Psychological Interventions to Improve Elite Athlete Mental Wellbeing: A Systematic Review and Meta-analysis.

backgroundMental wellbeing, one continuum alongside mental illness in a dual-continua mental health model, has attracted less attention compared with substantial studies concerning mental illness amongst elite athletes. Notably, the promotion and protection of mental wellbeing contribute to not only a positive status of flourishing but also a reduction in the future risk of mental illness, which can potentially facilitate a status of complete mental health. Despite the critical role of wellbeing promotion and protection, there are limited evidence-based strategies to design and implement wellbeing interventions in elite athletes.

objectiveThis review aims to identify the different types of interventions to improve mental wellbeing amongst elite athletes and meta-analyse their effects. Further, the study aims to narratively identify the factors affecting implementation success in elite athletes.

methodsPeer-reviewed articles were systematically searched through five electronic databases (SPORTDiscus, PsycINFO, PSYCArticles, Academic Search Complete and MEDLINE) in July 2023 and updated in May 2024. To enrich the overall findings and reduce the risk of publication bias, grey literature was also included in this review. Dissertations and theses were the main foci and were searched in September 2023 and updated in May 2024. Standardised mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to estimate the effects of the different types of interventions on mental wellbeing. Further, a narrative synthesis under the Consolidated Framework for Implementation Research was conducted to identify the potential factors that influenced the implementation success.

resultsA total of 27 studies were found from peer-reviewed and grey literature, of which 15 studies were subject to meta-analyses. Results indicated that psychological skills training (SMD = 0.78, 95% CI 0.24, 1.32), third-wave interventions (SMD = 0.32, 95% CI 0.01, 0.63) and positive psychology interventions (SMD = 0.58, 95% CI 0.31, 0.85) were all potentially effective in improving overall wellbeing amongst elite athletes. However, when quasi-experimental studies in the third-wave interventions were removed for the sensitivity analysis, the effect was no longer significant. Further, 11 facilitators and 3 barriers to implementation success were identified, of which adaptability, coach and teammate support, and instructor's capacity to connect with athletes were the key facilitators, and busy schedules and complex intervention contents were the main barriers.

conclusionsThis review indicated that psychological skills training, third-wave interventions and positive psychology interventions could be potentially effective for elite athlete mental wellbeing, but more studies with robust experimental designs are needed in future to increase confidence in the favourable results. Moreover, future researchers and practitioners need to be aware of context-specific implementation facilitators and barriers, optimising elite athletes' engagement and uptake of interventions. PROSPERO: CRD42023437986.