Ira D. Glick

In their letter to the editor, the authors discuss the need for sports psychiatry and neurology to be viewed as a central part of the sports medicine field.

Introduction: Sports psychiatry is an emerging medical and psychiatric discipline that has experienced significant development in recent years. This growth has been accompanied by an increase in scientific outputs from sports psychiatrists and other academics that address the three fields of activity of sports psychiatry: namely, mental health and disorders in competitive and elite sports, mental health and sport-specific mental disorders in recreational sports, and the use of sport, exercise and physical activity in the prevention and treatment of mental disorders. Conceptual publications have discussed the scope of sports psychiatry and education and training. However, some topics receive more attention than others, with evidence gaps in other key areas of sports psychiatry. Advancing the field towards evidence-based practice requires an assessment of the current state of the literature and the development of a strategic research agenda. Methods: Following the Working Group on Research Gaps, Priorities and Agenda at the Summit on Sports Psychiatry arranged by the International Society for Sports Psychiatry (ISSP), the ISSP Scientific Committee conducted a narrative review of the sports psychiatry literature to benchmark the current academic state of the discipline and further developed the research agenda to provide a strategic framework for future research directions. Results: We discuss a research agenda according to five key areas: sports psychiatry as a discipline, education and training in sports psychiatry, and the three clinical fields of activity of sports psychiatry. Conclusion: This sports psychiatry research agenda provides a framework to guide the strategic development of the scientific literature in the field.

In competitive and elite sports, mental health and athletic performance cannot be considered separately. Mental disorders in sports are bidirectionally associated with reduced athletic performance. A decline in performance, both within and outside of sport, can be a sign of mental disorder. Additionally, poor athletic performance is a potential risk factor for mental disorders in athletes. The central role sports psychiatrists play in the mental health of athletes is well‐established. However, their role in athletic performance is less well‐described and more controversial, perhaps due to a perception that performance is purely a secondary outcome of good mental health. This paper discusses the role that sports psychiatrists can play in athletic performance within competitive and elite sports. Performance can be distinguished into three key focus areas for sports psychiatrists: (i) performance restoration, (ii) performance maintenance, and (iii) performance enhancement. These should be considered throughout the continuum of mental health care, from prevention, treatment, to ongoing care for mental disorders. When reduced performance is due to a mental disorder, psychiatric treatment should purposefully aim to restore functioning and performance as part of management. Maintenance of performance is, similarly, an important element of the prevention, psychiatric treatment, and ongoing care of mental disorders. Holistic sports psychiatrists may also choose to aim for athletic performance enhancement beyond the context of mental health symptoms and disorders, to help athletes flourish and achieve their goals.

Sports psychiatry is a young field of medicine and psychiatry that focuses on mental health among athletes, and sports and exercise within psychiatry and mental disorders. However, the development of sports psychiatry and its fields of activity vary from region to region and are not uniform yet. Sports psychiatry and the role of sports psychiatrists have also already been discussed in the field of sports and exercise medicine, and within medical teams in competitive and elite sports. A uniform definition on sports psychiatry, its fields of activity, sports psychiatrist, and the essential knowledge, skills, and abilities ( plus attitudes, eKSA ^+A ) of the sports psychiatrist were developed as part of an International Society for Sports Psychiatry (ISSP) Summit, as well as First International Consensus Statement on Sports Psychiatry. Three fields of activity can be distinguished within sports psychiatry: (i) mental health and disorders in competitive and elite sports, (ii) sports and exercise in prevention of and treatment for mental disorders, and (iii) mental health and sport‐specific mental disorders in recreational sports. Each of these fields have its own eKSA ^+A . The definitions on sports psychiatry and sports psychiatrists, as well as the framework of eKSA ^+A in the different fields of activity of sports psychiatrists will help to unify and standardize the future development of sports psychiatry, establish a standard of service within sports psychiatry and together with the neighboring disciplines, and should be included into current, and future sports psychiatry education and training.