therefore conclude that existing public health interventions designed to address concussion in sport, and particularly the concept of cultural change, need to diversify from predominantly medical and psychology-based models and embrace more holistic, structural conceptions of culture.

BACKGROUND:Adolescents in secure psychiatric care typically report high obesity rates. However, longitudinal research exploring the rate and extent of change is sparse. This study aimed to analyse sex differences in longitudinal body mass index (BMI) change for adolescents receiving treatment in a secure psychiatric hospital. METHODS:The sample comprised 670 adolescents in secure psychiatric care. BMI trajectories from admission to 50 months of hospitalisation were produced using sex-stratified multilevel models. Systematic difference in mean BMI trajectories according to age at admission (14, 15, 16, or 17 years), medication (Olanzapine or Sodium Valproate), and primary diagnosis (Psychotic, non-Psychotic or Functional/behavioural disorders) were investigated. RESULTS:Together, males and females experienced a mean BMI increase of 2.22 m/kg2 over the 50-month period. For females, BMI increased from 25.69 m/kg2 to 30.31 m/kg2 , and for males, reduced from 25.01 m/kg2 to 23.95 m/kg2 . From 30 to 50 months, a plateau was observed for females and a reduction in BMI observed for males. Psychotic disorders in males (β 3.87; CI 1.1-6.7) were associated with the greatest rate of BMI change. For medication, Olanzapine in females was associated with the greatest rate of change (β1.78; CI -.89-4.47). CONCLUSIONS:This is the first longitudinal study exploring longitudinal BMI change for adolescent inpatients. Results highlight that individual differences in adolescent inpatients result in differing levels of risk to weight gain in secure care. Specifically, males with psychotic disorders and females taking Olanzapine present the greatest risk of weight gain. This has implications for the prioritisation of interventions for those most at risk of weight gain.

This study presents a novel contribution to understanding physical activity provision in secure psychiatric care. This is the first study to directly explore adolescent experiences, and triangulate these perspectives with two staff groups, a multidisciplinary team and physical health practitioners. This study included semi-structured with nine physical health practitioners, thirteen members of a multidisciplinary team (MDT), and five adolescent patients. Through an inductive reflexive thematic analysis, we constructed three overarching themes i) institutional barriers to PA, ii) the rehabilitative benefits of PA and iii) the need for collaborative working. Many of the barriers to PA were a function of the secure environment, which was associated with restrictions on movement, perpetuated by limited staff availability to escort to PA sessions. However, there was a widespread agreement that PA was multi-beneficial for patient's rehabilitation, incorporating mood improvement, increased engagement and increase in pro-social behaviours. For PA promotion and physical health support to become embedded within the service provision, collaboration and support is needed from a wider network of staff members. This suggests that future intervention work should target change at an institutional level, which involves targeting organisational policy. Such work could support staff to promote PA and motivate adolescent patients to engage in PA, whilst also supporting patient physical health within their job role.

ABSTRACT Adolescents with severe mental illness (SMI) engage in lower levels of physical activity (PA), a modifiable risk factor for poor physical health. Although PA is associated with physical and psychological benefits in adult SMI populations, few studies focus exclusively on adolescents. This systematic scoping review aimed to identify the characteristics, outcomes, and feasibility of studies which have attempted to engage or increase PA in adolescents with SMI. Web of Science, PsycINFO, PubMed and psycARTICLES were used to identify articles published between 2007–2019. PRISMA guidelines were followed in reporting the results. Ten studies, with a total of 281 participants (mean age: 16.1 ± 0.72) met the inclusion criteria. Seven studies aimed to yield improvements in the primary diagnosis in addition to other clinical outcome measures. Five studies adopted a 3x weekly schedule, though exercise modality, duration and intensity varied. Seven found improvements in the primary diagnosis, with five reporting sustained improvement at follow-up. Participant completion of the intervention ranged between 73-90%. Adolescents with SMI will adhere to and experience a range of positive outcomes from a range of exercise modalities and intervention lengths. However, significant heterogeneity between studies limits conclusions with that can be drawn regarding beneficial outcomes and feasibility.

This systematic scoping review synthesises and appraises applied interventions, consensus/position statements, and grey literature regarding strategies to support athlete mental health and draws necessary connections across these documents. This review is informed by the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines (Moher et al., 2009). SPORTDiscus, PsycArticles, PsycINFO and SCOPUS were used to identify documents, alongside a search of all UK-based Olympic sport governing body websites. Thirty-seven documents met the review criteria. There were twenty-two intervention studies (including four case studies), nine position or consensus statements, and six grey literature documents (e.g. athlete mental health policies). Most interventions resulted in moderate or non-significant findings. Although position/consensus statements provide recommendations, they lack detail and primarily address research and organisational strategy rather than applied practice. Some grey literature recommendations are coherent with previous research, however, there are a lack of mental health policies produced by national governing bodies within elite sport. This review provides a comprehensive overview of athlete mental health literature and draws necessary connections across these different types of documents. Interventions with improved methodology (e.g. larger sample sizes), and more detailed recommendations within grey literature are required to inform applied efforts, recommendations, and future research.

A meta-synthesis was conducted to explore the experiences of ultra-runners who had sustained a running related injury. We identified 10 narrative studies which were synthesised thematically before being re-organised within an Embodiment framework producing 5 taxonomies; The Disciplined Body, Embodied Distress, Corporeal Running Identity, Intersubjectivity of pain and Embodied Coping. Ultra-running is a body centred activity exemplifying Merleau-Ponty's embodiment. These runners develop a heightened kinaesthetic awareness and embodied sense of space developed through many hours of 'burning in' movement pathways. Running as a habituated and pre-reflective action means that when experiencing injury, the entire world of the ultra-runner is disrupted, calling into question their corporeal identity. Ultra-runners who experience pain or injury may have the opportunity to resist dominant pain narratives by adopting an embodied approach to healing. This meta-synthesis has implications for further research, examining the embodied meaning injured ultra-runners make from injury and how this impacts their experiences of their bodies.