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Prevalence and Type of Psychopathology in Ultra Endurance Athletes

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Prevalence and Type of Psychopathology in Ultra Endurance Athletes Prevalence and Type of Psychopathology in Ultra Endurance Athletes The Harvard community has made this article openly available. Please share how this access benefits you. Your story matters Citation Colangelo, Jill Ann. 2020. Prevalence and Type of Psychopathology in Ultra Endurance Athletes. Master's thesis, Harvard University Division of Continuing Education. Citable link https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37367600 Terms of Use This article was downloaded from Harvard University’s DASH repository, and is made available under the terms and conditions applicable to Other Posted Material, as set forth at http:// nrs.harvard.edu/urn-3:HUL.InstRepos:dash.current.terms-of- use#LAA Prevalence and Type of Psychopathology in Ultra Endurance Athletes Jill A. Colangelo A Thesis in the Field of Psychology for the Degree of Master of Liberal Arts in Extension Studies Harvard University May 2021 Copyright 2021 Jill A. Colangelo Abstract This study examined the prevalence and type of mental health disorders present in a population of ultra endurance athletes. Historically, most formal research into this population has centered on physiological implications of participation, but not on the psychological implications. 523 endurance athletes, between the ages of 19 and 73, participated in a general mental health survey to ascertain any prior diagnosis and answered a full Patient Health Questionnaire, as well as the Eating Attitudes Test. Participants were recruited through numerous online endurance athlete communities, clubs, and podcasts. The study hypothesized that there would be a greater incidence of mental disorder whether diagnosed or undiagnosed, in the population of ultra endurance athletes versus the general population in the United States. This research study found that there is a greater prevalence of mental disorder in this population as a whole, and a positive correlation between incidence of mental disorder and volume of training per week. Anxiety, depression, and alcohol abuse were found to be the most prevalent, though there is evidence of a wide variety of psychopathology in the population including, but not limited to, bipolar disorder, eating disorder, obsessive compulsive disorder (OCD), and post traumatic stress disorder (PTSD). Given the scarcity of available research on mental disorder in ultra endurance athletes, this study aims to bridge the current lack of information and provide evidence that there is a need for support and guidance surrounding the recognition and management of mental health concerns in this population. iii Dedication I dedicate this thesis to my parents, Elaine F. and Thomas D. Puleo, to whom it never occurred that I would ever fail. iv Acknowledgments I would like to express deep appreciation to Dr. Andrew Engelward, Dr. Jonathan Jenkins, and Dr. Dante Spetter for believing in my vision for this project and helping me to be successful despite the many challenges. Special thanks to Jason Pappas for Qualtrics mastery. Special, special thanks to Kelly Zuromski for fairy godmother services. I send a huge thank you to Bryon Powell of irunfar.com, Eric Schranz of ultrarunnerpodcast.com, and Alison Wade of the Fast Women Newsletter. The success of the survey relied heavily on their incredible generosity. This project, as well as my education at Harvard, would not have happened without the unwavering support of my parents, Thomas and Elaine Puleo. I cannot thank them enough for the hours of FaceTime chats, early morning rides to the train station, and yes, the other half of the tuition. I am truly grateful for my husband, Mauro Colangelo, who provided constant encouragement and love. Sei la cosa più bella che mi sia mai capitata. And to Tulip: thank you for being a most excellent writing buddy. Ti meriti tutti gli spaghettoni. v Table of Contents Dedication .......................................................................................................................... iv Acknowledgments................................................................................................................v List of Tables ................................................................................................................... viii Chapter I Introduction ..........................................................................................................1 Mental Health in Ultra Endurance Athletes is Often Overlooked ...........................2 Origins of Research in the Ultra Endurance Population: “Staleness” and the Morgan-Raglin Studies ..........................................................................6 Mental Disorder is Observed in the Ultra Endurance Sport Community ....9 Ultra Endurance Athletes Risk Developing Addiction ..............................13 There is a Lack of Research on Prevalence and Type of Mental Disorder in Ultra Endurance Athletes .......................................................................17 Chapter II Research Method ..............................................................................................21 Participants .................................................................................................21 Measures ....................................................................................................22 Procedure ...................................................................................................24 Data Analysis .............................................................................................25 Chapter III Results .............................................................................................................27 Prior Diagnosis of Mental Disorder ...........................................................27 Risk Analysis: PHQ and EAT-26 Data ......................................................31 vi Nonzero Suicide Risk ................................................................................34 Chapter IV Discussion .......................................................................................................36 Limitations .................................................................................................46 Future Research .........................................................................................50 References ..........................................................................................................................54 Appendix 1. Glossary of Terms ......................................................................................62 Appendix 2. Patient Health Questionnaire .....................................................................63 Appendix 3. Eating Attitudes Test-26 ...........................................................................68 vii List of Tables Table 1 Prior Diagnosis of Mental Disorder ...........................................................28 Table 2 Prior Diagnosis by Gender .........................................................................29 Table 3 Prior Diagnoses in General Sample Population Trending Data.................30 Table 4 Prior Diagnoses in Specific Study Populations Trending Data .................31 Table 5 Trending Data for PHQ/EAT-26 Assessed Risks in General Sample Population 32 Table 6 Trending Data Depicting Mental Disorder by Gender ..............................33 Table 7 Prevalence of Prior Diagnoses in >20 group vs. USA Total .....................34 Table 8 Prevalence of Prior Mental Disorder Diagnosis in >20 vs. USA ..............38 viii ix Chapter I Introduction Participation rates in ultra endurance sports such as triathlon, ultramarathon, and long distance cycling are increasing, though the psychological and physiological effects of high volume training are not well understood (Scheer, 2019). Despite evidence that exercise is beneficial to mental health, several recent studies have noted a tendency toward increased prevalence of mental disorder in ultra endurance athletes. In contrast to the idea that ever-increasing volumes of exercise would offer ever-increasing mental health benefits, there may be a U-shaped relationship between benefits of participation and training volume as outlined by the largely abandoned Mental Health Model in Sports Psychology, pioneered by William Morgan in the 1980s (Onate, 2019). This truth potentially leaves ultra endurance athletes vulnerable to increased risk of psychopathology due to their high training volume and grueling training regimen. There has been observation of an increasing amount of discussion of mental disorder in the ultra endurance athlete community. Mental disorder is acknowledged in the community and perhaps disturbingly, accepted or even expected as part of the training (Finn, 2019). There does not appear to be any other sport with this association, therefore it is important to begin an inquiry into if there is more mental disorder in this particular population and eventually, why this would be true. The goal of the current research is to understand the prevalence of psychopathology in ultra endurance athletes. This research also aims to gain insight into the possible relationship between endurance training and mental health disorders, by examining the timing of the onset of mental disorder and whether athletes with mental disorder are particularly attracted to endurance sport (ie: diagnosis pre-participation). In addition, the study investigates whether athletes who participate in endurance sport are prone to develop mental disorder (ie: diagnosis during/after participation) either
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