High-Functioning Depression in Elite Athletes (Aka Persistent Depressive Disorder)
Elite athletes are often idolized for their discipline, focus, and mental resilience. But what if that same resilience is masking something deeper? High-functioning depression—clinically known as Persistent Depressive Disorder (PDD)or dysthymia—is a silent struggle for many athletes who appear outwardly successful, yet internally battle chronic emotional distress. Unlike major depressive disorder, PDD allows individuals to maintain outward productivity while living with persistent low mood, fatigue, and hopelessness.
I’m going to explore the often-overlooked world of high-functioning depression in NCAA and professional athletes. Using psychological research and real-life examples to uncover how performance, identity, and mental health collide—and what we can do to help.
Understanding High-Functioning Depression
What is PDD/Dysthymia? Persistent Depressive Disorder is a chronic form of depression that lasts for at least two years, often going undiagnosed due to its subtler symptoms. Individuals may experience a persistent sad or “empty” mood, fatigue, irritability, sleep disturbances, difficulty concentrating, low self-esteem, and a sense of hopelessness. Despite these symptoms, they often continue to perform well in their daily responsibilities—including athletic training and competition.
Invisibility Factor Athletes with high-functioning depression are often among the highest performers on their teams. Their ability to “keep it together” externally leads coaches, fans, and even family members to overlook deeper mental struggles. This invisibility can result in delays in diagnosis and treatment, often for years, worsening the internal emotional toll.
The Athlete Mentality and Masking
The "Push Through It" Culture From a young age, athletes are conditioned to ignore pain and adversity. While this mindset can foster resilience on the field, it becomes dangerous when applied to mental health. Many athletes believe they must “tough it out” alone, fearing they’ll be seen as weak or less committed. A 2021 survey by Athletes for Hope found that 60% of college athletes reported feeling pressure to hide emotional struggles to maintain their status.
Emotional Suppression Research from the Journal of Clinical Sport Psychology shows that athletes are less likely to report emotional distress due to stigma, fear of losing playing time, or concerns about team dynamics. This emotional suppression not only exacerbates depressive symptoms but also delays effective treatment.
Perfectionism and External Validation A 2020 study from the Journal of Sports Sciences revealed that athletes who tied their self-worth to performance outcomes were significantly more likely to report symptoms of depression, anxiety, and low self-esteem. The constant pursuit of perfection often masks underlying emotional distress and creates a harmful feedback loop of achievement and self-criticism.
Data and Real-World Impact
Prevalence Rates According to the NCAA’s 2022 Mental Health Trends Report, over 30% of student-athletes report feeling down, hopeless, or mentally exhausted on a regular basis. Among those who show no drop in athletic performance, these symptoms often go unnoticed and unaddressed.
Elite Athletes Speaking Out
Michael Phelps has openly discussed his battle with long-term depression, including periods of suicidal ideation. His honesty has opened the door for countless others in elite sport.
Abby Wambach revealed she felt "numb and broken" during the height of her U.S. Soccer career, despite her external success.
Simone Biles, one of the most decorated gymnasts in history, stepped back from competition in the 2021 Olympics to protect her mental health, stating, “We’re human too.”
Suicide Risk High-functioning depression is strongly correlated with suicidal ideation, particularly in athletes experiencing identity foreclosure—where they define themselves solely through sport. A 2019 study in The American Journal of Sports Psychiatry found that nearly 20% of athletes experiencing chronic depressive symptoms also reported suicidal thoughts.
Barriers to Diagnosis and Treatment
Lack of Awareness and Training Many coaches and athletic administrators are not trained to recognize non-disruptive forms of depression. A smiling, hard-working athlete may be silently suffering, especially in team environments that reward emotional stoicism.
Underreporting Symptoms A 2023 meta-analysis from Frontiers in Psychology revealed that athletes, especially men and those in contact sports, significantly underreport mental health symptoms during screenings. This skewed reporting can lead to missed opportunities for early intervention.
Limited Access to Specialized Care While top-tier programs may offer in-house sports psychologists, many athletes at smaller institutions or in less prominent sports lack access to professionals who understand the unique pressures of competitive sport. Cultural competence in treatment—understanding the performance mindset, injury implications, and career pressures—is essential but often lacking.
Strategies for Prevention and Support
Normalize Conversations and Storytelling Integrating mental health check-ins into team culture helps reduce stigma. Teams should designate regular opportunities for emotional reflection—whether through one-on-one meetings, anonymous surveys, or group discussions. Personal storytelling from athletes, coaches, and alumni can make mental health struggles feel more relatable and less taboo.
Embed Mental Health Professionals in Athletics Colleges and pro teams should integrate sports psychologists directly into athletic departments—not as external referrals, but as embedded team members. This visibility and accessibility create trust and increase engagement with services.
Routine, Confidential Mental Health Screenings Annual screenings using validated tools like the PHQ-9 and GAD-7 should be standard practice. Follow-up protocols for athletes scoring above clinical thresholds must be in place, just as there are protocols for physical injury.
Comprehensive Coach and Staff Training Mandating QPR (Question, Persuade, Refer) or Mental Health First Aid training for all staff members equips them to identify subtle warning signs. These programs also empower staff to respond effectively and empathetically.
Elevate Peer Advocacy and Leadership Initiatives like Morgan’s Message, The Hidden Opponent, and Athletes Connected harness the power of peer voices. Equipping student-athlete ambassadors with mental health education enables them to serve as peer mentors, bridging the gap between athletes and formal services.
Mental Health as a Recovery Component Psychological care should be embedded in injury recovery protocols. Athletes recovering from physical injuries are especially vulnerable to depression, due to identity disruption and isolation.
My Thoughts
High-functioning depression in athletes is not a contradiction—it’s a lived experience for thousands of competitors who excel on the field but quietly suffer off it. These athletes often go unnoticed, their struggles dismissed because performance remains intact. But performance does not equal wellness.
Creating emotionally safe environments in sport requires intention, education, and cultural change. By normalizing help-seeking, embedding proactive care, and elevating lived experiences, we can protect the psychological well-being of our athletes without compromising their pursuit of excellence.
Mental health is health—and it’s time we treat it that way.
Sources
American Psychiatric Association. (2022). Diagnostic criteria for PDD.
Journal of Clinical Sport Psychology. (2021).
Journal of Sports Sciences. (2020).
NCAA Mental Health Trends Report. (2022).
Frontiers in Psychology Meta-Analysis. (2023).
The Hidden Opponent (https://thehiddenopponent.org)
Morgan's Message (https://morgansmessage.org)
Michael Phelps Foundation
U.S. Olympic & Paralympic Committee Mental Health Task Force Report (2021)
Mental Health First Aid USA (https://www.mentalhealthfirstaid.org)
QPR Institute (https://qprinstitute.com)
National Institute of Mental Health (https://www.nimh.nih.gov/health/topics/depression/index.shtml)
The American Journal of Sports Psychiatry (2019)
Athletes for Hope Mental Health Survey (2021)
Athletes Connected (https://athletesconnected.umich.edu)