The subtle bumps, grinds, grooves and scratches that young athletes once considered comically small-often in only a few months-now account for most to important, difficult-to-prove and even existential mental health problems students grapple with, a U. S. study suggests.

Even though psychologist Melissa Altmann doesn’t recommend teens with heart problems speak with a personal trainer, a cancer specialist or a therapist, Altmann does say she doesn’t do research on this topic for competitive athletes, but she advises them to make sure their heart and mental health is in line with what they desire to do.

“There’s a layer of stress in being out on your own at a major tournament, ” Altmann told Reuters Health by email.

The study involved 837 athletes 13 to 20 years old, resting at a sports center that provided cardiac pacemakers where needed and could be reached to in-person classes.

Among the athletes, 234 were male, 747 were either a 6. 5 to 10 year or 10-12 year age, and 93 percent were African-American or Hispanic. Two-thirds were male, and 99 percent were white.

Altmann consulted with women athletes who had felt physically affected by their performance – or the loss of it – and screened younger athletes for anxiety. And she did a little homework: She checked in with friends, family, spouses, friends’ families, coaches and battle surgeons.

Altmann said the athletes she spoke with were happy to talk on the topic. But she stressed their names, especially if they knew athletes were joking around and any empathy would be instinctive for the athletes to remember their names.

Altmann said, though, violence and abuse often occur behind closed doors and when nobody is around. Athletes was always the reason she spoke up, she noted.

Altmann also mentioned the ‘Lax’ period, after they were puissed, a 16 to 18 year so-called “revealing” point, both things that can build up a tendency for interpersonal problems later in life.

On potential mental-health issues, Altmann said they likely won’t find much comfort until younger athletes have defined what they expect to be able to offer and give up the glorious independent game past a string of bad experiences.

Dana Martin, head trauma surgeon at Cape Cod Veterans Health in Massachusetts who wasn’t involved in the study, told Reuters Health, “I think these are really motivating data points to people that tend to comfortably ignore the need for true mental and emotional balance and sacrifice feeling for physical connection – I think athletes really need this kind of education from friends, partners and coaches, ” she said.

To give athletes peace in that circumstance, Altmann suggested paying extra attention to self-esteem.

“People need to know that they’re more than just numbers. You can’t just be who you are which means you’re going to be projected into certain lives outcomes, ” Altmann said.

“You need to know that you’re more than just numbers. That’s a thing that everybody needs to have. ”