Compliance of Self-Efficacy and Resilience with Mental Health and Wellbeing

Differences in mental health and wellbeing between competitive, recreational and non-active individuals, were examined and how self-efficacy and resilience shape this relationship. It showed anxiety and depression were lower in elite and competitive athletes but higher in non-active individuals. Opposing this, wellbeing and resilience were higher in elite and competitive athletes but lower in non-active participants. Self-efficacy and resilience directly correlated with mental health and wellbeing. These results are discussed below.

Anxiety

It was hypothesised, based on previous research, anxiety levels would be higher in elite athletes (Gould et al., 1983; Highlen and Bennett 1979). However, results of this study suggested otherwise. Elite and competitive athletes had reduced anxiety compared to non-elite and recreational athletes. This was replicated in a study where international athletes had lower anxiety than regional and recreational ones (Campbell and Jones, 1994). A further study stated that prior to competition; better athletes are more anxious. Yet during crucial actual performance, this reverses (Mahoney and Avener, 1977).

One possible reason is anxiety interpretation, rather than differences in actual intensity. Jones et al., (1993) found elite gymnasts reported anxiety to be more facilitative than less elite gymnasts. Other studies reported similar findings (Perry and Williams 1998). Consequently, symptoms of ‘positive anxiety’ might not be acknowledged as anxiety, but instead as facilitative moods like excitement, arousal, and motivation, all deemed good traits. The way anxiety is perceived is critical because it diminishes negative consequences of anxiety (Mahoney and Avener 1977), perhaps explaining unexpected lower anxiety in elite athletes. Future studies should consider changes in anxiety patterns as this may be more informative than absolute levels (Jones, in press). Psychologists and coaches need to recognise elite and non-elite performers respond to anxiety differently. Specifically, non-elite may benefit more from relaxation strategies allowing them to interpret feelings as facilitative (Jones and Swain, 1995).

Similarly, better athletes report greater use of distraction and blocking strategies than non-qualifiers (Highlen and Bennet, 1979). More effective coping responses could give reason to the present results. Supporting this, elite athletes use superior anxiety control (Mahoney et al., 1987), mental strategies in training and competitions (Williams and Krane 1993) and had higher anxiety coping management (Meyers et al., 1999). Elite athletes typically have more competition experience, which could account for mastery of these skills.

Another potential explanation relates to success. Mahoney and Avener (1977) showed successful gymnasts had lower anxiety. Less successful athletes may feel immense pressure to prove themselves and make the team. This could lead to a downward spiral, where the need to perform well creates higher anxiety subsequently diminishing performance, and pressure becomes even greater. This may explain why sub-elite athletes in this study had the highest anxiety levels. They have yet to gain elite status and battling to advance, comes with immense pressure and anxiety, which perhaps is lessened once ‘elite status’ is obtained (Collins and MacNamara, 2012). Additionally, elite athletes are typically full-time sportspeople, so focus solely on ensuring successful performance whereas non-elite athletes divide efforts between sport and a traditional job, perhaps reducing capacities to excel in sport so increasing anxiety (Crook and Robertson, 1991).

However, this study lacks explanation for the bidirectional nature of anxiety and competition (Allen et al., 2015). Orlick and Botterill (1975) suggest avoidance of competition is likely if anxiety is high initially, since many want to compete but fear inferiority. Increased anxiety may therefore be unrelated to competition. Consequently, in future, a competition specific anxiety measure should be implemented. As this dissertation did not examine differences between sport types, sport-specific comparisons are needed, especially since Simon and Martens (1979) state anxiety changes between individual and team sports.

Depression and Overall Mental Health

Depression and overall mental health also opposed the hypothesis that elite and competitive athletes suffer most, despite studies suggesting they do (Hammond et al., 2013; Wolanin et al., 2015). This is supported by a meta-analysis showing no difference in high-performance athletes and non-athletes with respect to depression (Gorczynski et al., 2017). Athletes are significantly less depressed than non-athletes, irrespective of age (Brand et al., 2013). Despite this, they are susceptible to mental illness, just at a lower prevalence than the general population (Schwenk, 2000). It is plausible that social networks buffer the effects of depression on mental health. Participation in sport, especially at an elite level, implies parental involvement and a support team of coaches, psychologists and team-mates (Weber et al., 2018). Competitive elite athletes have greater perceived social connectedness (Proctor and Boan-Lenzo, 2010), allowing identification and comfort from those sharing similarities in appearance, experiences and talents (Lee et al., 2001). This may profoundly protect them from depressive symptomology and mental ill-health. Nixdorf et al., (2016) found higher depression in individual athletes compared to team sport athletes. Therefore, team sports may offer more accessible social support compared to nonathletes and individual athletes, further justifying the need to assess mental health across sport types.

Over a third of young adults with mental health issues do not seek help; most commonly due to stigmatisation (Lawrence et al., 2015). Yet sporting governing bodies continue to overlook the significance of mental-ill health (Reardon and Factor, 2010). Stigma increases pressures to be physically and mentally ‘tough’ meaning disorders are seen as personal failure and a character defect (Karp, 2016). Athletes are most affected by stigma so tend to not seek support (Watson, 2005) due to its potential indication of inadequacy and weakness (Gulliver et al., 2012). Therefore, they may discount depressive issues and present themselves as ‘fine’, hence a significant underreporting of depression is likely. Future work should consider social desirability and include indirect measures of psychological distress. Improving mental health literacy in elite sport personnel may help avoid presumptions that athletes are immune from mental ill-health (Wolanin et al., 2016).

Throughout elite sport prioritising winning is socialised above all personal needs (Leimer et al., 2014), further fuelling stigma and reducing the likelihood of elite athletes reporting mental ill-health. Seeking help is perceived as risky, due to questioning of athletic performance (Etzel et al., 1994). Unfortunately, this ignores the importance of associations between mental and physical health, where a healthy mind leads to successful performance and winning (Vandervoort and Skorikov, 2002).

Mental disorder symptoms can be misdiagnosed as they overlap with overtraining symptoms (Schwenk, 2000), athletes may be even more susceptible to underdiagnosis if viewed from a narrow physiological perspective. This is worsened by elite sport professionals being under intense pressure to improve performance compromising wellbeing and athlete treatment (Devitt and McCarthy, 2009). Thus, implementing mental health screening programmes alongside physical health checks (Gouttebarge and Sluiter, 2013) may prevent underreporting of mental-ill health in athletes. However, again, the direction of this relationship is unknown implying individuals with symptoms may not develop physical skills or desire to compete.

Wellbeing

It was previously hypothesised that wellbeing would be lower in elite and competitive athletes. However, since depression and anxiety contribute to wellbeing (Bradley and Lewis, 1990), the results of this study contradict original predictions. Multiple studies support this with athletes reporting higher scores in mental, emotional and physical wellbeing compared to non-competitive athletes (Snyder et al., 2010). Likewise, women athletes have higher scores than non-athletes (Snyder and Kivlin, 1975). Similarly, international athletes have higher wellbeing than national, regional and recreational groups (Campbell and Jones, 1994), suggesting competition level is important for psychological wellbeing.

Sport offers unique opportunities to achieve lifetime goals (Lundqvist and Sandin, 2014). Elite athletes had higher competence than non-athletes and higher self-esteem (Marsh et al., 1995) than non-elite (Fox, 1992), potentially due to, attainment of these goals. Hence, competitive sport challenges create positive self-identity, a clear sense of purpose and fulfilment (Burke and Utley 2013) for positive psychological wellbeing. This positively effects need satisfaction, through increased competence which is linked to self-efficacy (Smith et al., 2007). Therefore, self-efficacy may serve as a protective factor, perhaps justifying increased wellbeing in competitive and elite athletes (Brady and Shambrook 2003). Additionally, non-elite players often have more recreational and interest driven goals rather than outcome focused, perhaps further increasing wellbeing by decreasing pressure to perform.

Body image can also impact on psychological wellbeing. Sport participation relates to greater body image satisfaction (Snyde and Kivlin, 1975). The most supported theory for this is sociocultural theory; identifying social pressure, predominantly from the media, to conform to unrealistic body shapes. The current aesthetic of a thin but toned physique for females and a muscular physique for males is desired (Cusumano and Thompson 1997). Athletes have high physical activity levels, so may more closely resemble this (Brownell, 1991), with studies showing competitive athletes to have lower social physique anxiety (Hausenblas and Downs, 2001). It is plausible that athletes competing at a club/recreational level engage in less physical activity, so are less lean. Consequently, lower wellbeing is likely in non-elite athletes, who are less lean, so suffer adverse outcomes related to body image pressures.

Despite this, in the current study, even those recreationally active had higher wellbeing than population norms (Fat et al., 2017). This suggests sport participation, regardless of competition, creates positive mood and better wellbeing. However, wellbeing is a relatively new concept, with most studies focusing solely on negative aspects of mental health. Future studies need to further explore competition level on positive aspects like wellbeing. Additionally, this study measured emotional wellbeing in isolation, but overall wellbeing encapsulates physical, psychological and social domains (Ryff and Singer, 1996). It is necessary, in sport, to view wellbeing holistically as physical wellbeing can suffer (Houston et al., 2016). Therefore, viewing wellbeing as an entity rather than solely mental is crucial, perhaps explaining discrepancies in the current study.

Resilience

Consistent with previous research, this study found resilience to be higher in elite athletes compared to non-elite. Numerous studies show elite athletes are more tolerant to the effects of stress (Fletcher and Sarker, 2012, 2014; Belem et al., 2014). Increased resilience provides a buffer protecting psychological health. It was the only significant mediator between physical activity and mental wellbeing, accounting for 60% of this relationship (Ho et al., 2015).

Previous research shows self-esteem, social support and coping skills to reduce vulnerability to stressful situations (Smith et al., 1992). The best athletes are protected from elite pressures by high-quality social support, including family, coaches, team-mates and support staff (Fletcher & Sarkar, 2012). This underpins the resilience–stress–performance relationship. Social support may have stress-buffering effects, so it is important for resilience in elite sport. Specifically, perceived support allows stressors to be appraised as less detrimental (Cohen & Wills, 1985). Non-elite athletes may therefore lack resilience, since coaches and support staff likely care for multiple individuals, compared to in elite environments where one-on-one support teams are common (Baker et al., 2003). Also, non-elite lack psychological skills training to develop these traits (Hardy et al., 1996). Consequently, well-supported elite athletes see competitive situations as challenging, not threatening. However, athletes are placed under immense stress to produce successful performances that positively reflect coach’s effort. Sometimes this leads to inadequate coaching support (Balague, 1999). Therefore, support networks should be implemented for athletes but also their support team too, to ensure athlete resilience.

Sport may develop resilience (Padesky and Mooney, 2012), because it involves setbacks such as competition stress, failures and injuries to bounce back from. The risk of injury increases with competitive sports (Nicholl et al., 1995) perhaps why higher resilience is seen in elite athletes. Additionally, higher skilled participants encounter more stressors than lower skilled (Fletcher et al., 2012). The challenge model proposes that moderate stressors provide positive long-term outcomes, rather than no stressor or severe stressors (Garmezy et al., 1984). Consequently, wellbeing in elite may be impaired in the short term, but overcoming stressors develops a resilient mind-set and strengthens problem-solving skills long-term. Therefore, opportunities for appropriate standard challenges should be provided.

A common demand in sport is consistent high-performance expectations (McKay et al., 2008). External pressure sources, include being the favourite to win, starting well for the team and expectation of others. This may explain why sub-elite performers had lowest resilience, due to increased external pressures to reach elite level, the ultimate goal. On the other hand, elite performers integrate these demands with personally held values, critical for resilience. Therefore, although resilient individuals still experience negativity like anxiety and frustration (Tugade et al., 2004), they interpret this more positively, so effectively cope with sporting pressures (Golby and Sheard, 2004). Even when stressors are unavoidable, wellbeing is protected if resilience is high. Indeed, elite athletes argue without stressors, they would not be resilient enough to win gold medals (Fletcher & Sarkar, 2012). The present study showed, even the non-elite group had higher resilience levels compared to population norms (Kocalevent et al., 2017), suggesting any level of competition develops resilience.

However, athletes in the current study may not be truly elite (Olympic standard) as the ‘elite’ category used included those competing in University first teams and stressors they endure may differ to truly elite athletes. Thus, generalizations of findings for elite performers might be inappropriate (Balague, 1999). Further research with truly high-standard performers is needed.

Studies report that exercise is negatively associated with trait anxiety and depression and positively related to wellbeing (McDonald and Hodgdon, 2012). Exercise can also be used to treat psychological disorders (Asmundson et al., 2013), but mental ill-health is a barrier to participation (Firth et al., 2016). Therefore, relationships between exercise and mental health are complex and multifaceted. The current study supports the hypothesis that active participants would have lower anxiety and depression but higher wellbeing than non-active participants.

Anxiety

Anxiety decreasing with exercise agrees with a plethora of research (e.g. Goodwin, 2003; Petruzzello et al., 1991). One study suggests frequency of exercise, rather than previous history is most important for anxiety decrements and more anxious exercisers benefit most (Wilson et al., 1981). Impressively, exercise is as effective as traditional therapeutic approaches (Ryan et al., 1983). In contrast, exercise may induce acute panic attacks (Broocks et al., 1998) perhaps indicating needs to explore specific anxiety disorders.

This is especially true since anxiety sensitivity (AS) is a fear of anxiety sensations, based on appraisals that they lead to disastrous consequences (Reis, 1991). More specifically, those with high AS perceive sensations like a racing heartbeat indicative of a heart attack. Conversely low AS recognise feelings as unpleasant but harmless and temporary (Sabourin et al., 2011). Exercise has been found effective in reducing anxiety sensitivity (Broman-Fulks et al., 2004), a dominant characteristic of most anxiety disorders (Taylor et al., 1992). Even low intensity exercise is better than none (Broman-Fulks et al., 2004). Ströhle (2009) suggests exercise-based exposure to feelings which mimic anxiety symptoms, demonstrates the nonthreatening nature of them. Consequently, anxiety is reduced in those exercising. However, due to fear during exercise, AS can prevent exercise initiation (Sabourin et al., 2011) Subsequently, distress means avoidance is likely, reducing exercise frequency, and perhaps explaining increased anxiety with inactivity (Smits and Zvolensky, 2006).

Bahrke and Morgan (1978) propose the distraction hypothesis which suggests exercise distracts from stressful stimuli and allows ‘time-out’, reducing anxiety. However, this is perhaps a transient benefit suggesting alternative mechanisms are affecting the relationship. Alternatively, people may simply report feeling better after exercise because they expect it and are told they should. Media attention focuses on positive psychological consequences of exercise like endorphins and ‘runner’s high’, therefore a placebo effect may occur (Szabo, 2013).

A barrier to exercise is social anxiety (Treasure et al., 1998). More specifically, social physique anxiety (SPA) which involves concerns that physique is evaluated by others (Hart et al., 1989). Individuals anxious about a situation are less likely to participate so SPA inversely associates with exercise participation (Treasure et al., 1998), indirectly affecting anxiety. This is a potential reason for inactive people having higher anxiety. However, it functions both as an incentive and deterrent, as some people exercise to decrease physical insecurities, whilst others just avoid exercise (Gammage et al., 2004). Future studies may benefit from exploring which of these dominates. SPA is rife in exercise environments since the body is vulnerable to evaluation and participants are overcome by pressure to conform to certain body shapes (Krane et al., 2001). Given the importance of physical attractiveness in modern society, this is unsurprising. Previous research suggests non-active individuals have greater body dissatisfaction than exercisers (Petrie, 1996). Specifically, exercisers wear revealing clothing in mirrored rooms, raising bodily awareness and social comparison (Frederick and Shaw, 1995). These may increase SPA and prevent participation, explaining increases in anxiety with inactivity. On the other hand, exercise can decrease SPA by increasing physique confidence (Hausenblas et al., 2004) potentially further justifying why active individuals have reduced social anxiety.

SPA and AS predict negative affect during exercise, particularly among overweight individuals (Ekkekakis et al., 2010). Both factors may be important targets for intervention to help anxious individuals enjoy their initial exercise experience. Making individuals less identifiable and creating a supportive environment may decrease evaluation (Martin and Fox 2001). Consequently, reducing evaluation potentially diminishes social anxiety, allowing increased exercise behaviour to further decrease anxiety levels. However, the present study used the PASAS to measure social anxiety which is more sport-specific, so future studies should employ general exercise-based measures.

Depression

Depression was higher in those inactive compared to active, thus supporting the hypothesis in numerous studies (Weyerer, 1992; Strawbridge et al., 2004; Mammen and Faulkner, 2013; Paluska and Schwenk, 2000). Interestingly, Dunn et al., (2005) found those in accordance with meeting public health exercise recommendations had larger reductions, therefore, supporting the societal drive to adhere with nation-wide physical activity guidelines. Perhaps more impressive is exercise being as effective as antidepressant treatment (Blumenthal et al., 1999), especially important since drug therapies have unpleasant side effects, lack of compliance and are very costly (Martinsen, 1990). A happier patient should become receptive to even more physical exercise, creating a positive cycle.

Having limited social contacts intensifies depression (Lewinsohn et al., 1988) but exercise allows social interactions, with many participating alongside friends, family or in an exercise class. The social interaction hypothesis accounts for partial effects of exercise on mental health (Ransford, 1982). This is supported by a study where social support controlled the effects of Tai Chi on depressive symptoms (Cho, 2008), suggesting general social settings rather than exercise ones may decrease depression. This is most important for exercise initiation (North et al., 1990) rather than maintenance of long-term physical activity patterns.

Similarly, exercise leads to gains in strength, flexibility and cardiovascular fitness, which enhance personal control (Seligman, 1974), a factor associated with decreased depression. Additionally, with exercise comes positive feedback as friends complement engagement in a socially admired healthy behaviour (Stein and Motta, 1992). Therefore, exercise prescription to reduce depression is effective, especially because it lacks negative social stigma, unlike antidepressants (Dunn, et al., 2005).

Wellbeing

Unsurprisingly, wellbeing increased with physical activity since anxiety and depression contribute to overall wellbeing. This is generally accepted in the literature (Steptoe and Butler, 1996; Rosenbaum et al., 2014) and could be explained by motivation. Exercise allows command and empowerment over health behaviour, which may trigger feelings of autonomy (Fox, 1999), thus increasing self-determined motivation, empowerment from achieving change and mastery which associate with positive psychological states (Dalgard et al., 2007). Despite this, the current study fails to specify frequency and intensity of exercise needed to gain positive psychological effects so advice surrounding exercise adherence cannot be given.

Throughout this dissertation, self-efficacy and resilience are measured as mediating factors for mental health and wellbeing. The results supported the hypothesis of positive correlations between resilience and self-efficacy with wellbeing. This suggests that interventions to increase these will maintain good mental health and wellbeing. This is crucial since sport and exercise are risky to psychological health.

Resilience

This study revealed a positive correlation between resilience and wellbeing and a negative correlation with mental ill-health. Therefore, resilient individuals had better mental health and wellbeing. Resilience is a relatively constant trait, so provides a stable prediction of mental health. This finding is compatible with that of Lee et al., (2013), Rutter (1985) and Southwick et al., (2005). High resilience protects against adversities, meaning lower anxiety and depressive symptoms and positive psychological wellbeing (Gloria and Steinhardt, 2016). Additionally, low resilience relates to vulnerability, low wellbeing and psychological disorders (Campbell-sills et al., 2006). Such factors are vital for subjective wellbeing and positive affect.

One construct determining wellbeing is coping (Jonker et al., 2009). Maladaptive strategies like denial often lead to undesirable consequences (Brown et al., 2005) but positive emotions mean adaptive coping strategies and resilience. According to Fredrickson (2001) the broaden-and-build theory states those with positive emotions utilise greater numbers of coping strategies during adversity, thus this positively correlate with resilience (Cohn et al., 2009). Future studies should examine coping strategies and their effects on mental health and wellbeing.

Similarly, direct associations between resilience and wellbeing may be related to stress buffering. Studies show high stress significantly contributes to symptoms of anxiety and depression (Markou & Cryan, 2012; Melchior et al., 2007), yet highly resilient athletes effectively regulate negative emotions when stressed (Ong et al., 2009). Therefore, resilience moderates the relationship of stress with negative psychological outcomes (Wingo et al., 2010). Positive emotions improve stress coping abilities (Burns et al., 2008), which enhance resilience (Tugade et al., 2004), critical when athletes face unique stressors. Thus, increased resilience buffers mental health disorders and the relationship with positive emotions may be reciprocal. As a result, an upward spiral toward increasing emotional wellbeing occurs (Fredrickson and Joiner, 2002). Despite this, the current study only examined two aspects of mental health, so in future a wider range of mental health disorders is required.

Self-Efficacy

This study found self-efficacy correlates positively with wellbeing, but negatively with mental health disorders. This is in line with numerous other studies (e.g. Ehrenberg et al., 1991). Self-stigma is the internalisation of stigma leading to diminished self-efficacy and therefore wellbeing, due to concurrence with the negative belief (Corrigan and Watson, 2002). Common stereotypes include danger, incompetence and being blamed for illness (Corrigan and Kleinlein, 2005). Anticipation of rejection then leads to constriction of social networks and, further diminishing wellbeing (Perlick et al., 2001). It is likely in sport as the culture portrays mental illness negatively (Corrigan et al., 2006). Therefore, acknowledging mental health stigma is critical, especially since those soliciting help are considered weak (Watson, 2005). Endorsing mental illness stigma creates vulnerability to self-stigma and, diminished self-efficacy, resulting in poor psychological wellbeing.

Control is important for psychological health and self-efficacy is a situation-specific form of control (McAuley and Blissmer, 2000). Obtaining control helps one believe outcomes can change (Bartone et al., 2008). However, highly valued outcomes, low self-efficacy and therefore control, produces anxiety and depression. This is particularly true when outcome goals exceed perceived efficacy to attain them. A lack of social self-efficacy further impacts this due to beliefs of not meeting others’ outcome standards (Muris, 2002). Therefore, avoidance of evaluative situations, such as exercise is probable. Especially since those who doubt their capabilities, when faced with obstacles, problems or failure, tend to give up rather than increase efforts to master the task (Bandura and Schunk, 1981). Therefore, self-efficacy is vital to wellbeing, especially in sport where challenge is rife.

Limitations

There are several limitations with this study. Firstly, the sample size was relatively small creating issues for the generalisation of results. Also, there were substantially less inactive participants which may have affected the results. Similarly, more females than males participated perhaps altering the results, especially since Bayram and Bilgel (2008) state females are at higher risk of mental health issues. Additionally, 83.7% of participants were between 18-22 years, effecting reflectiveness to wider populations. This was a cross-sectional study so cause and effect associations cannot be established, and the hypotheses should be investigated experimentally. Using questionnaires relies on memory recall leading to the risk of social desirability bias, which is likely due to physical inactivity being socially undesirable (Rhodes et al., 2002). Although they were highly valid, Tavakol and Dennick (2011) recommend using questionnaires with more items to increase reliability. Therefore, to improve the study longer versions could be used. Despite such limitations, the dissertation developed existing knowledge by examining differences in mental health and wellbeing along a spectrum of exercise participation, including inactive individuals. Measuring a range of outcomes provided broader insight into psychological health, allowing a holistic view of sport participation. This allows effective implementation of support to encourage the inactive to be active and protect athletes from excessive psychological pressure.