Content uploaded by Andreas Küttel
Author content
All content in this area was uploaded by Andreas Küttel on Nov 21, 2023
Content may be subject to copyright.
The Team Denmark Applied Model of Athlete Mental Health
The Team Denmark Applied Model of Athlete Mental Health
Kristoffer Henriksen
Gregory Diment
Andreas Küttel
1
1
1
2
3
4
5
6
7
8
9
10
11
12
The Team Denmark Applied Model of Athlete Mental Health
Abstract
Mental health is a core component of any culture of excellence, but it is also complex, and
key stakeholders in elite sport struggle to negotiate their roles and responsibilities in promoting it.
In this conceptual paper, we present the Team Denmark Applied Model of Athlete Mental Health.
The model is theory-driven, informed by evidence, and intended for applied use; it was developed
heuristically through discussions in the Team Denmark sport psychology team and validated in
further discussion with multiple stakeholders such as coaches and managers. The model contains
four levels of mental health in elite sport (a) the athlete, (b) the training environment, (c) leadership,
and (d) everyday life. The four levels are situated in the greater context of Danish society and
culture. The four levels are divided into three colors (green, yellow, and red) that describe the
mental health of the athlete, the degree to which the environment supports athlete mental health,
and the required mental health interventions. The model contains two key messages. First, efforts to
promote mental health should target all athletes and not only those that are languishing. Second,
athlete mental health is not confined to the individual athlete. The model provides stakeholders with
a lens through which they can analyze, talk about, and optimize the way in which their sport
environments support the mental health of their athletes.
Keywords: athlete mental health; responsible elite sport; sport environments; safe sports; context-
driven practice
2
2
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
The Team Denmark Applied Model of Athlete Mental Health
The Team Denmark Applied Model of Athlete Mental Health
The Team Denmark sport psychology team has a successful history of developing and
sharing models of how we work. When the team was first created, the Danish sport world
recognized the potential of sport psychology but did not know how to approach this new field. We
started by developing and publishing our professional philosophy (Henriksen et al., 2011), which
turned out to be very helpful for the team. Within Denmark, it helped create a common language
about sport psychology and align practitioners’ work (Henriksen et al., 2016). Internationally,
publishing the models has opened beneficial discussions, created relationships, and laid the
foundation for international exchange. Therefore, the publication of an updated version followed
nine years later (Diment et al., 2020). Today, the field of athlete mental health in Denmark is in a
space somewhat similar to that of sport psychology fifteen years ago. The Danish sport world
recognizes its importance, is aware of the substantial research production in the field but does not
feel certain about how to approach the field. These experiences supported our wish to develop and
publish the Team Denmark Applied Model of Athlete Mental Health.
Athlete mental health is as an important a topic, as it is a complex one. Coaches and sports
managers who follow research and debates within the topic are likely to agree that athlete mental
health is a core component of any culture of excellence (Campbell et al., 2021; Henriksen et al.,
2019; 2020). They are also likely to agree with the overall proposition that within a sport
environment, mental health is everybody’s business. At the same time, at least in Denmark, coaches
and managers are uncertain of their own role. They discuss the premise of elite sport, and whether
elite sport will always and inevitably compromise athlete mental health with its requirement for
steely dedication, sacrifice and pushing the limits, or if good mental health is a precondition for
performance. Their intention is to create elite sport environments that simultaneously support
athletes’ mental health and their high performance, but they lack a suitable framework.
3
3
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
The Team Denmark Applied Model of Athlete Mental Health
Team Denmark is the Danish elite sport institution that oversees elite sport in Denmark and
supports the sport federations, which manage the actual practice of elite sport (Kuettel et al., 2020).
Team Denmark offers financial support and sport science services such as medical support,
nutritional guidance, physiological testing, and sport psychology. At the time of writing, Team
Denmark is in the process of discussing and designing their approach to athlete mental health,
including how to organize efforts for prevention, early detection, and treatment in collaboration
with the specific sport federations and within the context of a national health care system based on
the principles of free and equal access to healthcare for all citizens (Danish Ministry of Health,
2017). The previous lack of a coordinated national approach to athlete mental health led coaches
and managers to increasingly express uncertainty about their own roles and responsibilities in their
collaboration with the Team Denmark sport psychologists and sport managers. This expression of
uncertainty stimulated the Team Denmark sport psychology team to develop the Team Denmark
Applied Model of Athlete Mental Health as a framework for stakeholders (e.g., coaches, managers,
medical experts, dual career support providers) to discuss the nature of athlete mental health and the
role of the environment in promoting it. In the present paper, we share this model in the hope that
such sharing can stimulate discussions and initiatives in the Danish sport world and beyond.
Athlete Mental Health
Below, we highlight key aspects of the athlete mental health literature that has informed
our work in developing the model, including research that demonstrates the complexity of athlete
mental health, the personal and environmental factors involved, and the state of the art in Denmark.
Athlete Mental Health in Elite Sport is Complex
Mental health is not a simple construct, and although several definitions exist (e.g.,
Reardon et al., 2019), researchers in sport psychology have yet to agree on a definition. Mental
health is much more than the absence of mental illness (Henriksen et al., 2019) and encompasses
4
4
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
The Team Denmark Applied Model of Athlete Mental Health
also mental well-being with its hedonic (feeling good about life) and eudaimonic dimensions
(positive relationships, purposeful life) (Campbell et al., 2021; Lundqvist & Andersson, 2021). In
the present paper we use Kuettel and Larsen (2020) athlete-specific definition of mental health:
Mental health is a dynamic state of well-being in which athletes can realize their
potential, see a purpose and meaning in sport and life, experience trusting personal
relationships, cope with common life stressors and the specific stressors in elite
sport, and are able to act autonomously according to their values (p. 23).
This definition highlights the dynamic nature of athletes´ mental health, to be understood
on a continuum and not as a discreet, fixed state of mind or mood. Rather, athletes´ state might be
seen on a continuum from (a) active mental illness, to (b) sub-syndrome illness (frequent
symptoms), to (c) normal (occasional symptoms), to (d) good mental health (asymptomatic), and to
(e) thriving (high well-being and performance; Uphill et al., 2016). Athletes potentially move back
and forth on this continuum depending on their career development, transitions, and general critical
life events (Stambulova et al., 2020).
There is an ongoing debate about the relationship between elite sport and mental health.
Researchers have compared the prevalence of common mental disorders (e.g., depression, anxiety,
post-traumatic stress disorders, eating disorders) between athletes and the general population (e.g.,
Gerber et al., 2022; Golding et al., 2020). Despite methodological and conceptual difficulties
(Lundqvist & Andersson, 2021), there is consensus that athletes suffer from common mental
disorders at rates that are broadly comparable to their non-sporting peers (Gouttebarge et al. 2019;
Rice et al., 2016; Tahtinen et al., 2021). However, elite sport is intense and complex, and the
difficulty of distinguishing between experiences that are to be expected in high-pressure elite sport
on the one hand and symptoms of mental disorders on the other may not be sufficiently considered
in current research (e.g., Henriksen et al., 2019; Uphill et al., 2016). For example, increased but
5
5
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
The Team Denmark Applied Model of Athlete Mental Health
transient stress reactions related to challenging sports situations (competitions and setbacks) are
common and a normal part of life as an elite athlete. Psychological symptoms associated with the
pursuit of excellence in sport could therefore easily be misinterpreted as pathological issues if
generic assessments developed for the general population are used on athletes without consideration
of the psychosocial context in which various symptoms arise (Lebrun & Collins, 2017; Lundqvist &
Andersson, 2021).
Personal and Environmental Factors Interplay to Nourish Mental Health
Athlete mental health is not an individual affair. Rather, mental health is a lived
experience that is contingent on the individual athlete and their environment. Sport environments
can thus nourish or malnourish athlete mental health (Agnew & Pill, 2021; Henriksen et al., 2019).
Several risk and protective factors that influence the mental health of athletes have been identified
in the scoping review by Kuettel and Larsen (2020). These factors can be divided into a personal
and a sport-environmental domain. Within the personal domain, typical risk factors for athletes are
injuries and overtraining, chronic life stress, adverse life events, poor eating/drinking/sleeping
habits, and selection pressures (e.g., Birrer, 2019; Terry & Parsons-Smith, 2021) whereas protective
factors include self-reflection and setting meaningful goals, appropriate coping strategies, career
satisfaction, and a general focus on physical and mental recovery (Brown et al., 2018; Kellmann &
Beckmann, 2021). Little research has looked at environmental protective and risk factors. The few
studies investigating the environments’ role in athletes’ mental health have emphasized risk factors
such as stigma for help-seeking, performance pressure, athlete abuse, and lack of social support
from coaches and teammates, and protective factors such as supportive relationships (Dohsten et al.,
2020), support staff’s mental health literacy (Breslin et al., 2017), access to specialist support
(Coyle et al., 2017), and a trusting and mastery-orientated climate (Lundqvist & Raglin, 2015).
Within the broader literature on talent development environments, researchers have demonstrated
6
6
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
The Team Denmark Applied Model of Athlete Mental Health
that athletic talent development environments play a key role in athletes’ development (Henriksen
& Stambulova, 2023). More specifically, a recent review highlighted that environments with
features such as skilled coaching staff, accessible role models, psychological safety, coherent and
lived values, a whole-person approach, and collaboration between stakeholders are likely to lead to
outcomes such as well-being and long-term personal and athletic development (Hauser et al., 2022).
The Majority of Danish Athletes are Thriving
In a Danish context, the mental health of 612 elite athletes from different sports has been
investigated through the lens of risk and protective factors (Kuettel et al., 2021). Three distinctive
mental health profiles were identified through a latent profile analysis with depression, anxiety, and
mental well-being as decisive variables. The most frequent profile (64% of athletes) named
flourishing was characterized by above-average well-being scores and low mental illness
symptoms. Athletes in the moderate mental health profile (29%) expressed moderate symptoms of
depression and anxiety and moderate mental well-being, while the athletes in the languishing
profile (7%) experienced severe symptomatology together with low mental well-being. Profile
comparisons revealed significant differences in protective factors (e.g., social support from sport
and private domain, positive perception of the sporting environment, and sleeping habits) as well as
risk factors (e.g., perceived stress, high general workload) between the three profiles.
Altogether, the research on athlete mental health informed the model in several ways.
Firstly, it stimulated us to see mental health as a continuum upon which athletes can move back and
forth throughout their careers. Secondly, it stimulated us to shift our focus from solely looking at
individual athletes and their robustness or vulnerability, to considering how aspects of the
environment can either support or harm their mental health. Finally, it reminded us that a national
mental health model should not only focus on athletes that are languishing but include all athletes.
7
7
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
The Team Denmark Applied Model of Athlete Mental Health
The national and international research combined with the experiences of the Team
Denmark sport psychology consultants working on the front line with Danish elite athletes, coaches
and managers form the basis of the model presented below.
The Process of Developing the Team Denmark Applied Model of Athlete Mental Health
We use the term “applied model” to describe a model that is theory-driven, informed by
evidence, and intended for applied use (Cumming & Williams, 2013). The model is not the result of
a systematic literature review. Rather, it is heuristic in nature. Over a series of meetings and with
inspiration from existing models (e.g., the early intervention framework; Purcell et al., 2019),
international evidence and guidelines (e.g., IOC, 2021), and the challenges and needs of Danish
sports managers and coaches, Team Denmark’s sport psychology consultants discussed the design,
content and intended contribution of the model. We faced the challenge of simplifying a complex
field. For example, when we looked at the individual athlete, the number of experiences and
symptoms related to good and poor mental health reported in the literature far exceeded what could
be accommodated in a model that was meant to provide an overview (Kuettel & Larsen, 2020). This
was no different when we looked at the role of the environment, where, for example, a long list of
features of coaches’ and managers’ work has been related to athlete well-being (e.g., Bisset et al.,
2020; Mazzer & Rickwood, 2015).
Once the idea of developing the model matured within the sport psychology team, a
working group (first and second authors) met and developed a first and very comprehensive version
of the model based mainly on available position stands and research (e.g., Henriksen et al., 2019;
Kuettel & Larsen, 2020; Purcell et al., 2019) as well as on our experiences from working in the
field. During a subsequent whole day seminar, the team discussed the overall design of the model
and selected the concepts that we considered to be most pertinent to address the challenges in
Danish sport as we met them in our applied work, thus reducing the number of factors.
8
8
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
The Team Denmark Applied Model of Athlete Mental Health
After agreeing on a second and more focused version, at three separate meetings, we
presented the model to a range of stakeholders, including sport managers in Team Denmark and
heads of sport in selected federations. Their feedback included a need to find terms that were more
suited for sport, and discussions around where to place elements that are common but unhealthy
(e.g., control) in the model. We included their reflections and feedback in our discussions, and
through several iterations, we developed the current version of the model (Blazey et al., 2022). We
acknowledge that a reader may find some elements missing and others irrelevant. The purpose of
the model is not to provide a universal, all-encompassing, and conclusive model of athlete mental
health but rather to create a contextualized model that will help establish a common language and
stimulate discussion within sport-Denmark.
Theoretical Underpinning
The model has the holistic ecological approach (HEA; Henriksen et al., 2010) as its
underlying foundation. The HEA stimulates researchers and practitioners to look not only at the
individual athletes but also at the environments in which they are embedded and asserts that some
environments are more successful than others in supporting athletes’ progression and development.
The HEA had a significant impact on Danish talent development and elite sport and is visible in the
overall strategies of Team Denmark and sports federations to promote sports environments before
individual athletes. The environment is envisioned as encompassing micro- and macro levels,
athletic and non-athletic domains and as well as an organizational culture that provides stability to
the environment (Henriksen & Stambulova, 2023; Mathorne et al., 2019). The model is thus
informed by the central tenet outlined in the ISSP consensus statement on athlete mental health
(Henriksen et al., 2019) that the sports environment can nourish or malnourish not only
performance but also athlete mental health.
The Team Denmark Applied Model of Athlete Mental Health
9
9
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
The Team Denmark Applied Model of Athlete Mental Health
Figure 1 presents the Team Denmark Applied Model of Mental Health. Multiple
stakeholders play roles in athlete mental health (Larsen et al., 2021; Lundqvist & Andersson, 2021).
This model aims to develop the awareness of these stakeholders in sport environments about the
complex nature of athlete mental health and provide a lens through which they can analyze, talk
about, and optimize their talent development and elite sports environments in relation to how they
support the mental health of their athletes. Maintaining a high level of mental health requires a
concerted and continual effort from all the key actors.
The model contains four levels of mental health in elite sport. The first level is the ‘The
athlete’. This level describes the individual athlete and how they can experience life as an elite
athlete. The second level is ‘The training environment’ which describes the daily training
environment that the athlete is a part of and includes teammates and training partners. The third
level in the model is ‘Leadership’. This level includes coaches and sporting management within the
training group and sports federation. The fourth level is ‘Everyday life’, which describes the daily
life of the athlete, and includes the many domains that the athlete navigates outside of their close
training environment (e.g., education, job, family, social life, economic factors, travel, etc.) and the
key people within these domains. The four levels are situated in the greater context of ‘Danish
society and culture’ within which athletes and sporting environments are embedded.
Inspired by Mrazek and Haggerty’s (1994) mental health promotion spectrum, the four
levels of the model are divided into three colors. These colors describe the current status of mental
health of the athlete, the degree to which the various levels of environment support athlete mental
health, and the focus of the required mental health interventions. Green signifies good mental health
and a sound environment, and therefore mental health strategies in these situations are focused on
prevention and development. Yellow indicates athlete experiences and environment characteristics,
where we need to be extra aware and attentive, and therefore the related interventions are focused
10
10
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
The Team Denmark Applied Model of Athlete Mental Health
on early identification. Red signifies a toxic environment with languishing athletes in need of
treatment and referral to relevant experts.
- Please insert Figure 1 around here -
The Athlete: From Thriving to Languishing
At the center of the model is the athlete. Athletes´ mental health state can range from
thriving to languishing. The term “thriving” is often used in the sporting context to describe a
combination of high well-being (i.e., flourishing) and a sustained high level of performance (Brown
et al., 2018). A thriving athlete (green) will typically be in a good mood and engage in their training
with energy and a positive demeanor. Even though training can be hard, a thriving athlete will
generally be happy and experience their life as an elite athlete as meaningful. An athlete under
pressure (yellow) will typically display mood swings, a temporary loss of meaning in their sport,
and lack of engagement in the world around them (Terry & Parsons-Smith, 2021). The athlete will
often be fatigued or lack energy which can be associated with poor sleep quality, injuries, and the
early stages of overtraining (Kellmann & Beckmann, 2021). This is not unusual in elite sport but
should not be experienced over longer periods of time. An athlete that is languishing (red) can
experience low well-being and potentially diagnosable clinical issues such as depression, eating
disorders, anxiety, or burnout (Kuettel et al., 2021). Such an athlete can often be exhausted, socially
isolated, and feel that they cannot cope with the demands being placed on them as well as
experience a general loss of meaning in life (e.g., Birrer, 2019).
The Training Environment: From Safe to Toxic
The next level in the model presents the training environment the athlete is a part of, which
can nourish or malnourish athlete mental health (Henriksen et al., 2019). Training environments can
consist of athletes that are teammates competing for the same team (e.g., football or ice hockey
team) or training partners that compete individually (e.g., swimming squads or athletics teams).
11
11
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
The Team Denmark Applied Model of Athlete Mental Health
High-performance environments, by definition, focus heavily on outcomes of success and
achievement (Coyle et al., 2017; Lebrun & Collins, 2017). This focus can contribute to cultures that
do not equally acknowledge and support athletes’, coaches’, and support staff’s mental health. This
layer presents a spectrum ranging from a safe to a toxic training environment.
A safe training environment (green) is an environment where athletes are willing to speak
their minds and take interpersonal risks without fear of reprisal (Edmondson, 1999, Vella et al.,
2022). An important factor in achieving this is a sense of unity with a supportive training
environment and strong interpersonal relations with teammates (Agnew et al., 2021; Kuettel et al.,
2021), and a level of trust that allows people to regularly raise tough issues or offer feedback for
performance enhancement (Taylor et al., 2022). An unsafe training environment (yellow) is where
members of the group experience doubt and uncertainty. Members are uncomfortable speaking their
minds and worry their opinions and ideas will not be received positively. The group often includes
cliques that can lead to division among members, and relationships between team members are
often uncertain and lack mutual trust (Bisset et al., 2020). It is not uncommon for such
characteristics to surface during stressful periods, for example during internal team selection.
However, this should never be the norm or exist over long periods of time, or else there is a risk that
the training environment will become a toxic training environment (red). Here, athletes fear reprisal
and experience mocking or ridicule. Therefore, athletes keep their opinions, ideas, and problems to
themselves. It is an environment where athletes experience damaging rivalries, distrust, and
bullying, and where unresolved conflicts grow and spread throughout the group or team.
In Denmark, providing learning environments that stimulate questions and contributions is
an inherent part of the school system, and athletes expect this.
Coaches and Leaders: From Healthy to Dangerous Leadership
12
12
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
The Team Denmark Applied Model of Athlete Mental Health
The third level of the model includes coaches, team managers, and sporting directors that
form the leadership in a sports federation or club. Numerous studies have emphasized the central
role coaches and leadership within a sport have on athlete mental health (e.g., Bisset et al., 2020;
Vaughan, 2015), and how a positive influence requires high levels of mental health literacy (Breslin
et al., 2017), caring for athletes (Dohsten et al., 2020; Lewis, et al., 2022), and creating a
challenging yet supportive environment (Brown et al., 2018). However, caring for athletes does not
consist of simply being “nice” to athletes. Coaches and leadership should “focus on helping athletes
achieve what they want to achieve, which may include winning, but also caring for athletes with
issues and/or concerns that are situated outside the confines of sport itself” (Lewis et al., p. 8).
In the model, we suggest that healthy leadership (green) describes a situation where
coaches involve athletes in central decisions that affect their lives, have considerable mental health
literacy, and take an interest in their lives outside of sport (e.g., Dohsten et al., 2020). An autonomy
supportive coaching style and a holistic view of athletes is taught in Danish coach education
programs. Healthy leadership also means coaches and leaders live their values and that their
espoused values correspond to their actions, which creates a sense of coherence and stability for all
involved (Mazzer & Rickwood, 2015). Unhealthy leadership (yellow) describes situations where
coaches and leaders control the athletes, leaving little room for athletes to take initiative and to be
involved in important decisions around training, competition plans (e.g., Taylor et al., 2022) or
activities in other spheres of life. Unhealthy leadership may acknowledge the importance of athlete
mental health but not recognize that they themselves have low mental health literacy. Therefore,
leadership does not include mental health considerations in their decisions and plans, as evidenced
by questionable behaviors and the values underlying these behaviors. At the red end of the spectrum
lies dangerous leadership which describes a leadership style characterized by manipulative or
coercing behavior, a singular focus on performance with no interest in athletes’ mental health,
13
13
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
The Team Denmark Applied Model of Athlete Mental Health
acting unethically, as well as acceptance of unethical behaviors (e.g., Yukhymenko-Lescroart, et al.,
2015). A dangerous leadership style contributes to a toxic training environment of dominance,
distrust, and degradation, with a clear and negative impact on athlete mental health (Shaw et al.,
2011; Vella et al., 2022).
Everyday Life: From a Balanced to a Chaotic Everyday Life
Athletes are never isolated in just a sporting context but are part of a broader environment
that includes other life domains. This can include their educational and vocational activities, family
and social networks, sponsors, and economic factors (Stambulova et al., 2020), and the norm in
Denmark is for athletes to take an education while pursuing their athletic careers (Kuettel et al.,
2020). Athletes who have a balanced everyday life (green) effectively plan their time as well as
prioritize the many tasks at hand (Kegelaers et al., 2022). Key-stakeholders in sport, school, family,
and other arenas coordinate and communicate, leading the athletes to experience being met with
demands that are aligned. They have open and effective communication with these stakeholders,
find they have sufficient time for recovery, and generally experience concordance and synergy in
daily life. Athletes with an unbalanced everyday life (yellow) struggle to plan and structure their
lives. They experience that key stakeholders in different arenas do not communicate, leading them
to experience contradicting pressures in their daily life and a lack of support from key people (e.g.,
Terry & Parsons-Smith, 2021). Altogether, these features of their daily lives often lead to
insufficient or ineffective recovery (Kellmann & Beckmann, 2021). In some cases, an athlete lives a
chaotic everyday life (red) that is characterized by chaos and constant stress. Athletes experience
demands from key people in their lives that are not only misaligned but in conflict, and they are
unable to navigate within these demands (e.g., Birrer, 2019). They experience opposition from their
environment which may not support their sporting ambitions. Athletes feel pressure to perform on
various fronts with opposing expectations, and the generally heightened levels of stress and concern
14
14
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
The Team Denmark Applied Model of Athlete Mental Health
leave them unable to prioritize recovery, which negatively impacts their mental health (e.g.,
Sorkkila et al., 2017).
Mental Health as Contextualized: Danish Society and Culture
Mental health is contextualized, and athletes’ experiences as well as sporting and dual
careers are shaped and affected by the larger societal and cultural context within which they and
their sporting environments are embedded (Kuettel et al., 2020). These factors include Danish
cultural and societal norms as well as Danish sporting culture. As examples, Danish athletes learn in
the school system to expect to be involved and listened to, Danish coach education is built on values
of autonomy support, and Dual Careers are the norm in Denmark. Currently, Denmark sees a
general trend in society toward increased mental ill-health (Sundhedsstyrelsen, 2022). Young
people in Denmark experience pressure to perform across multiple settings including school, social
media, and friendship groups (Dilling & Petersen, 2022; Pisinger et al., 2020). Team Denmark has
little ability to directly influence these factors but plays an important role in helping athletes cope
with these potential negative influences on mental health.
Mental Health Interventions
Each color in the model is associated with specific support and intervention strategies.
Even flourishing athletes need to keep investing in their mental health which is a resource for their
career development and for dealing with setbacks and adversity (Campbell et al., 2021). Therefore,
green calls for mental health strategies focused on prevention and development. Athletes with a
moderate mental health profile benefit from preventative well-being strategies. Yellow thus calls for
interventions focused on early identification and improving aspects of the athletes’ environment.
Athletes with a languishing profile may benefit best from a combined therapy of psychiatric and
psychological care followed by well-being interventions. Red signifies a need for specialized
15
15
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
The Team Denmark Applied Model of Athlete Mental Health
treatment and referral to relevant experts, combined with some serious steps to amend or even
change the environment.
More specifically, mental health strategies focused on prevention and development (green)
on the individual level include providing direct access to support services such as sports
psychology, dual-career, and nutrition with the aim to help flourishing athletes continually
experience joy and meaning in their sport and life (Diment et al., 2020; Purcell et al., 2019).
Strategies on the training environment level can include group workshops with a focus on values,
team culture, psychological safety, and communication strategies to continually develop the training
group and prevent future challenges (Bisset et al., 2020; Breslin et al., 2017). At the leadership
level, strategies include helping coaches and management increase their awareness of their role as
cultural leaders and role models and improve their mental health literacy. Finally, at the everyday
life level, key strategies include creating flexible education opportunities for elite athletes and
educating key people in the athletes’ lives through workshops and psycho-educative material
(Kegelaers et al., 2022).
Interventions focused on early identification (yellow) at the athlete level can include
regular screening for well-being and mental health issues such as depression, anxiety, and eating
disorders (Kuettel et al., 2021; Rice et al. 2019), and teaching coaches to notice athletes’ energy
levels. Similarly, early identification at the training environment level can include the regular use of
group screening instruments related to psychological safety (Edmondson, 1999; Shaw et al., 2011)
or features of successful training environments. Perhaps most importantly, however, the regular
presence of sports psychologists in the daily training environment can allow the sports psychologist
to observe group dynamics and identify potential obstacles to thriving. Strategies on the leadership
and everyday life levels can include generalized well-being assessments with a focus on athlete
perceptions of coaches and management within their sport and the extent to which they feel their
16
16
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
The Team Denmark Applied Model of Athlete Mental Health
everyday life is balanced (Campbell et al., 2021; Gosai et al., 2021; Sorkkila et al., 2017). Another
strategy is to support research projects that increase the mental health literacy of stakeholders and
map factors that influence athlete mental health, particularly related to the leadership level. Early
identification should be followed by appropriate interventions, which may include improving
athletes’ recovery (Becker-Larsen et al., 2017), providing better dual career opportunities (Linnér et
al., 2020), and developing supportive cultures in a team (Henriksen, 2015).
Interventions focused on treatment and referral to appropriate experts (red) can include
establishing an external referral network of clinical psychologists and mental health experts to
which athletes in need of specialized help can be referred (Breslin et al., 201; IOC, 2021; Rancourt
et al., 2020). Danish elite sport has also created a ‘whistle-blower’ hotline for athletes if they feel
that they have been inappropriately or unethically treated by coaches, teammates, or other key
persons in their network. Both strategies aim to help athletes gain access to the best support and
treatment opportunities (Purcell et al., 2022). At the environmental level, if a dangerous coach or
leader creating a toxic environment is identified, it is necessary to have clear protocols to respond to
the issue appropriately and ethically, which will likely involve discontinuing their role but may also
include referring them to appropriate help or treatment. Finally, interventions aimed at an athlete's
everyday life can include mediation or conflict resolution services (e.g., Agnew et al., 2021; Gosai
et al., 2021).
Discussion
In the present paper, we shared the Team Denmark Applied Model of Athlete Mental
Health. Our hope is that such sharing will inspire others as well as shape discussions that allow us
to further refine the model. The aim of the model is to develop key stakeholders’ awareness of and
language for the complex nature of athlete mental health (Lundqvist & Andersson, 2021; Uphill et
al., 2016) and provide a lens through which they can analyze and optimize the way their
17
17
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
The Team Denmark Applied Model of Athlete Mental Health
environments support the mental health of their athletes. We have chosen the three colors green-
yellow-red with the traffic-light metaphor in mind for reasons of simplicity and intuitive
understanding but are aware that nuances are possible within all the layers, which we have indicated
by the shading of colors in Figure 1. The model creates an overview of mental health in elite sport
and highlights the key factors that can influence athletes’ well-being. We agree with Purcell et al.
(2022) that there is a need for a cultural shift away from a “winning at all costs” narrative, to
supporting mental health in the high-performance context and creating psychologically safe and
mentally healthy environments that allow athletes, coaches, and support staff to thrive.
Two overall and key messages can be derived from the model. First, the model is divided
into three colors. Green signifies well-being and mental health, as well as a healthy training
environment with good leadership and balanced everyday life. Yellow signifies athletes under
pressure, in unsafe environments with unhealthy leadership and stressful everyday life. Red
signifies languishing and mental ill-health, often associated with a toxic training environment with
dangerous leadership and chaotic everyday life. The first key message here is that mental health is
not only about the few athletes who are in distress (red). A comprehensive mental health effort must
aim to support the well-being of everyone, and not only those who are languishing (Breslin et al.,
2017; Campbell et al., 2021; IOC, 2021). It is important to note that while the three colors are of
equal size in the model, this does not reflect the current situation. Most Danish athletes are in green
(Kuettel et al., 2021), and fortunately, toxic leadership within Danish elite sport is rare.
Second, the model has four layers - the athlete, the training environment, leadership, and
everyday life - and is contextualized within Danish society and culture. The key message is that
athlete mental health is not confined to the individual athlete, but rather all these levels affect their
well-being and mental health. Maintaining a high level of mental health requires a concerted and
18
18
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
The Team Denmark Applied Model of Athlete Mental Health
continual effort from all the key actors, across all levels (Gosai et al., 2021; Kegelaers et al., 2022).
It is never solely the athlete’s responsibility.
A specific note on time is warranted. Although it is difficult to add a dimension of time in
a two-dimensional model, time plays a key role. Athletes cannot be expected to thrive all the time
(Brown et al., 2018). In fact, some of the practices described in “yellow” (e.g., lack of recovery and
support) are manageable over short periods but become detrimental over longer periods, and it is
likely difficult for athletes to avoid moving back and forth between the green and yellow zones. It is
hardly possible to avoid periods with mood fluctuations, feeling pressured from numerous sides,
and difficult relationships with teammates (e.g., Birrer, 2019; Becker-Larsen et al., 2017). It is,
however, important that these problems do not last for long periods of time, and that we are able to
quickly identify such cases and efficiently help those athletes back to the green zone. Purcell and
colleagues (2019) recognized the role of the broader elite sport ecology in athlete mental health by
illustrating that an athlete is embedded in a micro-, exo-, and mesosystem, and they further
developed a mental health promotion model that illustrates how interventions range from prevention
(green) and early intervention treatment (yellow) to continuing care and rehabilitation (red). We
supplement their work by integrating the ecological and intervention perspectives, and by
suggesting specific factors within different the layers. We thus present a comprehensive model that
not only focuses on the individual athlete and their lifestyle, but also on the function of their
training environment, and the leadership style of coaches and sports managers.
The model was developed to inform mental health support services in Denmark. Whereas
the ecological systems model (Henriksen & Stambulova; 2023; Purcell et al., 2019) places parents,
relatives, and friends closest to the athlete because they are part of the athlete’s microsystem, Team
Denmark’s model places these key people in the fourth level of the model. The primary reason for
this is that the model is intended to be an applied lens, and therefore the various levels are organized
19
19
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
The Team Denmark Applied Model of Athlete Mental Health
according to Team Denmark’s potential influence. Team Denmark’s ability to work directly with
parents, friends outside of sport, employers, and educational institutions is limited compared with
its ability to work directly with the athletes themselves and the sporting environment (i.e., coaches,
staff, and performance directors).
The model is informed by research and intended for applied use. The model holds promise
as a support for federations aiming to align their language and develop a mental health strategy.
Using the model as a lens, a given federation can look at its environments and organizations to
determine where they would benefit from initiating an extra focus on athlete mental health. The
model will also help create a common language between different organizations in the Danish elite
sport system, which will allow for an easier sharing of knowledge, ideas, and experiences (e.g.,
Breslin et al., 2017; Uphill et al., 2016).
The next steps in the life of the model are increasing awareness of its existence in the
sporting landscape, designing specific strategies to promote athlete mental health through a focus on
each of the elements in the model, and assigning roles, and responsibilities. For example, we plan to
develop a mental health literacy course for stakeholders based on the model, hang posters of the
model in strategic locations, and introduce the model in continued education initiatives for coaches
and performance managers. We recognize that bringing the model to life requires substantial
investment (Rancourt et al., 2019). Even in a high-income setting such as Denmark, funding is not
readily available, and therefore, top-level leadership in elite sport need to prioritize the area of
mental health promotion for athletes and staff.
Limitations
The model is not the result of a systematic literature review and should not be seen as an
authoritative and universal source to provide the sole foundation for mental health strategies and
interventions. First, we recognize that the model is a simplified version of reality (as are all models;
20
20
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
456
457
458
459
460
461
The Team Denmark Applied Model of Athlete Mental Health
Cummings & Williams, 2013; Uphill et al., 2016), and in real life, one might find athletes who
experience a safe training environment (green) but an unbalanced everyday life (yellow). Second,
the model does not encompass all themes investigated in research potentially related to athlete
mental health (Gouttebarge et al., 2019; Kuettel & Larsen, 2020). Third, the model suggests that
environment and athlete mental health are related, but we realize this is not a simple causal
relationship. We agree with Henriksen et al. (2019) that “an elite sport organization or environment
(e.g., structure, personnel, and culture) does not cause mental health problems per se. Individuals
respond differently to different environments. The environment can, however, nourish or
malnourish athlete mental health” (p. 5). Related, we recognize that an athlete can be “green” even
if he is inside an environment that is “yellow” or even “red”, just as some athletes may develop
symptoms of mental ill-health even if they are in a supportive “green” environment. Despite these
shortcomings, we believe the presented model will serve the purpose of directing attention towards,
and initiating a dialogue about, the nature of mental health in elite sport in Denmark.
Conclusion
All countries have their own elite sports systems and face unique opportunities and
challenges (De Bosscher et al., 2016). This is no different when it comes to athlete mental health,
where different countries have developed systems with different purposes, organizations, foci and
strategies for prevention, detection, and treatment (Larsen et al., 2021). In Team Denmark, the sport
psychology team has always had performance enhancement as their main function and clinical
psychology issues are referred to specialists (Diment et al., 2020). This means that while mental
health is everybody’s business, it can sometimes be unclear who are the few designated people
responsible. We are still in the process of developing our national strategy for athlete mental health
including mental health literacy programs for different stakeholders, strategies for monitoring and
detection, clear criteria for access to treatment, and a transparent division between the public health
21
21
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
The Team Denmark Applied Model of Athlete Mental Health
care system (which is for free for everyone in Denmark) and a sport-specific add-on. We believe
that having a contextualized applied model of mental health, such as the one presented in this paper,
will help in this process.
22
22
486
487
488
489
490
491
492
493
The Team Denmark Applied Model of Athlete Mental Health
References
Agnew, D., & Pill, S. (2021). Creating caring environments: An exploration of football managers
and coaching. Sports Coaching Review, 12(1), 27–46.
https://doi.org/10.1080/21640629.2021.1896209
Becker-Larsen, A., Stambulova, N., & Henriksen, K. (2017). “Organizing for excellence”: Stress-
recovery states in the danish national orienteering team during a training camp and the 2015
World Championship. Scandinavian Sport Studies Forum, 8, 87–111.
Bissett, J. E., Kroshus, E., & Hebard, S. (2020). Determining the role of sport coaches in promoting
athlete mental health: A narrative review and Delphi approach. BMJ Open Sport and
Exercise Medicine, 6(1), e000676. https://doi.org/10.1136/bmjsem-2019-000676
Blazey, P., Crossley, K. M., Ardern, C. L., van Middelkoop, M., Scott, A., & Khan, K. M. (2021). It
is time for consensus on ‘consensus statements.’ British Journal of Sports Medicine, 56(6),
306–307. https://doi.org/10.1136/bjsports-2021-104578
Birrer, D. (2019). Rowing over the edge: Nonfunctional overreaching and overtraining syndrome as
maladjustment—diagnosis and treatment from a psychological perspective. Case Studies in
Sport and Exercise Psychology, 3(1), 50–60. https://doi.org/10.1123/cssep.2019-0006
Breslin, G., Shannon, S., Haughey, T., Donnelly, P., & Leavey, G. (2017). A systematic review of
interventions to increase awareness of mental health and well-being in athletes, coaches and
officials. Systematic Reviews, 6(177). https://doi.org/10.1186/s13643-017-0568-6
Brown, D. J., Arnold, R., Reid, T., & Roberts, G. (2018). A qualitative exploration of thriving in
elite sport. Journal of Applied Sport Psychology, 30(2), 129–149.
https://doi.org/10.1080/10413200.2017.1354339
Campbell, N., Brady, A., & Tincknell-Smith, A. (2021). Developing and supporting athlete well-
being: Person first, athlete second. Routledge. https://doi.org/10.4324/9780429287923
23
23
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
The Team Denmark Applied Model of Athlete Mental Health
Coyle, M., Gorczynski, P., & Gibson, K. (2017). “You have to be mental to jump off a board any
way”: Elite divers’ conceptualizations and perceptions of mental health. Psychology of
Sport & Exercise, 29, 10–18. https://doi.org/10.1016/j.psychsport.2016.11.005
Cumming, J., & Williams, S. E. (2013). Introducing the revised applied model of deliberate
imagery use for sport, dance, exercise, and rehabilitation. Movement & Sport Sciences,
82(4), 69-81. https://doi.org/10.1051/sm/2013098
Danish Ministry of Health (2017). Health care in Denmark: An overview. www. SUM.dk
De Bosscher, V., Shibli, S., Westerbeek, H., & van Bottenburg, M. (2016). Convergence and
divergence of elite sport policies: Is there a one-size-fits-all model to develop international
sporting success? Journal of Global Sport Management, 1(3-4), 70-89.
https://doi.org/10.1080/24704067.2016.1237203
Dilling, J., & Petersen, A. (2022). Embodying the culture of achievement: Culture between illness
and perfection is a ‘thin line’: Obtaining the ideal female body as an act of achievement.
Culture & Psychology, 28(3), 375-394. https://doi.org/10.1177/1354067x211004085
Dohsten, J., Barker-Ruchti, N., & Lindgren, E.-C. (2020). Caring as sustainable coaching in elite
athletics: Benefits and challenges. Sports Coaching Review, 9(1), 48–70.
https://doi.org/10.1080/21640629.2018.1558896
Diment, G., Henriksen, K., & Larsen, C. H. (2020). Team Denmark’s sport psychology professional
philosophy 2.0. Scandinavian Journal of Sport and Exercise Psychology, 2, 26–32.
https://doi.org/10.7146/sjsep.v2i0.115660
Edmondson, A. (1999). Psychological safety and learning behavior in work teams. Administrative
Science Quarterly, 44(2), 350–383. https://doi.org/10.2307/2666999
Gerber, M., Kellmann, M., Brand, S., Gygax, B., Ludyga, S., Müller, C., Ramseyer, S., & Jakowski,
S. (2022). Differences in mental health outcomes between adolescent elite athletes and peers
24
24
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
The Team Denmark Applied Model of Athlete Mental Health
not engaged in elite sport. Current Issues in Sport Science (CISS), 7, 013.
https://doi.org/10.36950/2022ciss013
Golding, L., Gillingham, R. G., & Perera, N. K. P. (2020). The prevalence of depressive symptoms
in high-performance athletes: A systematic review. The Physician and Sportsmedicine, 1–
12. https://doi.org/10.1080/00913847.2020.1713708
Gosai, J., Jowett, S., & Nascimento-Júnior, J. R. A. D. (2021). When leadership, relationships and
psychological safety promote flourishing in sport and life. Sports Coaching Review, 1–21.
https://doi.org/10.1080/21640629.2021.1936960
Gouttebarge, V., Castaldelli-Maia, J. M., Gorczynski, P., Hainline, B., Hitchcock, M. E., Kerkhoffs,
G. M., … Reardon, C. L. (2019). Occurrence of mental health symptoms and disorders in
current and former elite athletes: A systematic review and meta-analysis. British Journal of
Sports Medicine, 53(11), 700–706. https://doi.org/10.1136/bjsports-2019-100671
Mrazek, P. J., & Haggerty, R. J. (1994). Reducing risks for mental disorders: Frontiers for
preventive intervention research. National Academies Press (US).
Hauser, L.-L., Harwood, C. G., Höner, O., O’Connor, D., & Wachsmuth, S. (2022). Talent
development environments within sports: A scoping review examining functional and
dysfunctional environmental features. International Review of Sport and Exercise
Psychology, 1–27. https://doi.org/10.1080/1750984x.2022.2129423
Henriksen, K. (2015). Developing a high-performance culture: A sport psychology intervention
from an ecological perspective in elite orienteering. Journal of Sport Psychology in Action,
6(3), 141-153. https://doi.org/10.1080/21520704.2015.1084961
Henriksen, K., Diment, G., & Hansen, J. (2011). Professional philosophy: Inside the delivery of
sport psychology service at Team Denmark. Sport Science Review, 20(1-2), 5–21.
https://doi.org/10.2478/v10237-011-0043-6
25
25
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
The Team Denmark Applied Model of Athlete Mental Health
Henriksen, K., Schinke, R., McCann, S., Durand-Bush, N., Moesch, K., Parham, W. D., . . .
Hunziker, J. (2020). Athlete mental health in the Olympic/Paralympic quadrennium: A
multi-societal consensus statement. International Journal of Sport and Exercise Psychology,
18(3), 391-408. https://doi.org/10.1080/1612197x.2020.1746379
Henriksen, K., Schinke, R. J., Moesch, K., McCann, S., Parham, W. D., Larsen, C. H., & Terry, P.
(2019). Consensus statement on improving the mental health of high performance athletes.
International Journal of Sport and Excercise Psychology 15(5), 553-560.
https://doi.org/10.1080/1612197X.2019.1570473
Henriksen, K., & Stambulova, N. (2023). The social environment of talent development in youth
sport. Frontiers in Sports and Active Living, 5. https://doi.org/10.3389/fspor.2023.1127151
Henriksen, K., Stambulova, N., & Roessler, K. K. (2010). Holistic approach to athletic talent
development environments: A successful sailing milieu. Psychology of Sport and Exercise,
11(3), 212–222. https://doi.org/10.1016/j.psychsport.2009.10.005
IOC (2021). IOC Mental Health in Athlete Toolkit. Retrieved from:
https://stillmed.olympics.com/media/Document%20Library/IOC/Athletes/Safe-Sport-
Initiatives/IOC-Mental-Health-In-Elite-Athletes-Toolkit-2021.pdf
Kegelaers, J., Wylleman, P., Defruyt, S., Praet, L., Stambulova, N., Torregrossa, M., … De Brandt,
K. (2022). The mental health of student-athletes: A systematic scoping review. International
Review of Sport and Exercise Psychology, 1–34.
https://doi.org/10.1080/1750984x.2022.2095657
Kellmann, M., & Beckmann, J. (2021). Recovery and well-being in sport and exercise:
Interdisciplinary insights. Routledge. https://doi.org/10.4324/9781003258117-18
Kuettel, A., Christensen, M. K., Zysko, J., & Hansen, J. (2020). A cross-cultural comparison of dual
career environments for elite athletes in Switzerland, Denmark, and Poland. International
26
26
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
The Team Denmark Applied Model of Athlete Mental Health
Journal of Sport and Exercise Psychology, 18(4), 454–471.
https://doi.org/10.1080/1612197x.2018.1553889
Kuettel, A., & Larsen, C. H. (2020). Risk and protective factors for mental health in elite athletes: A
scoping review. International Review of Sport and Exercise Psychology, 13(1), 231-265.
https://doi.org/10.1080/1750984x.2019.1689574
Kuettel, A., Pedersen, A. K., & Larsen, C. H. (2021). To flourish or languish, that is the question:
Exploring the mental health profiles of Danish elite athletes. Psychology of Sport and
Exercise, 52, 101837. https://doi.org/10.1016/j.psychsport.2020.101837
Larsen, C. H., Moesch, K., Durand-Bush, N., & Henriksen, K. (Eds.). (2021). Mental health in elite
sport: Applied perspectives from across the globe. Routledge.
https://doi.org/10.4324/9780367854973
Lebrun, F., & Collins, D. (2017). Is elite sport (really) bad for you? Can we answer the question?
Frontiers in Psychology, 8, 324. https://doi.org/0.3389/fpsyg.2017.00324
Lewis, C. J., Sawiuk, R., & Grimes, S. M. (2022). “It looks like he cares, but he doesn’t.”: Athletes’
experiences of “good” and “bad” care in women’s football. Sports Coaching Review, 1-16.
https://doi.org/10.1080/21640629.2022.2045137
Linnér, L., Stambulova, N., Storm, L. K., Küttel, A., & Henriksen, K. (2020). Facilitating sports
and university study: The case of a dual career development environment in Sweden. Case
Studies in Sport and Exercise Psychology, 4(1), 95–107. https://doi.org/10.1123/cssep.2020-
0011
Lundqvist, C., & Andersson, G. (2021). Let’s talk about mental health and mental disorders in elite
sports: A narrative review of theoretical perspectives. Frontiers in Psychology. 12.
https://www.frontiersin.org/articles/10.3389/fpsyg.2021.700829
27
27
590
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
The Team Denmark Applied Model of Athlete Mental Health
Lundqvist, C., & Raglin, J. S. (2015). The relationship of basic need satisfaction, motivational
climate and personality to well-being and stress patterns among elite athletes: An
explorative study. Motivation and Emotion, 39(2), 237–246. https://doi.org/10.1007/s11031-
014-9444-z
Mathorne, O. W., Henriksen, K., & Stambulova, N. (2019). An “organizational triangle” to
coordinate talent development: A case study in danish swimming. Case Studies in Sport and
Exercise Psychology, 4(1), 11-20. https://doi.org/10.1123/cssep.2019-0017
Mazzer, K. R., & Rickwood, D. J. (2015). Mental health in sport: Coaches’ views of their role and
efficacy in supporting young people’s mental health. International Journal of Health
Promotion and Education, 53(2), 102–114. https://doi.org/10.1080/14635240.2014.965841
Pisinger, V., Thorsted, A., Jezek, A. H., Jørgensen, A., Christensen, A. I., & Thygesen, L. C.
(2020). Sundhed og trivsel blandt gymnasieelever 2019. [Health and well-being among
Danish upper secondary students in 2019]. Statens Institut for Folkesundhed.
https://www.sdu.dk/da/sif/rapporter/2020/sundhed_og_trivsel_blandt_gymnasieelever
Purcell, R., Gwyther, K., & Rice, S. M. (2019). Mental health in elite athletes: Increased awareness
requires an early intervention framework to respond to athlete needs. Sports Medicine-
Open, 5(1), 1–8. https://doi.org/10.1186/s40798-019-0220-1
Purcell, R., Pilkington, V., Carberry, S., Reid, D., Gwyther, K., Hall, K., … Rice, S. (2022). An
evidence-informed framework to promote mental well-being in elite sport. Frontiers in
Psychology, 13:780359. https://doi.org/10.3389/fpsyg.2022.780359
Rancourt, D., Brauer, A., Palermo, M., Choquette, E. M., & Stanley, C. (2020). Response to
Tomalski et al. (2019): Recommendations for adapting a comprehensive athlete mental
health screening program for broad dissemination. Journal of Sport Psychology in Action,
11(1), 57–67. https://doi.org/10.1080/21520704.2020.1722770
28
28
613
614
615
616
617
618
619
620
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
The Team Denmark Applied Model of Athlete Mental Health
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., … Engebretsen, L.
(2019). Mental health in elite athletes: International Olympic Committee consensus
statement (2019). British Journal of Sports Medicine, 53(11), 667–699.
https://doi.org/10.1136/bjsports-2019-100715
Rice, S. M., Parker, A. G., Mawren, D., Clifton, P., Harcourt, P., Lloyd, M., … Purcell, R. (2019).
Preliminary psychometric validation of a brief screening tool for athlete mental health
among male elite athletes: The Athlete Psychological Strain Questionnaire. International
Journal of Sport and Exercise Psychology, 1–16.
https://doi.org/10.1080/1612197x.2019.1611900
Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The
mental health of elite athletes: A narrative systematic review. Sports Medicine, 46(9), 1333–
1353. https://doi.org/10.1007/s40279-016-0492-2
Shaw, J. B., Erickson, A., & Harvey, M. (2011). A method for measuring destructive leadership and
identifying types of destructive leaders in organizations. The Leadership Quarterly, 22(4),
575–590. https://doi.org/10.1016/j.leaqua.2011.05.001
Sorkkila, M., Aunola, K., & Ryba, T. V. (2017). A person-oriented approach to sport and school
burnout in adolescent student-athletes: The role of individual and parental expectations.
Psychology of Sport and Exercise, 28, 58–67.
https://doi.org/10.1016/j.psychsport.2016.10.004
Stambulova, N. B., Ryba, T. V., & Henriksen, K. (2020). Career development and transitions of
athletes: The International Society of Sport Psychology Position Stand revisited.
International Journal of Sport and Exercise Psychology, 19, 524-550
https://doi.org/10.1080/1612197X.2020.1737836
29
29
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
656
657
658
659
The Team Denmark Applied Model of Athlete Mental Health
Sundhedsstyrelsen (2022). Danskernes sundhed: Den Nationale Sundhedsprofil 2021. [Health of the
Danish population: The national health profile 2021]. Ministry of Health, Copenhangen.
https://www.sst.dk/da/udgivelser/2022/danskernes-sundhed
Tahtinen, R. E., Shelley, J., & Morris, R. (2021). Gaining perspectives: A scoping review of
research assessing depressive symptoms in athletes. Psychology of Sport and Exercise, 54.
https://doi.org/10.1016/j.psychsport.2021.101905
Taylor, J., Collins, D., & Ashford, M. (2022). Psychological safety in high-performance sport:
Contextually applicable? Frontiers in Sports and Active Living, 169.
https://doi.org/10.3389/fspor.2022.823488
Terry, P. C., & Parsons-Smith, R. L. (2021). Mood profiling for sustainable mental health among
athletes. Sustainability, 13(11), 6116. https://doi.org/10.3390/su13116116
Uphill, M., Sly, D., & Swain, J. (2016). From mental health to mental wealth in athletes: Looking
back and moving forward. Frontiers in Psychology, 7, 935.
https://doi.org/10.3389/fpsyg.2016.00935
Vaughan, R. (2015). Measuring leadership in sport coaching. In I O`Boyle, D. Murray, & P.
Cummins (Eds.), Leadership in Sport (pp. 223–239). Routledge.
https://doi.org/10.4324/9781315745374-25
Vella, S. A., Mayland, E., Schweickle, M. J., Sutcliffe, J. T., McEwan, D., & Swann, C. (2022).
Psychological safety in sport: A systematic review and concept analysis. International
Review of Sport and Exercise Psychology, 1–24.
https://doi.org/10.1080/1750984x.2022.2028306
Yukhymenko-Lescroart, M. A., Brown, M. E., & Paskus, T. S. (2015). The relationship between
ethical and abusive coaching behaviors and student-athlete well-being. Sport, Exercise, and
Performance Psychology, 4(1), 36-49. https://doi.org/10.1037/spy0000023
30
30
660
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
681
682
683
The Team Denmark Applied Model of Athlete Mental Health
Figure captions
Figure 1: The Team Denmark Applied Model of Athlete Mental Health. Printed with permission
from Team Denmark
31
31
684
685
686
687
688
