The most striking finding was the dominance of stigma as a barrier to athletes seeking help for mental health problems. Over 40% of the barriers listed by participants related to stigma and the embarrassment an athlete would feel in seeking help. Additionally, it was noted during the groups that the discussion on stigma was clearly an important topic for the athletes, and was substantial in length. Although this was partly attributable to the larger number of questions on this topic due to the focus on stigma in the literature, it was also a consequence of the lengthy and animated nature of the participants’ discussion of the issue.
The focus group discussion suggested that the athletes may have high levels of self-stigmatising attitudes
. As is consistent with previous research on the stigmatisation of help-seeking in athletes
, the participants considered it more acceptable for an athlete to see a psychologist for performance or goal-setting reasons. They considered it would be much more embarrassing for the athlete if they were to seek help for depression, or any other “major” (F1) concern not related to sport.
The athletes also demonstrated high levels of perceived stigma (a perception that others hold stigmatising views)
. They were most concerned about people connected with their sport finding out if they were to seek help as it may be perceived as a sign of their “weaknesses” or inability to cope, and expose them to the negative views of others. Their coach, team mates, and their competitors were all cited as people they would not want to find out if they were to seek help for a mental health problem. However, some participants thought that disclosure to friends could be useful as the support network of their close friends could help them through their problem. Friendship networks often replace the support network of the family when the athlete is required to move away from home
. However, when explicitly questioned about what they thought of other athletes seeking help, they appeared very accommodating of this behaviour in others. This may reflect social desirability
 or a genuinely lower level of stigmatising attitudes to others, whilst retaining a strong sense of self (or internalised) stigma
It was evident that the participants strongly disapproved of the media’s portrayal of athletes with mental health problems. In general they felt that the media determined what the public thought of athletes, and tended to exaggerate mental health problems experienced. Additionally, media articles often claim that the public see athletes as immune to the challenges facing members of the general community
[63, 64], which may place additional pressure on the athletes to avoid identifying potential mental health problems. Despite this, the participants saw the value of an athlete telling their story, not only for other athletes but also to help the public understand that they, like anyone can develop mental health problems.
The prominence of stigma as a barrier to help-seeking in athletes is consistent with previous reviews on young people in general
[28, 33]. It is clear that stigma is an important barrier to seeking help in athletes and may be even more influential in this group than in the general community due to the athletes’ perceived attitudes of the media and the general public. It may be helpful to implement programs for young elite athletes that can reduce the level of stigma surrounding common mental disorders
, which might in turn lead to increased help-seeking in this group. It might be equally or more important to promote help-seeking among athletes by providing evidence-based online programs that can be accessed anonymously.
A lack of knowledge about symptoms of mental disorders was considered a major barrier to seeking help in the present study. The participants considered it particularly problematic to apply their knowledge of the symptoms of mental disorders to themselves, and to determine whether the symptoms they experienced were severe enough to require professional attention. This issue has also been reported in research involving young adults in the community
. A key finding was that the athletes found it very difficult to determine the difference between normal feelings of tiredness and sadness associated with their sport, and symptoms of a possible mental disorder. This supports Schwenk’s
 assertion that athletes may be more susceptible to misdiagnosis, especially for problems related to training and performance as their symptoms may be viewed from a physiological perspective. In this case it is the athlete themselves who may misdiagnose their problem. Schwenk
 further argues that there are strong similarities between overtraining or “a negative response to training stress”
, and depression, which could also result in under-diagnosis by professionals of depressive disorders. The participants in the present study reported that eating disorders may remain undetected by the athletes. Low body fat levels are often required for participation at an elite level and this may contribute to an athlete’s perception that their eating disorder is acceptable or even ‘normal’. As such, the participants proposed that the athlete’s support network was an important means of providing perspective on this issue and helping the athlete see that they may have a problem. This view is consistent with the conclusions of a review of the research by Rickwood et al.
, which highlighted the importance of social influences on help-seeking.
Whilst they acknowledged that some athletes similar to their peers in the community
[30, 32], may not know about mental health services, this particular sample of athletes felt that they knew about accessing available services. However, they did believe that not knowing what to expect during a visit could be a significant barrier for athletes. This fear of the consultation itself has also been found in previous research on young people
[33, 35, 67]. In particular, a lack of knowledge about when it might be necessary to access these services was highlighted by the comment expressing that it may not be appropriate to seek help from a counsellor for something like feeling only “a bit sad”. The athletes also did not believe that a general practitioner was an appropriate place for seeking help for mental health problems, a finding that is consistent with prior studies involving young people
[32, 68]. Finally, in accordance with the literature on community-dwelling youths
 the participants believed that athletes might be concerned that a health provider would not understand or might think negatively of them. This lack of knowledge about mental disorders and their treatment has important implications for the continued refinement and delivery of programs that improve mental health literacy both for young people in the general community
 and among young elite athletes
The athletes in the present study considered that males would have more difficulty seeking help than females, a finding in agreement with previous research involving young people in the community
[2, 40]. However, their opinions for age were less clear. The participants had differing views on whether older or younger age could be a barrier. In the literature, younger aged athletes have been found to possess more negative attitudes to seeking help
; thus, attitudes could act as a barrier for younger age groups. Nevertheless, the participants considered immaturity irrespective of age to be important. Previous literature has demonstrated that more mature young people, especially females are likely to have higher levels of emotional competence, which is associated with seeking help
As described in reviews of help-seeking among young people in general
, the athletes considered that negative past experiences could act as a barrier to future help-seeking. This opinion was informed by their personal experiences involving unsatisfactory contacts with potential sources of help. They particularly thought it important that the provider adhered to confidentiality principles, and observed that failure to do so would serve as a serious deterrent to help-seeking, which is consistent with previous research using a community sample of young people
[32, 34, 43].
The athletes were divided as to whether time constraints were a significant barrier to seeking help. Generally, the younger participants (16—17 years of age) were less likely to consider lack of time a problem. Given, the likely workload of older young athletes (e.g., schoolwork, university and other commitments), this is an expected result, particularly as time factors are generally endorsed as a barrier to help-seeking in studies with adults
[70, 71] and older (M = 19.1 years) college student-athletes
. The participants felt that money and transport were not relevant to them, though they acknowledged this may be a problem for more isolated athletes who do not have access to facilities. This contrasts with the findings from prior research on young people for cost
[30, 34] and transport
. However, this is unsurprising given the cost-free facilities available to the participants in the present study.
Generally, the athletes believed that encouragement sourced from trusted close relationships, the positive attitudes of others, and a good relationship with a mental health provider would facilitate help-seeking.
The athletes thought it was very important to help-seeking to have an established relationship with an appropriate provider, in their case a psychologist. This is consistent with reviews of help-seeking in young people
. Considering that positive relationship with providers, only represented 9% of the facilitators reported prior to the focus group discussion, and already knowing a health professional quite well was ranked first after the discussion, it appears that the participants found this relationship more important after discussing it with their peers. Considering they may potentially need to see a psychologist regularly particularly for performance issues, this may to be an especially important facilitator for athletes. Given the importance placed by the athletes on the establishment of a relationship with a provider, it seems important that providers of mental health care develop a rapport with the athletes, even if this is outside professional consultations. The athletes believed the characteristics of the actual provider themselves was vital, a view which is consistent with previous qualitative research investigating adolescents’ views on provider characteristics
[41, 72]. This also relates to the impact of negative past experiences
[39, 40], in that the positive nature of previous encounters with the provider is important.
Consistent with previous research involving non-athletes
, the participants believed that athletes would consider it very important for those around them to have a positive attitude towards seeking help. In particular, they thought it was vital that their coach had a positive attitude, and this was also reflected in the ranking of facilitators, where coach clearly outranked all other sources including friends, family and team mates. A previous Australian study implemented an educational program for football coaches in a rural community setting
. Data from the current study suggest that such programs should be made available to elite sport coaches to enhance their understanding of mental health problems and needs and to assist them to facilitate help-seeking among elite athletes. The athletes in the present study also considered it important to normalise mental health problems as well as seeking help, a suggestion that is consistent with the findings of a previous study of young people
. The athletes felt that encouragement to seek help by others could only be effective if it came from a highly trusted source, such as the coach or a close friend or family member. Encouragement to seek help from a person close to the individual with mental health problems has been reported in past reviews and research as a facilitator of help-seeking among young people
[33, 40]. However, the athletes emphasised that the source must be a trusted individual, and even then, the issue must be dealt with sensitively.
Participants in the present study believed that online resources might be useful for those athletes not comfortable with face-to-face contact. This is consistent with prior research indicating certain groups may be more comfortable with internet help-seeking
. They also considered that an online resource from a trusted source, which primarily assisted them to determine whether they should seek help, could be useful for all athletes.
The athletes had differing views about whether emotional competence was a significant facilitator of seeking help. Some felt that it was important, whereas others thought it may only facilitate the consultation itself, rather than the initiation of help-seeking. The latter view contrasts with the findings from previous reviews
 indicating that emotional competence is an important factor in help-seeking.