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Center court: exploration of access to mental health services by female university athletes
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Running head: FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 1
CENTER COURT: EXPLORATION OF ACCESS TO MENTAL HEALTH SERVICES BY
FEMALE UNIVERSITY ATHLETES
by
Ann Foster Golay
A Dissertation Presented to the
FACULTY OF THE USC ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2020
Copyright 2020 Ann Foster Golay
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 2
DEDICATION
This dissertation is dedicated to my family:
To my parents and brothers who instilled the values of character, commitment, and academic and
athletic achievement.
To my late husband, Keith, my love and colleague, who taught me to be a healer in every aspect
of my life.
To my daughter, Allison, my son-in-law, Michael, and my grandchildren, Owen and Ainsley;
to my daughter, Lara, and her partner, Oscar;
you all demonstrate love through acceptance, encouragement, honesty, kindness, and patience. I
have complete gratitude for your dedication to me during this process and I have realized this
goal because of each of you.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 3
ACKNOWLEDGEMENTS
I want to acknowledge my dissertation chairman, Dr. Rudy Castruita, for his expert
guidance and support through the entirety of this dissertation process, and acknowledge my
dissertation committee members, Dr. Briana Hinga for her encouragement to excel in the
conceptual framework of this process, and Dr. David Cash for his collaboration to create a
quality study.
I want to acknowledge Dr. Michael Keller for his consistent encouragement, support, and
direction to achieve this goal.
I also want to acknowledge the exceptional dedication and education I received from
each professor during this doctoral program; and acknowledge my first professor, Dr. Pedro
Garcia, for his example of transformational and servant leadership. I want to acknowledge my
USC colleagues who offered support and kindness through this doctoral program.
And, I want to acknowledge the outstanding former Division I female university athletes
who generously shared their time to participate in my interviews and who demonstrated their
commitment to girls and women in sport to overcome barriers and receive equity in access and
opportunity.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 4
TABLE OF CONTENTS
Dedication 2
Acknowledgements 3
List of Tables 6
List of Figures 7
Abstract 8
Chapter One: Overview Of The Study 9
Background of the Problem 14
Statement of the Problem 17
The Purpose of the Study 18
Research Questions 18
The Importance of the Study 19
Limitations and Delimitations 21
Definitions 22
Organization of the Study 23
Chapter Two: Review of the Literature 24
Historical Perspective of Female University Athletes as Leaders 24
Background of Societal View of Female Athletes as Leaders 24
Background of Societal View of Female University Athletes as Leaders 27
Background of Mental Health Factors for Females Impacting Female University
Athletes 28
Female University Athletes as an At-Risk Population for Depression and Mental Health
Issues 32
Barriers Influencing Underutilization of Mental Health Services by Female University
Athletes 34
Social Stigma of Accessing Mental Health Services 34
Objectification and Stereotyping 38
Impact of Microaggressions Maintaining Objectification and Stereotyping 41
Coping Strategies Utilized by Female University Athletes in the Absence of Mental
Health Services 42
Societal View of Female University Athletes Represents a Greater Social Justice Issue
for Women 47
Conclusion 48
Chapter Three: Methodology 51
Research Questions 52
Qualitative Methods 53
Sample and Population 54
Qualitative Instrumentation 55
Interviews 55
Documents 57
Qualitative Data Collection Approach 57
Protocols 58
Documents 61
Qualitative Data Analysis 61
Credibility and Trustworthiness 65
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 5
Summary 66
Chapter Four: Summary of Findings 68
Purpose of the Study 69
Presentation of Findings 70
Organization of Data Analysis 74
Descriptive Characteristics 75
Interview Data Collection 75
Interview Participants 77
Interview Data Analysis 79
Interview Data Presentation 80
Popular Culture Document Data Collection 81
Popular Culture Document Participants 81
Popular Culture Document Data Analysis 82
Popular Culture Document Data Presentation 83
Popular Culture Documents Findings 83
Findings: Billie Jean King Interview 84
Findings: U.S. Women’s Tennis Open 2018 86
Findings: Nike Dream Crazier Commercial 89
Research Question Findings 91
Findings: Research Question 1 92
Findings: Research Question 2 101
Findings: Research Question 3 110
Findings: Research Question 4 122
Summary 134
Chapter Five: Conclusions 139
Purpose of the Study 139
Research Questions 140
Major Findings 140
Findings and Transformative Worldview 144
Findings and Popular Culture Documents 144
Implications for Practice 145
Future Research 149
Conclusions 150
References 155
Appendix A: Participant Recruitment Letter 163
Appendix B: Participant Information Sheet 164
Appendix C: Participant Interview Protocol 166
Appendix D: Qualitative Interview and Popular Culture Document Coding Legend 170
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 6
LIST OF TABLES
Table 1: Participant Interview Data 77
Table 2: Participant Characteristics of Athletic Experience Prior to Division I Competition 78
Table 3: Participant Characteristics as Former Division I Athletes 79
Table 4: Popular Culture Document Data 82
Table 5: Billie Jean King Interview Document Communications as Percentage of A Priori
Factors Related to Barriers to Access to Mental Health Services 84
Table 6: U.S. Women's Tennis Open 2018 Document Communications as Percentage of
A Priori Factors Related to Barriers to Access to Mental Health Service 86
Table 7: Nike Dream Crazier Commercial Document Communications as Percentage of
A Priori Factors Related to Barriers to Access to Mental Health Services 89
Table 8: Participants Responses as Percentage of A Priori Categories Related to Access to
Mental Health Services 93
Table 9: Participant Responses as Percentage of Empirical Factors Related to Access to
Mental Health Services 97
Table 10: Participant Responses as Percentage of A Priori Categories Related to Barriers to
Access to Mental Health Services 102
Table 11: Participant Responses as Percentage of Empirical Factors Related to Barriers to
Access to Mental Health Services 106
Table 12: Participant Responses as Percentage of A Priori Factors Related to Mental
Health Issues 111
Table 13: Participant Responses as Percentage of Empirical Factors Related to Mental
Health Issues 116
Table 14: Participant Responses as Percentage of A Priori Factors Related to Coping
With Mental Health Issues 123
Table 15: Participant responses as Percentage of Empirical Factors related to Coping with
Mental Health Issues 126
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 7
LIST OF FIGURES
Figure 1: Participants’ cycle of processing observations of the athletic system. 152
Figure 2: Rational emotive behavioral therapy process. 153
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 8
ABSTRACT
Research identifies barriers to female university athletes’ access to mental health services
that are unique to this population. This qualitative study gained knowledge of factors and
phenomena that contribute to female university athletes’ experience of barriers to mental health
services and the coping strategies they utilize in the absence of these services. This study
implemented explanatory qualitative methods through semi-structured interviews with six former
NCAA Division I female university athletes between the ages of 25 and 31 who attended a
California university. Popular culture documents were selected for analysis of communication to
girls and women in sport and alignment with the conceptual framework. Significant findings
included new knowledge about the participants’ observation of the athletic systems’
communication, their perception of explicit or implicit messages, their beliefs about maintaining
competitive status, their resultant anticipatory anxiety about their competitive status, and their
coping strategies to manage their emotions independent of disclosure to the athletic system. This
study informs the university athletic system toward a transformational leadership environment
and provides mental health practitioners with data to identify evidence-based psychotherapeutic
methods of cognitive therapy or cognitive behavioral therapy for prevention and treatment of this
unique populations’ mental health needs.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 9
CHAPTER ONE: OVERVIEW OF THE STUDY
Female university athletes represent a societal image as leaders and models of physical
and mental strength and bring this image to their performance on and off the court. Underlying
this model image is a population that displays higher rates of depression and lower rates of
access to mental health services. Statistics derived from student self-report questionnaires show
females have a higher rate of depression than males in the overall population and show that U.S.
female university students display almost double the incidence of major depressive disorder than
their male counterparts (Albert, 2015; Eisenberg, Gollust, Golberstein, & Hefner, 2007; National
Institute of Mental Health [NIMH], 2010). During a major depressive episode, an individual
displays the following symptoms for most of a day: depressed mood, decreased interest in
activities, insomnia or hypersomnia, fatigue, and lower ability to concentrate (American
Psychiatric Association, 2013).
Female university athletes are challenged to achieve the mission of winning national
championships, but barriers restrict access to mental health services to support peak performance
(Scott & Derry, 2005). These barriers are unique to female athletes and confirm that sex
differences exist and that female athletes are treated differently (López & Levy, 2013; Selby,
Weinstein, & Bird, 1990). These barriers may prevent female university athletes from
acknowledging their mental health issues as well as from seeking treatment of these issues when
needed (Kern et al., 2017). It is necessary to increase knowledge about factors that contribute to
female university athletes’ underutilizing mental health services and the coping strategies they
utilize in the absence of these services.
Female university athletes are an at-risk population because of their higher rate of
depression and underutilization of mental health services, as stated by Etzel, Watson, Visek, and
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 10
Maniar (2006). In their seminal study in 1990, Selby et al. found only 5% of student university
athletes access services from a mental health practitioner. National Collegiate Athletic
Association (NCAA, 2016) research indicates only 36% of female student-athletes strongly agree
that they have access to mental health services within the athletic department. Female athletes
report elevated issues with diet, weight, and body image which create negative emotional
responses (Selby et al., 1990).
Student university athletes have indicated that barriers to access include social stigma due
to protection of privacy and perception by coaches, athletic staff and team members, and they
maintain a negative view of sports psychology providers (López & Levy, 2013). The stigma of
being perceived as unhealthy, weak or mentally ill may cause the student-athlete to remain
within the team system for assistance (López & Levy, 2013) The model image of female
university athletes contributes to compliance with team norms, which seems prohibitive of
treatment for depression. This study will address the underutilization of university resources by
this population, the reliance on coaching staff to provide support, and the issue that this reliance
on coaching staff may mean athletes are relying on individuals who activate their self-
objectification (Selby et al., 1990).
Female athletes’ perception of coaches as the gatekeepers to athletic development can
create a power relationship and limit access to services unless the coach provides support
(Norman & French, 2013). López and Levy (2013) corroborate this finding in asserting that
athletes perceive a barrier to seeking mental health care from other providers because of fear of
violation of privacy and rely solely on care from athletic staff. In the quantitative study
implemented by Kern et al. (2017), their pilot educational program on mental health increased
student-athletes’ reports of seeking counseling through utilizing former student-athletes to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 11
present their personal stories of the benefit of counseling. This study supports that these student-
athletes can be marginalized because of the stereotype that seeking help represents weakness and
could result in coaches withdrawing support.
The societal objectification of the female university athlete presents an additional barrier
to utilization of mental health services (López & Levy, 2013). Objectification theory asserts a
significant number of women are treated as an object and valued only for their utility to others
(Szymanski, Moffitt, & Carr, 2011). This theory proposes that females are at increased risk for
mental health problems directly resulting from interpersonal relationships of objectification by
others and the intrapersonal relationship of self-objectification. Being objectified by others can
be internalized, resulting in self-objectification, which causes females increased anxiety about
their appearance and increases their risk for mental health issues (Szymanski et al., 2011).
Behavior is also affected by the female’s continued internal critique of their physical
appearance, which interferes with peak performance. Scott and Derry (2005) propose that much
of the lack of progress with Title IX is due to the gender socialization of females and the
objectification of females to value their bodies for physical form, not physical ability. There is
social pressure for the female athlete to appear feminine, and a muscular build and strength are
identified as masculine (Scott & Derry, 2005). Females experience paradoxical messages in
objectification by society: “I want you to be feminine and I want you to want to be feminine.”
Watzlawick, Weakland and Fisch (1974) discuss that this paradoxical message is symptom
producing. Weakland (1960) discusses that paradoxical messages create a double bind for the
individual; either way the individual responds is wrong, and there is an illusion of choice. Thus,
female university athletes may experience an illusion of choice when faced with objectification.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 12
This objectification of female athletes through the media’s presentation of sexualized
images fostered research that challenged the hegemonic views of masculinity and femininity in
sport (Hall & Oglesby, 2016). The media’s focus on these images of female athletes increases
adolescent and college females’ reporting of self-objectification (Daniels, 2009). This research
provides a consensus regarding the historical issue of objectification and stereotyping of female
athletes and women in sport.
Kaskan and Ho (2016), in their review of scholarly literature and media reports, discuss
the types of microaggressions from society and the media that are asserted against female
athletes who do not exemplify the model image and how these microaggressions may affect
these athletes physically, psychologically, and behaviorally. Female athletes are also subject to
microaggressions through the media’s support of restrictive gender roles, the discount of their
abilities, and a focus on their sexual appeal (Kaskan & Ho, 2016). These microaggressions
contribute to increased mental health risks for female athletes (Kaskan & Ho, 2016). If an athlete
confronts the microaggressor, the female athlete can be judged as over-emotional and over-
reactive, then placing the athlete in a double bind that continues the oppression of females. The
stereotyping and objectification of female athletes results in a bias that can affect all women’s
choices related to physical activity (Kaskan & Ho, 2016). Through these microaggressions,
female athletes continue to receive the communication that they are inferior, objectified for
physical desirability, and restricted to acceptable feminine behavior.
If microaggressions create stress for the female university athlete, then the biological
ramifications of stress will affect them, including in their ability to compete and perform. In
addition, the cognitive processing of microaggressions occupies mental energy and affects
attention to performance. These microaggressions can also increase the risk for mental health
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 13
concerns of disordered eating and body image issues. Behaviorally, the double bind aspect of the
microaggression can result in anxiety symptoms. All of these outcomes of the microaggression
align with oppression, compliance, and adaptation of the female athlete to adhere to the model
image.
Gender-based biases may take a subtle form for female athletes even in view of
continuing changes in gender roles (Kaskan & Ho, 2016). Title IX of the Education Amendments
Act of 1972 granted equal treatment in university athletics for women, but the image of equal
treatment is narrowed by restrictive gender roles placed on female athletes (U.S. Department of
Education, 2005). Cooky and Dworkin (2013) report that institutional sport has been organized
by binary sex categories and reference the history of procedures by governing bodies to ensure
female athletes were female since the 1900s. Societal pressure to conform to gender norms is
formed by implicit rules that may result in social reinforcement or punitive actions against the
female university athlete (Steinfeldt et al., 2011). An example of punitive actions against female
athletes may include the controversary regarding track star, Caster Semenya, and the policing of
her body by the International Association of Athletics Federations (IAAF) by requesting gender
verification tests to determine her eligibility to complete in women’s sports because she
displayed characteristics defined as masculine (Cooky & Dworkin, 2013). The societal standards
for femininity are not aligned with the standards for athletic achievement because athletics
continues to be perceived as a masculine endeavor. Therefore, adaptation to these restrictive
gender roles creates an additional barrier to access to mental health services, identifying another
characteristic of the model image which is incompatible with seeking help.
The Women’s Tennis Association is attempting to restrict players from grunting and
yelling during play, which is deemed as a masculine behavior, but this sanctioning of behavior is
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 14
potentially restrictive of performance (Kaskan & Ho, 2016). Female university athletes value the
masculine characteristics of competitiveness, strength, and power and also deal with the
paradoxical message to maintain the cultural desirability of femininity. The media coverage of
feminine sports like figure skating and gymnastics displays social bias and support of traditional
gender roles, but athletes in these sports have the highest rates of eating disorders (Kaskan & Ho,
2016; Selby et al., 1990).
Selby et al. (1990), in their seminal quantitative study, present that female athletes report
elevated difficulties with diet, weight, and body image, which create negative emotional
responses. Female university athletes’ self-judgement and anticipation of judgement by others
related to their body weight was significantly higher than those of male athletes, and female
athletes reported greater levels of anxiety, depression, and anger if they were not able to maintain
their ideal weight (Selby et al., 1990). Selby et al. (1990) noted female athletes feeling
traumatized by coaches’ comments about being overweight, which supports the pressure that
female athletes feel to maintain the ideal weight. Etzel et al. (2006) present the phenomena of
female athlete triad of disordered eating, amenorrhea, and osteoporosis, causing possibly
irreversible health consequences as these athletes prioritize performance, acceptance, and praise.
Background of the Problem
Although Title IX became law in 1972 and opportunities have grown for women in
university sports, there continue to be historical issues in the advancement of women in
competitive sports. There are continued stigmas, objectification and stereotyping, gender issues,
and media and financial inequalities contributing to female university athletes not reaching peak
performance and experiencing barriers to access to mental health services to manage issues and
maximize performance (Hall & Oglesby, 2016).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 15
There is a media and marketing side to athletics from the university level to professional
sports, and resources are first allocated to men’s sports. Women’s athletic accomplishments are
not equally acknowledged through media representation, sponsorships, or financial reward, as
illustrated by a decrease in media attention over the last 20 years (Hall & Oglesby, 2016). Also,
women represent 40% of sports participants yet receive only 4% of media coverage (Hall &
Oglesby, 2016).
Sociologists state that the media contributes to maintaining the traditional female gender
role by sexualizing women athletes, which devalues women’s athleticism and maintains a
patriarchal power (Daniels, 2009). Daniels (2009) states that psychological research over the last
10 years validates the problematic impact of sexualized images of female athletes on female
body image. The equal opportunity of Title IX for females in high school and university sports is
dependent on compliance through funding and institutional support and hindered by traditional
female gender socialization and the interference of femininity with active participation in sports
(Scott & Derry, 2005). Scott and Derry (2005) summarize psychologists’ findings that
objectification results in self-objectification and increases female athletes monitoring, sense of
shame, and anxiety regarding their bodies.
Additional historical barriers to women’s participation in sports draws from the
stereotype that women are the weaker sex, which has been supported by a value of women’s
weakness among privileged classes (Dowling, 2001). In The Frailty Myth: Redefining the
Physical Potential of Women and Girls, Dowling discusses the historical roots of the Victorian
period and the cultural value that women’s responsibility is reproduction, which, then, requires
all of a woman’s mental and physical energy. There is a subtle cultural message that it is
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 16
unfeminine to display male characteristics of strength, competition, and toughness (Scott &
Derry, 2005).
The historical issues of equity in financial compensation and treatment for professional
performance have been limited since the 1960s and only recently gained prominence. In an
interview, Billie Jean King (Prime Video UK, 2018) discussed her advocacy for open tennis. In
1968, at Wimbledon, Rod Laver received 2000 GBP for winning the men’s singles, and King
received 750 GBP for winning the women’s singles. She stated she believes sports is a
microcosm of society and that female athletes have to keep fighting for freedom and equality,
and now prize money is equal for both men and women. In the 2018 U.S. Open, Serena Williams
intensely discussed with the umpire what she defined as another historical equity issue:
There are men out here that do a lot worse, and, because I’m a woman, you’re going to
take this away from me. That is not right. And you know it, and I know you can’t admit
it, but I know you know that is not right. I know you can’t change it, but I’m just saying
it’s not right (para. 10).
The discussion of barriers that prevent female university athletes from accessing mental
health services leads to the exploration of the coping strategies these athletes utilize in the
absence of mental health services. “Coping describes how people mobilize, modulate, manage,
and coordinate multiple aspects of the self under stress (or fail to do so)” (Fingerman, Berg,
Smith, & Antonucci, 2011, p. 562). Rice et al. (2016) report that these athletes focus on
strategies to deal with psychosocial stressors rather than mental health issues and their coping
strategies can include approach strategies, mastery climate, motivation and goal setting. Nicholls
and Polman (2006) indicate athlete’s coping strategies address performance stressors rather than
mental health issues. Athletes’ coping strategies for psychosocial and performance stressors
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 17
result intrapersonal outcomes of resilience, self-reliance, positive self-talk, and interpersonal
outcomes of social support and seeking a supportive training culture (Nicholls & Polman, 2006;
Rice et al., 2016).
Statement of the Problem
If barriers restrict access to mental health services to support maximizing athletic
performance, then female university athletes may display utilization of coping strategies in the
absence of mental health services. Exploration of these coping strategies can provide increased
knowledge about the gap between non-professional help and professional help for mental health
issues.
The NCAA published and distributed Mental Health Best Practices (NCAA, 2013a) and
Mind, Body and Sport: Understanding and Supporting Student-Athlete Mental Wellness (NCAA,
2013b) with recommendations for supporting and promoting student-athlete mental health. The
four (NCAA, 2013b) best practice recommendations are (a) clinical licensure of practitioners
providing mental health care, (b) procedures for identification and referral of student-athletes to
qualified practitioners, (3) pre-participation mental health screening, and (4) health promoting
environments that support mental well-being and resilience.
The stereotype of the university athlete as a model of physical and mental toughness may
contribute to attitudes and social norms which result in underutilization of mental health services
(López & Levy, 2013). This lack of access to mental health practitioners by this underserved
population does not align with the NCAA mission to have structures and systems to meet the
mental health needs of this population and provide care for the mind, body and sport.
Objectification, social stigma, protection of privacy, and perception by coaches, athletic staff,
and team members represent barriers to access to services (López & Levy, 2013).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 18
The Purpose of the Study
This study uses basic research to gain knowledge about factors and phenomena that
contribute to female university athletes’ underutilizing mental health services and the coping
strategies they utilize in the absence of mental health services (Merriam & Tisdell, 2016). This
study is focused on former undergraduate female competitive athletes at Division I universities
in California. The alignment of the extensive research on athletes’ lack of access to mental health
services and the limited research on athletes’ management of mental health issues lead to the
need to explore and understand the female university athletes’ experience with these issues.
Research Questions
Exploration of why and how of female university athletes experience mental health issues
begins with determining barriers to access and strategies to manage these barriers and cope with
mental health issues (Merriam & Tisdell, 2016). The following research questions will guide this
study:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 19
The Importance of the Study
The female athlete model image represents a greater and enduring social justice problem
for women in our society. Objectification denies equity in treatment for ability and increases risk
of mental health issues (Scott & Derry, 2005). The female athletes’ model image exemplifies the
denial of equity in treatment for ability because of continued expectations that women must be
feminine and attractive to be accepted and valued by society. This bias applies not only to
women in sports, as it affects all women because of the implied directive about participation in
physical activity. Daniels (2009) emphasizes the model image of female athletes as sexualized,
and this gender bias places females at greater risk for self-objectification. Both Kaskan and Ho
(2016) and Daniels (2009) discuss the negative impact of branding as a desirable object on the
performance of the athlete. Selby et al. (1990) also confirm coaches treat female athletes
differently than male athletes in terms of weight and body image. Etzel et al. (2006) also
addresses the impact of prioritizing performance and acceptance on female university athletes as
placing these athletes at risk for long-term health issues from eating disorders. This study seeks
new knowledge to understand the societal pressure for female athletes to comply and adapt to the
model image to succeed, placing their physical and mental health at risk while underutilizing
mental health services. This study seeks to gain knowledge about the coping strategies female
university athletes utilize in the absence of mental health services. Additionally, this study seeks
to gain knowledge about their perceptions of barriers to access to mental health services and the
mental health issues they experience.
Female university athletes represent the factors of athletes as societal models of
leadership and physical and mental strength. This population’s barriers to access to mental health
services may generalize to other populations that demonstrate leadership roles in our society. The
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 20
knowledge gained from this study may assist practitioners in aligning female university athletes’
unique mental health needs with evidenced-based psychotherapeutic methods for prevention and
treatment.
A review of research revealed common themes regarding female athletes’ mental health
symptoms and needs and provides recommendations for educational interventions. This study
seeks to provide new knowledge about how female university athletes describe their experiences
with access to mental health services. For practitioners, this study may provide information on
strategies to reduce barriers to mental health services and on how these athletes utilize personal
problem-solving strategies which align with evidenced-based psychotherapeutic methods. It is
hoped that the information gained from this study will provide information for practitioners to
strategically reduce barriers to mental health services by implementing interventions that can be
utilized by the athlete based on their perspective and level of readiness.
This study may provide evidenced-based methods for the prevention of barriers to mental
health services. From a societal lens, when our model images experience a lack of access to
mental health care, the public’s access may suffer as well. The transformative worldview
provides a framing for the social justice in this population’s access to services (Creswell, 2014).
The philosophical assumptions of the transformational worldview support inquiry that addresses
social oppression at any level (Creswell, 2014). The focus on access to mental health services by
any marginalized population can be addressed collaboratively between the organization and the
informants to give voice to perceptions or experiences of inequity in access due to power
relationships (Creswell, 2014). In the 1970s, Billie Jean King (Prime Video UK, 2018, p.2)
stated that female athletes were “really living through what was evolving and happening in
politics and all over.” Two decades later, Selby et al. (1990) identified in their seminal study that
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 21
female athletes are treated differently and Goldner (1991, p. 4) asserted that “gender identity is a
socially instituted normative ideal,” and that the psychiatric community subscribes to a binary
gender system. King advocated for gender equity while understanding the political change
required ongoing dialogue. She stated in her interview,
a long, long time ago, I didn’t use the word feminism because it turned people off and I
don’t want to turn people off, I want them to keep listening and having dialogue. All
feminism means is everyone’s equal, equal rights for everybody. (Prime Video UK,
2018).
The focus in this study on the specific population of female university athletes may contribute to
the dialogue on current issues in policing the boundaries of sex in sports for all genders related to
stigma, objectification and stereotyping, and microaggressions for differentness from normative
sex roles.
A gap exists in terms of solutions from a mental health perspective and those stemming
from an educational perspective. The specific area of interest herein is identifying
psychotherapeutic methods for female university athletes to manage stigma, objectification and
stereotyping, and restrictive gender roles. This study may also identify these athletes’ beliefs
about mental health services and barriers to those services which may align with learning
theories to assist researchers in developing preventive programs.
Limitations and Delimitations
The limitations of this study are related to the population of female university athletes or
former female university athletes who were full-time students and competed at NCAA Division I
universities in California. The study is delimited to include only female participants who meet
the criteria and who participate in interviews.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 22
Definitions
For the purpose for clarity in this study, the following terms are defined.
Double bind: An emotionally distressing dilemma in communication in which an
individual receives two or more conflicting messages with one negating the other (Bateson et al.,
1956).
Major depressive disorder: Includes periods of depressed mood and loss of interest. The
symptoms cause clinically significant distress or impairment in social, occupational, or other
important areas of functioning (American Psychiatric Association, 2013).
Mental health practitioner: Clinical professional, with an advanced degree and licensed
by the state, who provides diagnosis and treatment for mental health problems (California Board
of Behavioral Sciences, 2018).
Microaggression: Subtle forms of racism expanded to include gender, sexual orientation,
and other marginalized groups (Kaskan & Ho, 2016).
Objectification: Depersonalizes the female body and equates a woman’s worth with her
body’s appearance and sexual functions (Szymanski et al., 2011).
Paradoxical messages: Incongruent communication, where incompatible statements exist
on different logical levels, usually verbal and non-verbal (Bateson et al., 1956).
Self-objectification: Greater emphasis on one’s appearance and treating oneself as an
object to be looked at and evaluated on the basis of appearance (Szymanski et al., 2011).
Title IX: A law within The Education Amendments Act of 1972 which stipulates that
girls and women be granted equal treatment in school and college athletics (U. S. Department of
Education, 2005).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 23
Organization of the Study
This study is presented in five chapters. Chapter One introduces the study through an
overview of female university athletes’ mental health issues and a discussion of the value of
conducting research to gain further knowledge on utilization of mental health services. In
addition, Chapter One provides the background of the problem through an examination of the
historical and contextual influences on the advancement of women in competitive sports.
Chapter Two reviews and presents contemporary research corresponding to the research
questions of the study which further illustrates and supports the need to implement research on
this populations’ barriers to access mental health services and coping strategies in the absence of
access to these services. Chapter Three follows the overview and literature review by presenting
the methodology and specifying the purpose of the study, the research questions, and the
rationale for the utilization of qualitative methods within the transformative worldview
conceptual framework. Chapter Four presents the analysis of the data and findings obtained from
the qualitative interview transcriptions and analysis of popular culture documents in the study.
The conclusive Chapter Five presents the discussion of the results and findings and addresses
implications and recommendations for further research regarding the mental health needs of
female university athletes.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 24
CHAPTER TWO: REVIEW OF THE LITERATURE
This purposeful review of the literature presents current research on female university
athletes as societal leaders and as an elite population displaying higher levels of depression and
lower rates of access to mental health services (Etzel et al., 2006). In addition, this review of the
literature, explores current research in these athletes’ utilization of coping strategies in the
absence of mental health services (Rice et al., 2016). The research is reviewed to understand
current evidence on the leadership role of female university athletes as models of physical and
mental strength and how this model image is held within a context of underutilization of mental
health services due to barriers of social stigma, objectification and stereotyping,
microaggressions, and restrictive gender roles (Etzel et al., 2006; Kern et al., 2017; López &
Levy, 2013).
Historical Perspective of Female University Athletes as Leaders
A leader’s viewpoint and impact can be understood through definitions of leadership
styles. Northouse (2013) presents the characteristics of the transformational leader, according to
the Bennis and Nanus, as defining a clear vision, acting as a social architect, creating trust, and
deploying self through strengths.
Background of Societal View of Female Athletes as Leaders
Transformational leadership presents a reciprocal relationship between the leader and
follower, resulting in raising each to their highest potential and highest performance (Northouse,
2013). The leader-follower relationship can be exemplified by the athlete-coach relationship,
each alternating the role of leader and follower, bound together, and both changed in the
collaborative leadership process. The transformational leadership aspect of idealized influence
incorporates an “attributional component” which illustrates the follower’s perception of the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 25
leader as a role model and a “behavioral component” which illustrates the follower’s observation
of the leader’s behavior and action toward the mission (Northouse, 2013, pp. 191–192).
In a historical review of events that shaped the destiny of female athletes, George (1988)
presents the legacy of women who persisted as athletes, coaches, and administrators to open
opportunities in sport for women. George discusses the impact of Title IX on equality of athletic
opportunity for women, resulting collegiate competition, quality facilities and training, and
quadrupling of athletic scholarships (George, 1988). George also illustrates how, in 1928, after
32 years of effort, female university athletes were allowed to compete in Olympic track and field
events. Female athletes met with microaggressions for participating in sports that were identified
with strength and power. Mary Washburn Conklin, one of the first track and field competitors in
the 1928 Olympics, overcame the barriers stigma, objectification, and microaggressions after
being lectured by New York University professors that women should not compete in
intercollegiate sports (George, 1988).
The objectification of the female university athlete at the 1928 Olympics is documented
in the description by The New York Times of the 100-meter dash as “aside from the race itself,
other scenes entirely unfeminine and never before witnessed in an Olympic stadium” (George,
1988, p. 39). There were multiple news reports on the emotionalism and loss of control of the
female athletes as opposed to their performance and achievements (George, 1988). This author
discusses how Billie Jean King utilized her unique platform as an athlete to become leader in
reducing gender division, increasing gender equity, and advocating for women in sport by
founding the Women’s Sport Foundation (George, 1988). In the 1960s and 1970s, the feminist
movement aligned with increased opportunity in women’s sports as women’s sports entered the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 26
arena of live television and Billie Jean King helped reduce gender division during her “Battle of
the Sexes” match against Bobby Riggs (Dowling, 2001, pp. 169–170).
George (1988) further discusses efforts by the Congress of the International Amateur
Athletic Federation and the Amateur Athletes Federation of the United States to limit women’s
track and field events through attempts to limit the 800-meter event as too difficult and intense
for women. In, The Frailty Myth, Dowling (2001) states that, during the late nineteenth century
and early twentieth century, women’s physical education instructors wanted to maintain a
feminine approach to sport, reasoning that women were not matched to competition. This author
further discusses the philosophy and statement of the medical community during this time to
limit mental and physical activity for females because vigorous sport could undermine health and
reproductive ability (Dowling, 2001).
The historical journey of females into the competitive realm of sport is characterized by
the vision, strength and persistence of founding female athlete leaders. These women
demonstrate the idealized influence component of transformational leadership through their
model of athletic achievement and their influence in changing organizations through their vision
and motivation of others to accomplish a mission for gender equity in sport. When followers
attribute vision and mission to the leader and observe behaviors to reach these, followers become
motivated to participate in the movement toward them as well. The historical objectification and
resultant microaggressions regarding physical form rather than ability and performance continues
into the current issue of female university athletes as societal leaders who demonstrate higher
levels of mental ill health and underutilization of mental health services. This historical
perspective further validates seeking increased knowledge about the coping strategies these
athletes utilize in the absence of mental health services.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 27
Background of Societal View of Female University Athletes as Leaders
Meier (2015) qualitatively reviewed case studies to evaluate the importance of female
sporting role models in society and outline the value of the sporting role model (SRM) in the
efforts of the worldwide organization of Sport for Development and Peace (SDP). SDP seeks to
foster the use of athletics toward the enhancement of social change and leadership skills to have
an impact on self-efficacy (Meier, 2015) The educational focus of SDP incorporates the principle
that sport aligns with body and female SRMs can be a vehicle for providing gender-based
information on issues such as sexual harassment and violence (Meier, 2015). Meier verifies that
the objectified and stereotyped female SRM can perpetuation the expectation of femininity in
athletics (Meier, 2015). The author discusses the characteristics of the role model and factors that
generate emulation of the role model’s behavior, stating that scholars indicate the observation of
a coping model assists learners in acquiring self-regulatory skills to improve performance and
success (Meier, 2015).
Findings indicate that female SRM promote leadership among women who hold positions
in sport and sport organizations, dispelling objectification and stereotypes as well as advocating
for opportunities for girls and women (Meier, 2015). The case examples of African female
student footballers demonstrate opposition to gender stereotypes as coaches and athletes become
an example of gender role transformation (Meier, 2015). In addition, the transformational leader
is illustrated in this author’s discussion of the female SRM as an inspirational model who
encourages followers to seek a happier and healthier life in the face of hardship which may
transfer beyond the world of sport (Meier, 2015).
Galante and Ward (2016) specifically investigated the differences between NCAA
Division I female athletes and non-athletes on factors of self-esteem and transformational
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 28
leadership. This qualitative study surveyed 635 university women, one-third of whom were
identified as Division I athletes. Transformational leadership traits were assessed through the
Student Leadership Practices Inventory which measured five qualities: “Model the Way,”
“Inspire a Shared Vision,” “Challenge the Process,” “Enable Others to Act,” and “Encourage the
Heart” (Galante & Ward, 2016, p. 158). Galante and Ward used the Rosenberg Self-Esteem
Scale to measure students’ global self-esteem (Galante & Ward, 2016). Results from this study
indicate that female university student-athletes report higher leadership traits and higher self-
esteem than their non-athlete female counterparts. Galante and Ward found two significantly
higher areas of transformational leadership trait reported by the athletes. These are “Model the
Way,” meaning setting a model and example of excellence, and “Encouraging the Heart,”
pertaining to acknowledging contributions (Galante & Ward, 2016, p. 160). In addition, these
athletes report significantly higher self-esteem (Galante & Ward, 2016). Variables considered to
affect these results are the nature of participation in organized sports, which builds leadership
characteristics, and the building of athletic competence, which may increase self-esteem (Galante
& Ward, 2016). Limitations of this study are the use of self-report instruments and reliability on
participants’ perceptions of self. The results of this study further validate the need for increased
knowledge to understand the factors that lead female university athletes to report higher
transformational leadership traits and higher self-esteem while also reporting higher rates of
depression.
Background of Mental Health Factors for Females Impacting Female University Athletes
Female university athletes maintain the additional role as females and female university
students. Women in general demonstrate higher rates of depression and mental health symptoms
than men. As female athletes enter the university as competitors in academics and athletics,
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 29
research clarifies that this elite population is not exempt from higher rates of mental health
symptoms. There is an intersection of factors in being a female, a female university student, and
a female university athlete that amplifies specific mental health risks for this population.
Statistics derived from student self-report questionnaires show females have a higher rate
of depression than males in the overall population and show that U.S. female university students
display almost double the incidence of major depressive disorder than their male counterparts
(Albert, 2015; Eisenberg et al., 2007; NIMH, 2010). Evidence highlights that females represent
8.5% of depressive episodes while males represent 4.7%, as shown in a 12-month assessment of
major depressive episodes in U.S. adults (NIMH, 2010). In the student population, 14% of
female students, compared to 7% of male students, met the criteria for a major depressive
episode in the first year of university (Kruisselbrink Flatt, 2013).
Overall, universities report an increased incidences of mental health issues among
students and increased utilization of university counseling center services. Empirical studies need
to focus on this growing public health issue and gather epidemiological data because, as mental
health issues increase in higher education, there is a need to understand the risk factors that
contribute to these issues and the symptoms which co-occur with depressive episodes (Eisenberg
et al., 2007). Eisenberg et al. (2007) conducted a web-based survey at a large Midwestern public
university with 2,843 students. Although female and male students screen for similar rates of any
depression, female students screen for higher rates of major depression, and 13.8% of female
students with major depressive disorder report a 22.4% rate of missed academic obligations due
to their symptoms (Eisenberg et al., 2007).
Lombardo et al. (2014) explored the relationship between eating disorders, sleep
disorders and depression by administering a self-report questionnaire to 1,019 female university
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 30
students. They found students reporting persistent insomnia also reported higher rates of
depression. Hysenbegasi, Hass, and Rowland (2005) also evaluated the relationship between
depression and academic performance and determined that depression impairs academic
performance and results in a 0.49 drop in GPA.
In the last decade, reports of increased rates of depression in female university students
motivated significant interest in understanding the factors contributing to student depression and
its impact on student success in universities throughout the world (Eisenberg et al., 2007;
Hysenbegasi et al., 2005). Depression in female university students poses a significant health risk
and decreases academic performance, which may be correlated to their future performance
(Hysenbegasi et al., 2005). The results of these studies all indicate a need for further study to
determine epidemiological data regarding higher rates of depression among female university
students and provide information for treatment of symptoms and improvement of health and
academic success.
Main activators of depression in female university students include insomnia, eating
disorders, anxiety, and intrusive thoughts (Field, Diego, Pelzez, Deeds, & Delgado, 2012;
Lombardo et al., 2014). During the major depressive episode, an individual displays the
following symptoms for most of a day: depressed mood, decreased interest in activities,
insomnia or hypersomnia, fatigue, and lower ability to concentrate (American Psychiatric
Association, 2013). These specific symptoms of depression also have an impact on students’
abilities to perform tasks that contribute to academic achievement. In addition, associations
among sleep disturbances, depression, and biochemical imbalances have been established, but
research on these factors in the female university student population is limited (Field et al.,
2012). Although additional factors like anxiety, intrusive thoughts, disordered eating, and
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 31
insomnia contribute to depression in female university students, the research that could
determine the effect of these factors on concentration and academic achievement is not thorough
(Field et al., 2012; Lombardo et al., 2014).
The first onset of depression is reported to occur in individuals by age 24, and university
communities have an opportunity to reduce the onset of these symptoms (Eisenberg et al., 2007).
However, there is no integrated model for behavioral care to facilitate increased health for
university students, enhance cost effectiveness, remove barriers to treatment, increase ease of
obtaining treatment, and reduce the stigma of seeking treatment (Alschuler, Hoodin, & Byrd,
2008). While existing studies have provided promising evidence linking the completion of a
patient health questionnaire with university students’ level of comfort in discussing behavioral
health with a primary care provider, the types of initiation by this provider or by a college health
center to elicit this information have not been studied (Alschuler et al., 2008).
As treatment options are explored, there is a need for further research on the effectiveness
of specific treatment modalities for depression that can reduce re-occurrence of depression.
Significant gaps in the identification of education and treatment methods limit meaningful efforts
to address the problem of depression in female university students. Lombardo et al. (2014) assert
that disentangling the variables of disordered eating, insomnia, and depression and evaluating
female students’ coping strategies, regulation of emotion, and management of life stress events
could lead to treatment techniques to reduce these factors and thereby reduce depression. Such
disentanglement of factors could lead to specific treatment interventions for each factor. For
example, specific interventions may match to reducing sleep disorders, and specific
psychotherapeutic methods may match to reducing depression (Lombardo et al., 2014). Scholars,
including Alschuler et al. (2008), Beiter et al. (2015), Field et al. (2012), and Haddock, Weiler,
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 32
Trump, and Henry (2017), emphasize the need to clarify the factors activating depression in
female university students to provide effective treatment and reduce the impact of depression on
their ability to attend to academic tasks (Hysenbegasi et al., 2005; Khanam & Bukhari, 2015).
Attention to effective interventions to assist depressed female university students is incumbent
on universities because the design and implementation of a specific treatment model that
addresses these mental health issues can prevent the re-occurrence of depressive episodes that
can impact life-long achievement and success.
Female University Athletes as an At-Risk Population for
Depression and Mental Health Issues
Females demonstrate higher levels of depression than males, female university students
demonstrate multiple symptomatic factors that contribute to higher levels of depression than
male students, and female university athletes demonstrate unique mental health symptoms.
Female university students demonstrate mental ill health symptoms which align with the
symptoms displayed by female university athletes, but, for these athletes, the symptoms are
demonstrated within a context of societal pressure to maintain a model image of physical and
mental strengthen and attain peak performance.
The seminal study by Selby et al. (1990) generates new knowledge about university
athletes by collecting data in the areas of substance use, diet, weight and body image, stress
factors and knowledge, and use of health resources. Female athletes demonstrate increased issues
with diet, weight, and body image, which results in negative emotional responses. The
methodology included a survey and administration of the Athlete’s Health Questionnaire to 27
competitive varsity athletic teams at Stanford University. The respondents were 56% male and
44% female, with an approximately even distribution among classes. The number of respondents
is not specified, and the authors do not include an explanation of the respondent selection
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 33
method. The design, content, construct validity, and reliability of the Athletes’ Health
Questionnaire are not discussed. Results are displayed in six tables, presenting data on athletes’
use of alcohol and drugs, emotion reported regarding ideal weight, weight acceptability, eating
binges, stress factors, and use of helping resources in traumatic situations. The proposal does not
present the steps of data analysis and interpretation. This research aligns with the purpose of this
study and confirms sex differences and that the factors of ideal weight, eating behaviors, and
self-criticism and criticism of coaches affect university female athletes’ negative emotions. It
also supports that female athletes are treated differently regarding diet, weight, and body image.
This study adopts a post-positivist worldview, discussing the correlation between female
athletes’ attitudes and their belief about these factors on their performance.
Etzel et al. (2006) present a literature review and address the causal question “will it work
for me?” (McKwan & McKwan, 2003). Their aim was to educate administrators about the
factors that place collegiate student-athletes at greater risk for physical and behavioral health
problems in comparison to non-athlete students and the useful practices to reduce these risk
factors. These authors focused on educating administrators on specific student-athlete health
issues, including training and overtraining, alcohol, drug use and drug testing, depression and
suicidality, dysfunctional eating behaviors, injury and hazing. The authors present a section on
each topic pertaining to useful practices to address these issues. In the area of depression and
suicidality, education of staff members on depressive signs and symptoms and life stressors,
development of referral networks for student-athletes, and ongoing screening for depression and
suicidality is recommended. There is a discussion of the phenomena of the female athlete triad of
disordered eating, amenorrhea, and osteoporosis. Useful practices for these issues for females
include precollege preventive education on the effects of competitive athletics on female
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 34
athletes’ mental health. The authors draw from empirical research by the NCAA, NIMH, and
statistics from the World Health Organization. This literature review relates to the purpose of this
study by identifying the higher rates of depressive symptoms for female student-athletes and the
possible irreversible health consequences of disordered eating as female athletes prioritize
performance, acceptance and praise. This study allows a transformative worldview for these
athletes so that they are not isolated in their athletic departments and increase their access to
services due to increased awareness and advocacy for treatment by staff and student affairs
professionals.
Barriers Influencing Underutilization of Mental Health Services by
Female University Athletes
Female university athletes experience unique barriers that restrict access to mental health
services, which confirm findings that female athletes are treated differently because of sex
(López & Levy, 2013; Selby et al., 1990). The social stigma of accessing mental health services
for these athletes includes privacy issues, perception by others, and withdrawal of support. In
addition, objectification and stereotyping of these female athletes relating to feminine appearance
increases self-objectification and seeking mental health services compromises their model image
and utility (Scott & Derry, 2005; Szymanski et al., 2011). If female athletes do not exemplify the
model image of femininity, they may be the targets of microaggressions, affecting their ability to
compete and perform (Kaskan & Ho, 2016). The barriers of social stigma, objectification,
stereotyping, and microaggressions may result in lack of access to mental health services because
of fear of loss of support by coaches, athletic staff, and team members.
Social Stigma of Accessing Mental Health Services
López and Levy (2013), in a quantitative study which is the first known study of its type,
sought to provide new knowledge about the barriers to intercollegiate student-athletes’ seeking
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 35
psychological counseling and to provide new knowledge about what counselor characteristics
intercollegiate student-athletes prefer when seeking assistance with personal psychological
concerns. The methodology included a survey pertaining to two self-report measures: The
Barriers to Help-Seeking Checklist and the Counseling and Psychotherapy Preferences
Questionnaire. This was a single stage sample, and subjects were contacted by email. In all, 165
NCAA intercollegiate varsity athletes participated, and 67.3% were women ranging from 18 to
26 years of age, 80.6% were Caucasian/White, 14.5% African American/Black, Hispanic, Asian
or other, and 4.9% were biracial. All academic levels were represented from 20 intercollegiate
sports. The authors specified limitations due to the small sample size and due to gender and race.
The development of these self-report instruments was not discussed, and the validity and
reliability of the methods were not referenced.
López and Levy (2013) found the significant barriers to seeking counseling were
available time to seek services and social stigma. Preferences for type of counselor were a
counselor familiar with sports, of the same gender, and within a similar age range.
Recommendations were made to educate current staff regarding barriers to counseling, reduction
of barriers, and protecting student-athletes’ privacy. This study informs the current study in its
finding that barriers to student-athletes’ seeking counseling is the perception of others, their
coaches, athletic staff, and team members. This study incorporates a transformative worldview as
the student-athlete may conform to social norms to only receive assistance from known athletic
staff and may feel restricted from accessing professional psychological counseling because of
potential violation of privacy and confidentiality. This restriction can lead to isolation of the
student-athlete within the athletic department.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 36
Beauchemin (2014) introduces a qualitative study and utilizes self-report questionnaires
and qualitative interviews to explore stressors that can compromise student-athletes’ well-being.
The author explored whether an integrative outreach model can change awareness and attitudes
of student-athletes about mental health and counseling. The goal of implementing the outreach
model was to increase awareness and understanding for student-athletes in the areas of mental
health, sport psychology, and sport psychology skills to determine if these interventions reduced
barriers to access to mental health support and services. This study was conducted at a large mid-
western public university, and methodology included workshop and classroom instruction
consisting of lectures, video, participatory exercises, and the completion of questionnaires at the
end of the instruction.
The stigma of mental health treatment as a significant barrier to student-athletes’
receiving services was reduced after participating in the outreach model. Subjects completed
questionnaires on their perceptions of mental health and counseling, sport psychology skills,
performance, attitudes and usefulness of outreach. Semi-structured qualitative interviews were
also conducted, and quotes from these illustrate the resulting themes. A peer reviewer provided
consensus validation. There were 10 student-athletes interviewed, and 26 completed
questionnaires which included open-ended questions and Likert scale questions. The validity and
reliability of the questionnaires was not discussed. The authors specified primary limitations of
the study as the small sample size and the issue of participants self-selection as contributing to
population bias. This study relates to the purpose of the present study by providing an additional
level of qualitative collection of student-athlete reports on the changing of perceptions of the
stigma of mental health. After the instructional course of sports psychology skills, students
reported an increase in their performance and generalization of these skills to other life issues.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 37
This movement to a positive student-athlete experience with psychology skills aligns with the
transformative worldview by providing a voice for student-athletes, raising their consciousness
through education, and reducing barriers to counseling.
Kern et al. (2017) conducted a quantitative study utilizing the model of a pilot program to
implement contact and education-based interventions on mental health and mental illness with
collegiate student-athletes and then collect data on the efficacy of these interventions through
pre- and post-survey questionnaires. The goal of this study was to influence student-athletes
regarding mental health and mental illness in the areas of knowledge, stigma, and attitudes. The
four categories of supporting teammates, own help-seeking, knowledge, and stigma were
assessed for positive attitude improvement after presentations, and all categories displayed
improvement. Student-athletes reported a 99% engagement level in the interventions, and 96%
reported a likelihood of utilizing the information presented. After intervention, there was a
significant increase in student-athletes’ willingness to seek help. The participants were 626
varsity collegiate student-athletes from one university. The age range was 18 to 23, and 28.3%
were male while 25.1% were female, and 46.6% were unassigned for gender. Student-athletes
were asked by their coaches to attend the pilot program presentation. Presentations included
components of an educational overview of mental health, two brief videos on the struggle with
mental health issues of previous college student-athletes, personal disclosure by student-athletes
in the videos regarding their experiences, and an open discussion with these student-athletes.
A pre-survey questionnaire was completed prior to the presentation, and, after the
presentation, participants completed a post-survey questionnaire. A discussion of the
development of the questionnaire referenced research that contributed to the items selected.
Additional questions were structured on a Likert scale and were derived from student-athlete
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 38
interviews. The results from these Likert scales were coded, and the data were statistically
analyzed utilizing SPSS and Stata software. This quantitative study adds another dimension to
data from the other studies on the stigma. The specific area of interest is now expanded by the
use of education on mental health and barriers to mental health services by licensed mental
health professionals and the introduction of videos of a female and male former student-athlete
dealing with significant mental health issues, seeking help from the university’s athletic
counseling team, and improving with counseling. This real-life explanation and modeling of
help-seeking behavior illustrates the transformative worldview that brings attention to this
student-athlete population, which can be marginalized because of stigma regarding seeking help
which could result in lack of support by coaches. The student-athletes in the videos advocate for
remove barriers to counseling and demonstrate through learning theory that modeling to-be-
learned strategies or behaviors improves self-efficacy, learning, and performance (Denler,
Wolters, & Benzon, 2006).
Objectification and Stereotyping
Female university athletes experience objectification and stereotyping, and these societal
attributions have a significant impact on their access to mental health services. This study utilizes
a review of the literature to examine the factors that contribute to female university athletes’
adherence to the model image and contributors to the underutilization of mental health services.
Female athletes have been socialized to be feminine and attractive, and the societal and media
support of this image results in self-objectification. They also have higher rates of depression and
lower rates of utilization of mental health services. This review of the literature demonstrates that
additional research is required to align these athletes’ unique behavioral health needs with
evidenced-based psychotherapeutic methods for prevention and treatment.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 39
Objectification theory asserts a significant number of women are treated as objects and
valued only for their utility to others (Szymanski et al., 2011). Szymanski et al. (2011) completed
an extensive literature review of current advances in objectification theory to assist counseling
psychologists integrate education on sexual objectification and power and equity issues with
counseling methods with women. This theory proposes that females are at increased risk for
behavioral health problems directly resulting from the interpersonal relationship of
objectification by others and the intrapersonal relationship of self-objectification.
When females are objectified by others, they can internalize this treatment, resulting in
self-objectification, which causes increased anxiety about their appearance and increased risk for
behavioral health issues (Szymanski et al., 2011). Behavior is also affected because of a
continued internal critique of physical appearance which interferes with peak performance states.
Scott and Derry (2005) propose that much of the lack of progress with Title IX is due to the
gender socialization and objectification of females. Through their literature review and essay
about their college level seminar, they discuss that the consequences of objectification limit
participation in physical activities and continue sex discrimination in athletics (Scott & Derry,
2005). They propose that socialization to appear feminine and objectification have been
illustrated, but behavioral interventions for self-objectification have not been explored (Scott &
Derry, 2005). The authors established there is social pressure for the female athlete to appear
feminine and that a muscular build and strength are identified as masculine. The objective of
their course is to provide education and experiences for female college students that reduce
barriers to physical activity and increase awareness and positive body image through physical
experiences in natural environments.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 40
These researchers present an educational approach to facilitate the reduction self-
objectification and indicate that qualitative information gained from participants supports that
education works. Thus, there may be an underlying assumption that education is the only
intervention required. However, these studies do not address the complex level of behavioral
health symptoms of anxiety and depression or the need for a higher level of psychotherapeutic
intervention for these participants. Females experience paradoxical messages in objectification
and stereotyping by society, and, as Watzlawick et al. (1974) discuss, this paradoxical message is
symptom producing. Weakland (1960) found that paradoxical messages create a double bind for
the individual in that there is an illusion of choice, when reality is that either way the individual
responds will be deemed wrong. Similarly, female university athletes may experience an illusion
of choice when faced with objectification and stereotyping.
Daniels (2009) evaluated self-objectification by adolescent and college females through a
between-participants review of photographic images and a written response to structured
questions of their feelings about themselves after viewing the photographs. Results illustrated
that performance images of women athletes elicited more descriptions of physicality than beauty,
indicating an empowering of the participants to focus on their bodies as opposed to
sexualization. Daniels found sexualized images increased reports of self-objectification whereas
performance images reduced these reports.
Hall and Oglesby (2016), in their literature review, summarized articles that challenge the
hegemonic views of masculinity and femininity in sport and changes in media representation of
the female athlete as sex sells. These articles provide evidence that the model image for female
athletes and resultant behavioral health issues can be changed by reformulation of gender
stereotypes against female and strength. These articles support increasing knowledge of existing
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 41
and new barriers and creating a definition of females as feminine and powerful, and encouraging
athletic staff and administrators to develop excellence through caring philosophy. These articles
provide a consensus regarding the historical issue of the objectification and stereotyping of
female athletes and women in sport and increased awareness of the issues facing female
university athletes. Unfortunately, these articles do not address the coping skills that will be
benefit female athletes facing these issues.
Impact of Microaggressions Maintaining Objectification and Stereotyping
Kaskan and Ho (2016), in their review of scholarly literature and media reports, discuss
the types of microaggressions from society and the media that are asserted against female
athletes who do not exemplify the model image and how these microaggressions may affect the
physical, psychological and behavioral health of these athletes. Female athletes are also subject
to microaggressions through the media’s support of restrictive gender roles, the discount of their
abilities, and a focus on their sexual appeal (Kaskan & Ho, 2016). These microaggressions also
increase behavior health risks for female athletes (Kaskan & Ho, 2016). If an athlete confronts
the microaggressor, the athlete can be judged as over-emotional and over-reactive, then placing
the athlete in a double bind. Furthermore, stereotyping and objectification of female athletes
results in a bias that can affect all women’s choices related to physical activity (Kaskan & Ho,
2016). If, through these microaggressions, female athletes continue to receive the communication
that they are inferior, objectified for physical desirability, and restricted to acceptable feminine
behavior, the oppression of females as less-than continues.
If microaggressions create stress for the female university athlete, then the biological
ramifications of stress will affect these athletes, which can affect their ability to compete and
perform. In addition, the cognitive processing of microaggressions occupies mental energy and
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 42
reduces attention to performance. These microaggressions also increase the risk for behavioral
health issues. Behaviorally, the double bind aspect of the microaggression can increase anxiety
symptoms. All of these outcomes of the microaggression align with oppression, compliance, and
adaptation of the female athlete to adhere to the model image. The research addresses the impact
of microaggressions and brings another dimension to the pressure on the female athlete to
exemplify the model image. The level of impact of these microaggressions is not fully
researched, and intervention strategies to manage or cope with microaggression also need
additional research. However, the scope of this study does not include interventions or strategies
for individuals or organizations to manage microaggressions.
Coping Strategies Utilized by Female University Athletes in
the Absence of Mental Health Services
The scope of the previously reviewed research encompassed symptoms, barriers to
treatment, and educational programs for treatment options for physical injury and mental health
issues (Etzel et al., 2006; Kern et al., 2017; López & Levy, 2013). Etzel et al. (2006) recommend
that university athletes not be isolated to their athletic departments for mental health treatment,
and that staff be educated to refer to professionals for the best care for these athletes. López and
Levy (2013) corroborate this recommendation by asserting that athletes perceive a barrier to
seeking behavioral health care from other providers because of fear of violation of privacy, and
they become relegated to care from athletic staff. Kern et al. (2017) increased student-athletes
seeking counseling, through an educational program on mental health and former student-
athletes presenting their personal stories of the benefit of counseling. Kern et al. support that
student-athletes can be marginalized because of the stereotype of seeking help as weakness,
which could result in coaches’ withdrawing support. The research presents an educational and
informative intervention that may reduce the barriers for female university athletes’ seeking
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 43
mental health treatment. Currently, in this review of the literature, although mental health
services are recommended, there are no evidenced-based mental health interventions specified
for female university athletes to cope with the stigma of seeking mental health services,
objectification and stereotyping, and microaggressions.
Since studies provide evidence that female university athletes underutilize mental health
services, a purpose of the study is to explore the coping strategies these athletes utilize in the
absence of mental health services. In a review of 60 studies of elite athletes, findings indicate a
higher incidence of mental health issues than within the normal population but indicate a lack of
research on intervention strategies to assist these athletes (Rice et al., 2016). The researchers
review the literature on elite athletes to synthesize the incidence and nature of mental ill health
and psychological well-being. Rice et al. (2016) further explore mental ill health and mental
health in elite athletes and report research on coping strategies utilized by these athletes,
highlighting strategies focused on coping with psychosocial stressors rather than coping with a
mental ill health diagnosis (Rice et al., 2016). Coping strategies identified in the review of the
literature include approach strategies, mastery climate, motivation and goal setting resulting in
resilience, self-reliance, positive self-talk, and seeking a supportive training culture (Rice et al.,
2016).
Nicholls and Polman (2006) systematically reviewed the literature on athletes’ coping
strategies in 64 studies but indicated that the coping strategies are related to performance in sport
rather than with mental health issues. These authors indicated that the studies in the systematic
review of the literature focused on performance stressors and coping responses as opposed to
mental health issues and coping responses. This systematic literature review collected data from
52 quantitative and 12 qualitative studies, examining trait and process perspectives. A trait
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 44
perspective is defined as athletes’ stable coping styles measured by interviews or questionnaires
and the process perspective asserts that coping with stress involves a dynamic process of
interactions between athletes’ intrapersonal beliefs, goals and values and their environment. The
researchers reviewed 11 studies related to coping in sport and gender, reporting tentative findings
that males use more problem-focused coping and females utilize more emotion-focused coping
such as seeking social support, venting, positive reframing, positive self-talk, dissociation, and
meditation. The authors suggest that socialization of genders may influence the differences of
coping between genders.
The extensive research on athletes’ lack of access to mental health services and the
limited research on athletes’ coping with mental health issues leads to the need to explore and
understand the female university athletes’ specific experience in coping with mental health
issues.
The literature on motivation provides multiple intrapersonal and achievement-related
theories which may provide increased knowledge about how female university athletes cope with
mental health issues and barriers to mental health treatment. Certain theories frame or reframe
the constructs for individuals by providing an explanation for the outcome of successful
achievement. Csikszentmihalyi, Abuhamdeh, and Nakamura (2007) discuss the intrapersonal
aspect of events processed in an individual’s consciousness that result in a report of the flow
experience and that this experience becomes aligned with the individual’s sense of mastery. The
descriptors of the individual experience of flow provides a detailed explanation of the impact of
flow on the individual’s motivation to continue and increase competency in activities. The results
have applications to the elite athlete regarding quality of life at the intrapersonal and
interpersonal level. Further, as Csikszentmihalyi et al. (2007) state, education about the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 45
characteristics and reported experiences of flow is different than development of a procedure or
method to achieve flow.
An explanatory construct can provide knowledge about factors contributing to
motivation, but it may not provide the information for methods to increase goal achievement.
Gollwitzer and Sheeran (2006) provide a meta-analysis of implementation intentions which
emphasizes a model to bridge the gap between goal intention and behavior or action. In this
model, the formulation of an athlete’s goal intention to win a particular competition defines the
movement from thought about the event to determination of what action is to be performed and
what level of effort will be put forth. This model is an intrapersonal dialogue which contributes
to imagining or visualizing the specifics of the intention and asking oneself the questions of
“when, where, and how one intends to achieve it” (Gollwitzer & Sheeran, 2006, p. 82).
Gollwitzer and Sheeran (2006) also propose strategies for the individual with the goal intention
to assure self-regulation in goal striving, with a focus on behaviors that lead to goal attainment
and behaviors that prevent goal attainment. There is also an appendix that provides if-then
statements to manage the four problems of goal striving (Gollwitzer & Sheeran, 2006).
Maehr and Zusho (2009), in their discussion of the 2 x 2 model of achievement goals
present a parallel to Gollwitzer and Sheeran (2006) by posing the mastery approach as including
the intrapersonal question of “how can I do it?” Mastery seems more aligned with an
intrapersonal theory of motivation whereas performance seems more aligned with an
interpersonal theory. There is an additional parallel to goal intention through their “Hierarchy of
Goals,” as “Personal Strivings” align with goal intention and “Concerns, Projects, Tasks” align
with implementation intentions, and “Specific Action Units” align with the problems
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 46
encountered on the path to goal achievement and the self-regulatory strategies utilized (Maehr &
Zusho, 2009, p. 78).
The aspect of automaticity could be related to athletic skills as an overlearned activity.
The response to the question of “how one can do something” may be difficult for athletes to
describe because they are in the present, highly efficient in task implementation, and do not
experience conscious intent (Gollwitzer & Sheeran, 2006). The richness of description in
Gollwitzer and Sheeran’s (2006) qualitative study could provide information about the
processing of an athlete to maintain positive self-talk and a positive mood as well as on how they
cope if negative self-talk or a negative mood arises during the performance. Internal dialogue
may be revealed during the self-regulation of goal striving to “bridge the intention-behavior
gap”(Gollwitzer & Sheeran, 2006, p. 82). The procedure is outlined, but the description of the
self-talk the athlete generates, the “if, then” implementation intention, needs to be elicited from
the athlete. The if-then statement provides the athlete with a choice; if the statement is followed,
then the athlete will have success.
The constructs of attribution theory contribute to an intrapersonal theory of motivation in
goal intention and implementation intentions. There appears to be a parallel of attributional
consequences and causal consequences with strength of the goal intention. For example, an
athlete may attribute their performance success to effort, and success viewed as due to effort
increases self-esteem (Graham & Williams, 2009). An “inclined actor” may have intention to act
and the implementation intention of taking action also increases self-esteem (Gollwitzer &
Sheeran, 2006, p. 78).
Locke and Latham (2002), presenting an historical perspective on goal setting, stated a
finding that also supports Gollwitzer and Sheeran’s (2006) intrapersonal theory but present
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 47
results that individuals demonstrated higher performance when they had specific and difficult
goals and did not demonstrate higher performance when urged or encouraged to do their best in
an interpersonal communication. This finding also supports the intrapersonal goal of mastery and
indicates that communication from others does not increase performance, which gives support
for the goal intention which emanates from intrapersonal self-instruction based on beliefs in the
athletes’ ability, desire for the action to be achieved, and the commitment to achieve this goal.
(Gollwitzer & Sheeran, 2006).
Gollwitzer and Sheeran (2006) discuss topics for future research and the exploration of
implementation intentions. They found that increasing an individual’s self-efficacy beliefs
requires the inductive and deductive data analysis. The participants will disclose, through an
interview protocol, their motivational belief system regarding what they can determine and
control and whether that system aligns with the intrapersonal dialogue of goal intention and
implementation intention. If these participant descriptors are provided, then these data can
contribute to future development of skill sets for athletes who experience difficulty or mental
disorders to improve their goal attainment.
Societal View of Female University Athletes Represents
a Greater Social Justice Issue for Women
The female athlete model image is representative of a greater and longstanding social
justice problem for women. Objectification denies equity in treatment for ability and increases
risk for behavioral health issues because of gender (Scott & Derry, 2005). The female athletes’
model image exemplifies denial of equity in treatment for ability because of continued
expectations of femininity and attractiveness. This bias does not just apply to women in sports
but affects all women because of the implied directive about participation in physical activity.
Daniels (2009) also emphasizes the model image of female athletes as sexualized. This gender
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 48
bias places females at greater risk for self-objectification and brands the female athlete as a
desirable object. This branding then has a negative impact on the athlete’s performance (Daniels,
2009; Kaskan & Ho, 2016). Selby et al. (1990) confirms sex differences among university
athletes resulting in female athletes being treated differently. Further, there is a correlation
between female university athletes’ attitudes and their beliefs about the impact on their
performance which places them at risk for long-term health risks (Etzel et al., 2006). The themes
in the research address the societal pressure on female athletes to comply and adapt to the model
image to succeed, placing their physical and behavioral health at risk.
Conclusion
The female university athlete presents a valuable role model in the utilization of athletics
to enhance social change, develop leadership traits, and increase self-esteem (Meier, 2015).
Although Title IX created a legal structure for equity in sport, female athletes continue to face
barriers of stigma, objectification and microaggressions when displaying masculine
characteristics of power and strength (George, 1988). As these athletes face societal barriers to
performance, they demonstrate a coping model, and the observations of these behaviors can help
learners implement self-regulatory skills to improve performance and success (Meier, 2015). In
changing the focus from leadership traits and self-esteem to mental health symptoms, the
research displays evidence of the higher rate of mental ill health symptoms and the
underutilization of mental health services to reduce these symptoms. If female university
students display twice the rate of depression of males, and female university athletes are at risk
for mental health issues, then strategies to assist these populations in ameliorating these issues
require additional research (Albert, 2015; Eisenberg et al., 2007; Etzel et al., 2006; NIMH,
2010).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 49
The barrier of objectification and stereotyping further contributes to the underutilization
of mental health services by female university athletes because of paradoxical messages of
gender socialization (Scott & Derry, 2005). Objectification increases self-objectification,
verifying the hegemonic views of masculinity and femininity in sport and the need for
reformulation of gender stereotypes against strength and power (Daniels, 2009; Hall & Oglesby,
2016). Microaggressions additionally contribute to the maintenance of restrictive gender roles
and increase stress for athletes by absorbing mental energy, which affects attention to
performance and perpetuates the cycle of mental health issues of anxiety (Kaskan & Ho, 2016).
As the research regarding female university athletes identifies mental health symptoms
and barriers to services to reduce symptoms and increase performance, another aspect of research
attempts to identify the coping strategies these athletes utilize to manage these barriers and reach
their highest potential. Evidence shows that female university athletes employ coping strategies
to manage psychosocial stressors and performance issues and do not focus on mental ill health
symptoms (Nicholls & Polman, 2006; Rice et al., 2016). However, research on how they manage
mental ill health symptoms remains unclear (Rice et al., 2016).
Multiple intrapersonal theories of motivation and goal achievement can provide more
specific information on these athletes’ implementation of strategies to manage barriers to
performance, but, if coping strategies are applied to immediate psychosocial and performance
barriers, then the underlying mental health issues may not be addressed.
The transformational worldview of female university athletes as a marginalized
population is representative of a greater social justice issue for women. As objectification denies
equity in treatment for ability because of the societal expectation that female university athletes
maintain an image of femininity, this gender bias places them at greater risk for mental health
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 50
issues (Scott & Derry, 2005). This dilemma requires a bridging of the roles of female university
athletes as models of transformational leadership and as a population who benefit from
transformational leadership to find strategies to cope with social stigma, objectification and
stereotyping, microaggressions, and resultant mental health issues.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 51
CHAPTER THREE: METHODOLOGY
The intent of the study is to implement explanatory qualitative methods research to gain
knowledge about phenomena that contribute to female university athletes’ underutilizing mental
health services and the coping strategies they utilize in the absence of these services (Creswell,
2014; Merriam & Tisdell, 2016). The utilization of qualitative research provides for a description
of experiences with mental health symptoms disclosed by female university athletes and specific
factors, attitudes, and beliefs that decrease their access to mental health services. This qualitative
type of research also allows exploration of the phenomena experienced by these athletes in
coping with mental health issues so that a descriptive voice can be given to the phenomenon and
coping strategies. The qualitative phase of the study will also include analysis of popular culture
documents to frame critical research and the transformative worldview in the context of a
historical and current perspective of the female athlete from a feminist view. This study will
gather qualitative data to provide a detailed and descriptive understanding of the participants
experience of mental health symptoms and barriers to mental health services and gather
qualitative data to provide a real-life experiential explanation of this evidence and barriers within
a context of coping strategies (Creswell, 2014).
Female university athletes exhibit higher rates of depression and lower rates of access to
mental health services which may be due to stereotypes and objectification of the female
university athlete as a leader and a model of physical and mental strength (Etzel et al., 2006;
López & Levy, 2013). Student university athletes have indicated that barriers to access include
social stigma, protection of privacy, and perceptions of coaches, athletic staff, and team members
(López & Levy, 2013). These barriers may prevent them from acknowledging mental health
issues and seeking treatment (Kern et al., 2017). Nicholls and Polman (2006) indicate that the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 52
athletes’ coping strategies are related to performance rather to mental health issues. The
alignment of the extensive research on athletes’ lack of access to mental health services and the
limited research on athletes’ management of mental health issues lead to the interest to explore
and understand the female university athletes’ experience with these issues.
Research Questions
Increasing knowledge requires exploration of when and how female university athletes
may experience and identify barriers to access to mental health services and determine their
resultant strategies to manage these barriers and cope with mental health issues (Merriam &
Tisdell, 2016). The following research questions will guide this study:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
The specific population of female university athletes represents the factors of athletes as
societal models of leadership and physical and mental strength. The barriers to access to mental
health services for this population may generalize to themes in barriers and underutilization of
mental health services among other populations that demonstrate leadership roles in our society.
The transformative worldview provides a framing for the social justice issue in this population’s
access to services (Creswell, 2014). The philosophical assumptions of the transformative
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 53
worldview support inquiry that addresses social oppression at any level (Creswell, 2014). The
focus on access to mental health services by any marginalized population can be addressed
collaboratively with informants to give voice to perception or experience of inequities to access
due to power relationships (Creswell, 2014). This worldview aligns with critical research and a
feminist perspective with the purpose of exploring issues of power and marginalized groups
within the social structure of an institution (Merriam & Tisdell, 2016).
Qualitative Methods
The use of qualitative methods in this study provides the design to understand the
experiences of female university athletes and the meaning they constructed related to mental
health access and coping with mental health issues (Merriam & Tisdell, 2016). Qualitative
methods provide the potential to understand the phenomenology of social science through a
philosophical perspective as female university athletes describe their experience with mental
health issues, access, and how they interpret their experience (Merriam & Tisdell, 2016). It also
provides the collection of data about the context in which these athletes act and the influence this
context has on their actions to access mental health services or to cope with their mental health
issues independent of outside assistance (Maxwell, 2013). The qualitative method of researcher-
participant collaborative dialogue lends to critical research to increase understanding of factors
that may maintain barriers and support a feminist perspective, critical theory and a
transformative worldview to eliminate barriers to mental health services and facilitate action to
address these issues (Creswell, 2014; Merriam & Tisdell, 2016).
In addition, the qualitative method defines the researcher as the instrument and facilitates
the integration of the researcher’s motivation, interest and personal goals with the conceptual
framework to provide justification for the research (Maxwell, 2013)
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 54
Sample and Population
This qualitative study is an example of two-tier sampling by establishing criteria for
participants and documents and by selecting participants and documents based on the criteria
(Merriam & Tisdell, 2016). Six participants will be recruited by communication with NCAA
Division I university athletic department staff, university educators, former athletes, mental
health professionals, and professionals in sports related fields. This communication will facilitate
a purposeful sampling and will result in a snowball or network sampling from the initial
participants (Merriam & Tisdell, 2016). These participants will be deliberately selected and will
be critical in testing the theories in the study (Maxwell, 2013). The population in the study will
consist of six interviewees of different ages and different sports backgrounds. These participants
will be selected because they meet criteria regarding knowledge and experience as former female
university athletes who attended a California university and competed at the NCAA Division I
level while enrolled as full-time students. Participants will be between 25 and 35 years of age.
Former female university athletes meet the criteria for cognitive and emotional development for
reflection on the possible barriers to mental health services and their coping strategies for mental
health issues during their competitive years. This adult period of life span displays numerous
coping strategies including effort, exertion, problem-solving, and information seeking which
contribute to coping and self-regulation (Fingerman et al., 2011). In addition, these former
athletes will be able to participate in the study without the inhibitions or restrictions due to
stigma, objectification, stereotyping, or microaggressions (Kaskan & Ho, 2016; López & Levy,
2013; Scott & Derry, 2005).
The documents selected are three popular culture documents: a transcript of a video
interview with Billie Jean King conducted hours prior to the 2018 U.S. Open Tennis Women’s
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 55
final match between Serena Williams and Naomi Osaka on September 8, 2018; a full transcript
of Serena Williams’ dialogue with the umpire and referee during the U.S. Open Tennis Women’s
final match on September 8, 2018; and the transcript of the Nike “Just Do It” commercial,
“Dream Crazier”, played on February 24, 2019. The authenticity of these documents was
assessed based on the dates of recording of live video and the date of the upload of the
commercials on the internet (Merriam & Tisdell, 2016). Authenticity issues could include editing
of the live videos and commercial and the real and idealized version of the personalities
(Merriam & Tisdell, 2016). The selection of these documents was based on the proximity of the
date and time of these transcripts and the perspective on female athletes, the researcher utilizing
intuition as the primary instrument in data gathering, and the researcher’s hunch that these
popular culture documents may be a relevant and a timely discovery related to the conceptual
framework of this study (Merriam & Tisdell, 2016).
Qualitative Instrumentation
This study utilizes both interviews with former female university athletes and document
analysis to gain increased knowledge about factors that may contribute to female university
athletes underutilization of mental health services and the coping strategies they may utilize in
the absence of mental health services. Qualitative methods provide the design to understand the
experiences of female university athletes and the meaning they have constructed related to
mental health access and coping with mental health issues (Merriam & Tisdell, 2016).
Interviews
Qualitative interviewing focuses on the researcher as the instrument, and disclosure of
information by the participants is dependent on the characteristics and skills of the interviewer
(Patton, 2002). If the interviewer relates true interest and genuine care about the perspectives of
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 56
participants, then the depth of disclosure of the participant is increased (Patton, 2002). Interviews
to gain knowledge about female university athletes’ perceived barriers to mental health services
and strategies to cope with mental health issues seem most aligned with the qualitative
investigative method of interview through semi-structured questions. The use of semi-structured
questions facilitates a collaborative dialogue by selecting questions that vary from less to more
structure and allow flexibility in language within an interview guide for systematic and
sequenced questioning on topics and issues (Merriam & Tisdell, 2016; Patton, 2002). Qualitative
types of interview questions are best matched to gaining the female university athletes’ feelings,
opinions, values, knowledge, and present and past beliefs and behaviors regarding mental health
issues (Patton, 2002). These methods provide for the individualization of interview questions for
each participant, which allows for the collection of a richer, denser material to provide greater
understanding of the participants’ experiences (Weiss, 1994).
These interviews will assist the researcher in providing data related to the qualitative
research questions that guide the study:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 57
Documents
Three popular culture documents were selected to provide a framing for critical research
and the transformative worldview. They also providing a context of a historical and current
perspective of the female athlete from a feminist view as well as the image of the female athlete
from a consumer marketing view. The female university athlete is placed in an environment
which has historical barriers to access to mental health services, and the current context of media
and popular culture influence that environment and how these athletes and the public make sense
of their everyday lives (Bogdan & Biklen, 2007). These popular culture documents communicate
a message to female athletes and spectators, and analysis of these documents will evaluate what
message is communicated based on the paradigm of a critical or transformative belief system
(Bogdan & Biklen, 2007). The analysis of popular culture documents provides a “holistic
account” in the development of a complex view of the data from the research questions and
opens the study to multiple perspectives (Creswell, 2014, p. 186).
Qualitative Data Collection Approach
Data will be collected through individual interviews with former female university
athletes in a mutually agreed upon setting. The interviews will be recorded using a smart phone
and a voice recording and transcription application. The explanation of confidentiality,
anonymity and consent for recording of the interviews will be established in the interview
protocol, and verbal consent will be recorded (Glesne, 2011). The interviews will range from 30
minutes to 60 minutes. The intent is to capture the interview by recording and transcribing the
recording verbatim because the analysis will focus on participants’ verbal descriptions. The
researcher’s attention will be focused on utilization of reflective listening skills to draw deeper
disclosure from the participants. Notes will be taken at the time of the interview to capture the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 58
researcher’s reflective comments such as initial interpretations or meanings of the participant
descriptions.
Since the researcher selected former female university athletes as opposed to current
ones, issues of access with gatekeepers who determine access or consent was not required. In
addition, the ethical consideration of relationship reciprocity with gatekeepers was not necessary
to establish and eliminate a power relationship (Glesne, 2011). The researcher’s profession as a
licensed psychotherapist could influence design decisions that can facilitate or constrain the
research (Maxwell, 2013). The researcher’s profession could be a concern if the participants
anticipate professional judgement about their responses and restrict their disclosure of
information. Ethically, the researcher’s role needs to be defined as collaborator.
Protocols
The purpose of the protocol is to facilitate responses by the participants to the research
questions, which results in increased knowledge about the interior experiences of female
university athletes’ accessing mental health services or coping with mental health issues.
Structuring a protocol that allows the participant to relate their past experiences from their
perceptions and their interpretations of their perceptions yields information on thoughts and
feelings known only to the participant (Weiss, 1994). Additionally, the purpose of the protocol
design is to ethically care for the participant by adhering to all ethical responsibilities of respect,
maintaining commitments, confidentiality, not pressuring, and not doing harm (Rubin & Rubin,
2012).
The protocol sections on introductions, brief explanation, explanation of confidentiality,
request to utilize voice recording, freedom and flexibility in responses, length of interview and
other logistical concerns begin to frontload the participant regarding the study and protection of
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 59
participants’ rights (Glesne, 2011). These sections are structured to define the relationship
between the researcher and participant to lead to a conversation aligned with the research
questions that guide the study (Merriam & Tisdell, 2016).
Initial semi-structured questions were designed to collect specific data from the
participants by learning more about them (Merriam & Tisdell, 2016; Appendix A). These
questions were purposefully neutral and descriptive of experience and behavior regarding their
involvement and participation in their sport (Merriam & Tisdell, 2016).
The next questions were aligned with the research questions based on Merriam and
Tisdell’s (2016) types of questions that would stimulate deep responses. The structure of the
interview presented seven questions related to Research Question 1. The interview began with a
“feeling question” to allow the researcher to probe through affirming non-verbal and verbal
responses and displaying acceptance of the responses to facilitate a comfortable conversation
with the participant (Merriam & Tisdell, 2016). The next two interview questions were formatted
to elicit knowledge about mental health services, and the third question focused on the
experience of the participant. These questions are followed by asking a devil’s advocate
question and an ideal position question, which allow the participant to reveal information in a
disqualified way (Merriam & Tisdell, 2016). The use of these questions at this time was to
ameliorate any restriction of revealing data by the participant because the researcher is a licensed
psychotherapist and licensed educational psychologist. The seventh question was an opinion
question, again designed to elicit data but not so directly as to pressure the participant (Rubin &
Rubin, 2012).
Research Question 2 and Research Question 3 followed a format of a knowledge
question, feeling question and experience question. The five interview questions aligned with
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 60
Research Question 4 followed a format of feeling question, experience question, devil’s advocate
question, ideal position question, and opinion question with the purpose of finding a balance
between the comfort of the participant and the eliciting of deep, rich information (Merriam &
Tisdell, 2016).
The interview questions related to each Research Question were designed to generate
transcripts that could be triangulated with transcripts from the popular culture documents. The
questions were designed to generate knowledge about the participants within the frame of critical
research and feminist theory and learn if they experience an element of power influencing their
choice to access mental health services or manage their mental health issues. The answers may
provide insight into participants’ use of negative or positive attribution that reveal responsiveness
to power relations and, on an organizational level, may reveal information that is not aligned
with the goals and values of the organization for mental health of female university athletes.
The structure of the protocol was designed to deepen the relationship with the participant
and gradually request a higher level of personal disclosure. If the participant does not experience
or have a response to the participant-specific questions, then the devil’s advocate, ideal position,
and opinion questions provide a platform for the participant to report their experiences related to
others if they are not ready to report on themselves (Merriam & Tisdell, 2016).
During the interviews, the researcher will be attuned to limiting focus on external events
and encouraging the disclosure of internal states (Weiss, 1994). The utilization of probes that
incorporate reflective listening techniques, such as attentive verbal and non-verbal
acknowledgement, acceptance of internal states or emotions, and reflecting the emotions elicit
more disclosure on internal states. These internal states can incorporate expression of negative or
positive attributions that can support research that female university athletes are marginalized in
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 61
their access to mental health services and that power relations exist. If experiences are related
that indicate a marginalized population, then the application of critical theory, or feminist theory,
may align with evaluating the goals and values of the organization to address access to mental
health services for these athletes. This power relation can extend to the researcher and attention
to the actual research process must be examined (Merriam & Tisdell, 2016).
Documents
Documents were selected after a review of videos related to the professional tennis player
Serena Williams and national video commercials portraying females in sports. The criteria for
selection included the most current postings related to the 2018 US Open Tennis Women’s
Championship finals that presented or illustrated the power relations in professional women’s
tennis and commercials presenting an explicit or implicit communication about girls and women
in sports. Transcripts will be generated from audio recordings or will be available online from
videos of Serena Williams in 2018 and of the commercial.
Qualitative Data Analysis
The qualitative data will be gathered to explore responses to these research questions that
guide the study:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 62
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
Semi-structured questions were designed to collect specific data from the participants,
(Merriam & Tisdell, 2016). These questions were purposefully neutral and descriptive of
experience and behavior regarding their involvement and participation in their sport (Merriam &
Tisdell, 2016). The structure of the a priori codes will provide a basis for a conversation with the
data to note what could be relevant to the study (Merriam & Tisdell, 2016). The research
specified certain categories identified as barriers to access to mental health services. In this
study, the process includes collecting the interview and document data prior to implementing the
analysis and interpretation (Bogdan & Biklen, 2007). The analysis and interpretation for this
qualitative study will be guided by the focus of the study, to utilize basic research to gain
increased knowledge about phenomenon that contribute to female university athletes
underutilizing mental health services and the coping strategies they utilize in the absence of
mental health services (Merriam & Tisdell, 2016).
The research questions are substantive theoretical questions focused on the participants
and their lived experience that contributes to their actions (Bogdan & Biklen, 2007; Merriam &
Tisdell, 2016). The codebook will consist of a priori codes from the research and empirical codes
from the interviews, which generate reflections and ideas that contribute to modifying future
interviews through reading and re-reading the transcripts (Merriam & Tisdell, 2016). For
example, if a barrier to access to mental services is lack of knowledge of services and lack of
motivation to seek services, then a question can be generated as to whether participants
experienced explicit or implicit directives to not access services in the culture of the athletic
experience.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 63
To clearly analyze and interpret the data, a legend of numbers will be assigned to the a
priori and empirical codes in the codebook (Appendix D) to generate a categorical inventory of
the six interview transcripts and three document transcripts (Merriam & Tisdell, 2016). As the
transcripts are coded, numerical identification all categories from the codebook will referenced,
and notes will be made alongside the transcripts to identify commonality and an emerging
summary of themes (Harding, 2014). For example, although codes may be available to identify
multiple categories of objectification by the participants in the transcripts, these codes may be
discarded because of lack of reference by the participants (Harding, 2014).
The goal of the data analysis and interpretation will focus on the phenomenological
tradition and thematic analysis based on critical and transformative paradigm and feminist theory
to address issues of power and marginalization (Creswell, 2014). The goal is to explore
experiences of these athletes through their real-life perspective because the “experience a person
has includes the way in which the experience is interpreted” (Merriam & Tisdell, 2016, p. 9).
The categories and themes in the interview transcripts and document transcripts will be
evaluated for first cycle codes that develop into pattern codes to identify the communications that
result in causes or explanation for lack of access of female university athletes to mental health
services (Miles, Huberman, & Saldana, 2014). For example, if the female university athlete
experiences a communication to act empowered, then she may interpret she should not access
mental health services because she then is weak. These pattern codes can be supported by a
narrative description from the transcripts.
The data analysis and interpretation of the public culture document will focus on the
identification of a priori codes and empirical codes within document communication to female
athletes, again, based on the paradigm of a critical or transformative belief system.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 64
Analytic strategies for the interview transcripts and document transcriptions will be
included by the comparison of codes from the codebook against the data obtained in the
transcripts (Corbin & Strauss, 2008). The interview strategies will include the use of questioning
and making comparisons between interviews and documents throughout the process of analysis
and interpretation, focusing on understanding the participants’ perspective and allowing the
interviewer to conceptualize a deeper analysis while maintaining an awareness of the concrete
facts communicated by the participants and limit researcher attributions (Corbin & Strauss,
2008). For example, this researcher values sensitizing questions and theoretical questions, but
tempers the use of these questions with practical questions to move the emerging theory in a
direction supported by the data (Corbin & Strauss, 2008). The use of theoretical comparisons
allows this researcher to move from the participants’ descriptions to abstractions that explore and
answer the research questions while observing researcher assumptions or bias from the
professional perspective as a psychotherapist (Corbin & Strauss, 2008). In expanding the
awareness of the researcher of biases and assumptions, the analytical tool of “waving the red
flag” provided a method to watch for participants’ disclosure of absolute, all or nothing
responses so that the researcher does not accept the biases and assumptions of the participants
but maintains the collection of data on the coping strategies of the participants that align with the
research question (Corbin & Strauss, 2008, p.81).
The codebook also maintains a column for analytic memos detailing this researcher’s
thoughts, additional questions and potential themes in the data related to the paradigms and
psychological theories to be considered in the exploration of the data (Miles et al., 2014).
Recorded interviews will be coded and analyzed at the same time to generate a theory
that is close to the data as the raw data are constantly compared to generate a theory (Kolb,
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 65
2012). Interview transcripts will be hand coded by the researcher and a priori and empirical
codes will be assigned to participant text and entered on a spreadsheet assigned to each research
question. Member checking validates the accuracy of the participant descriptions, and
triangulation through interviews and documents will add to validity (Creswell, 2014).
Credibility and Trustworthiness
During the study, credibility or internal validity will be documented by several methods.
Triangulation represents the utilization of multiple sources of data to compare and cross-check
results by varying the sources of data collection, the time and place of data collection (Merriam
& Tisdell, 2016). The effort is to increase credibility by disputing the concern that data emerge
from a single method, source, interviewer’s biases, or theory (Merriam & Tisdell, 2016; Miles et
al., 2014). To illustrate triangulation in this study, six participants of different ages and different
sports background will be interviewed. In addition, popular culture documents provided a means
of collecting data so that the current environmental factors in the culture of female athletes could
be compared and cross-checked with the interviews.
Also, to increase credibility, member checks, or respondent validation, was implemented;
this strategy involves seeking feedback on preliminary description of participants data (Merriam
& Tisdell, 2016). Each participant will be emailed the full edited transcription. The goal of the
member check is to determine if the participants verify that the edited transcription puts forth
their experience in a way that portrays their perspectives (Merriam & Tisdell, 2016). The next
strategy will be an effort at adequate engagement in the understanding of the participants’
experiential account of the phenomena so that the researcher experiences a level of saturation of
the data and evolving findings (Merriam & Tisdell, 2016). The length of the interviews may
demonstrate a saturation level of categories representative of barriers and the exclusion of similar
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 66
categories. The researcher will also focus on openness of adequate engagement by increasing
awareness to alternative explanations for the data (Merriam & Tisdell, 2016). Given the
profession of the researcher as a psychotherapist, the aspect of researcher bias must be assessed
to avoid biased consequences on the data (Maxwell, 2013). The researcher will explain the biases
to the participants and discuss that the focus is to explore the participants’ experience and
perspective, not to interpret it from a psychotherapeutic perspective (Maxwell, 2013).
Miles et al. (2014) discuss the dependability or internal reliability of qualitative research
as demonstrating that the process of the study is consistent and stable in application to researcher
and methods. Points that can ensure dependability include clear research questions, definition of
the researcher’s role and status, clarity of paradigms, and consistency of data.
Summary
This chapter provides a summary of the methodology of the study within the context of
the statement of the problem, the purpose of the study, the research questions and the importance
of the study. The implementation of this qualitative study seeks to gain knowledge from
interview and popular culture document data. Participants will be former female university
athletes who attended a California NCAA Division I university and competed at this level while
full-time students. The qualitative research will provide an understanding of participants’
descriptive and interpretative experiences with mental health issues and their coping strategies
when facing mental health issues. Qualitative analysis of semi-structured interviews and
document analysis will be based on a priori codes from the research and empirical codes to
identify commonality and an emerging summary of themes. The richness of description from the
qualitative data aligns with the symptoms, factors, attitudes and beliefs that contribute to
underutilization of mental health services, increase knowledge of the maintenance of barriers,
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 67
and facilitate action to address underutilization of mental health services in other populations that
hold leadership roles in our society.
Chapter Four presents a discussion of the results of the data analysis and includes
reflections on the methodology and on the meaning of the results. Chapter Five presents a
discussion of utility and application of the results, implications for informing professional
practice, and recommendations for further study.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 68
CHAPTER FOUR: SUMMARY OF FINDINGS
This study utilized a qualitative method design to gain knowledge about factors and
phenomena that contribute to female university athletes underutilizing mental health services and
the coping strategies they utilize in the absence of these services. This summary of findings
presents the analysis of these data obtained from the participant interview transcripts and popular
culture document transcripts. The findings display the frequency of responses categorized by
participants’ disclosures of their knowledge, feelings, opinions, values, beliefs, and behaviors
aligned with their lived experiences with access, barriers to access, mental health issues, and
coping strategies. The frequency of responses generated the researchers’ perception of the
pattern of responses and reoccurring themes and contribute to an assertion about the pattern of
responses, reoccurring themes, and a casual explanation of the participants’ knowledge, beliefs,
opinions and behaviors. The findings from popular culture documents display the frequency of
responses that reflect current themes of social communication to girls and women in sport and
contribute to an assertion about the pattern of social communications that influence their beliefs
and behaviors. In addition, a detailed description of the implementation of qualitative
methodology and the rationale for the utilization of these methods within the transformative
worldview conceptual framework will be discussed.
Female university athletes represent a societal image of leadership and physical and
mental strength. They also face the challenge of winning national championships and achieving
peak performance. A review of the research literature indicates that, underlying this model
image, female university athletes are an at-risk population because of higher rates of mental
health symptoms and underutilization of mental health services (Etzel et al., 2006; López &
Levy, 2013). There is further evidence that barriers may restrict their access to mental health
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 69
services which may result in lack of acknowledgement of their mental health issues and lack of
seeking treatment when needed (Kern et al., 2017). Multiple barriers were identified in the
literature that are unique to female athletes and specify that fear of social stigma, objectification
and stereotyping, and microaggressions may contribute to underutilization of mental health
services. Research further indicates that the coping strategies utilized by these athletes focus on
sport performance issues rather than mental health issues (Nicholls & Polman, 2006).
Purpose of the Study
The extensive research literature on female university athletes’ lack of access to mental
health services and limited research on their management of mental health issues revealed a need
to explore and understand their experience with access, barriers to access, mental health issues,
and coping strategies. Research literature contributes to the view of historical barriers to women
as athletes and leaders in sport and the statistics for female university athletes as an at-risk
population for depression and mental health issues. A review of the literature also specifies
barriers to this population’s underutilization of mental health services, including social stigma,
objectification, stereotyping, and microaggressions to maintain objectification and stereotyping.
As female university athletes experience barriers and underutilize mental health services,
they may utilize coping strategies and may provide new knowledge through their voice to
understand why and how they use these strategies. The female athlete model image is
representative of a greater and longstanding social justice issue for women. The themes in the
research address the societal pressure on female athletes to comply and adapt to the model image
of physical and mental strength, placing their physical and mental health at risk. This data
analysis will contribute to casual explanations of the athletes’ lived experiences. The analysis of
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 70
popular culture documents will contribute to an assertion about current social communication to
female athletes.
In this effort to gain new knowledge, the analysis of these interview data presents
experiences from the participants’ disclosures that align with a priori codes generated from the
literature and those that align with empirical codes generated from their real-life explanation of
the phenomenon and coping strategies (Appendix D). The purpose of this study was to elicit
disclosure of the lived experiences of female university athletes to determine if there is alignment
with current research literature on access, barriers, mental health issues, and coping strategies or
if these experiences, given the limited literature on coping strategies, disclose new knowledge on
female university athletes’ strategies to cope with mental health issues.
These interview data were examined to generate themes from the participants’ real-life
explanation within the conceptual framework, and analysis of the popular culture documents
generated themes from a context of a historical and current perspective of the female university
athlete from a feminist and critical theory perspective and transformative worldview (Creswell,
2014) . These data also present information from the descriptive voice of the participants for
ideas for eradication of barriers to mental health services, interventions to improve mental health,
and current issues in equity in sport for all genders.
Presentation of Findings
This chapter presents the methods of the qualitative study through description and
discussion of the participants’ interview responses and the popular culture documents. Analysis
began with the review of the research literature to determine the applicable categories from what
is already known about female university athletes, access to mental health services, and
utilization of coping strategies for mental health issues (Maxwell, 2013). The review of
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 71
participant responses and disclosures determined categories of new knowledge about access,
barriers, mental health issues, and coping strategies. This phenomenological study utilized
constant comparison methods of data analysis to generate patterns, assertions, and casual
explanations by identifying the essences and core meanings of the lived experiences of the
participants (Corbin & Strauss, 2008; Creswell, 2014; Maxwell, 2013; Merriam & Tisdell,
2016). This research contributed the development of the conceptual framework to ground the
exploration of the phenomena in the study and is explored through the analysis of the popular
culture documents (Maxwell, 2013).
The summarizing and synthesizing of the frequency of responses from participant
interviews and popular culture documents inductively resulted in patterns and reoccurring
themes that support assertions and generate casual explanations about the participants’ lived
experiences. This analysis of the data was aligned to the research questions that guided the study:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
In this study, the utilization of explanatory qualitative methods research sought to gain
new knowledge about the phenomena that influence female university athletes’ underutilization
of mental health services and the coping strategies they may implement in the absence of these
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 72
services (Creswell, 2014; Merriam & Tisdell, 2016). The gathering of qualitative data from the
interviews fosters a detailed and descriptive voice of the participants’ experience of their access
to mental health services, their perception of barriers to these services, their disclosure of mental
health issues, and their discussion of strategies in coping with their mental health issues.
The qualitative research approach in this study provides the design to understand the
experiences of female university athletes and the meaning they constructed related to mental
health access and coping with mental health issues (Merriam & Tisdell, 2016). This design also
provides data on the context these athletes experience and the influence this context has on their
decisions to access mental health services or to cope with their mental health issues independent
of these services (Maxwell, 2013). The researcher-participant collaborative dialogue facilitates
critical research to increase understanding of the factors that may maintain barriers and may
support a feminist theory, critical theory and a transformative worldview to eliminate barriers to
mental health services and facilitate action to address these issues (Creswell, 2014; Merriam &
Tisdell, 2016).
The presentation of the findings will discuss each research question and the responses
from the related participant interview protocol questions. To clearly analyze and interpret the
data, a legend of numbers was assigned to the a priori and empirical codes in the codebook to
generate a categorical inventory from the six interview transcripts and three document transcripts
(Merriam & Tisdell, 2016).
These participant responses are displayed in tables indicating the frequency of response
based on a priori or empirical categories and facilitate induced patterns, themes, assertions and
causal explanations derived from the responses. Supporting participant quotes demonstrate prior
knowledge or a priori code illustrations aligned to the research literature review as well as
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 73
demonstrate new knowledge or empirical code illustrations that have not been demonstrated in
the research literature review. The themes or assertions derived from new knowledge align with
the need for additional research literature on coping strategies. The presentation of findings on
each research question will synthesize themes in participants’ responses and popular culture
documents to identify communication that illustrate issues of power and marginalization related
to barriers of stigma, objectification and stereotyping, and microaggressions resulting in lack of
access and equity.
The qualitative investigative method of semi-structured interviews is most aligned with
eliciting participants’ descriptions of barriers to mental health services and strategies to cope
with mental health issues (Merriam & Tisdell, 2016). The use of semi-structured interviews
facilitates a collaborative dialogue and is best matched to gaining the participants’ knowledge,
feelings, opinions, values, present and past beliefs, and behaviors regarding mental health issues
(Merriam & Tisdell, 2016; Patton, 2002). These methods allow flexibility for the collection of a
richer, denser material to provide greater understanding of the participants’ experiences (Weiss,
1994).
Three popular culture documents were selected to provide a framing for feminist and
critical theory and transformative worldview, providing a context of a historical and current
perspective of the female athlete. The female university athlete is placed in an environment
which has historical barriers to access to mental health services, and the current context of media
and popular culture influence that environment and how these athletes and the public make sense
of their everyday lives (Bogdan & Biklen, 2007). These popular culture documents communicate
a message to female athletes and spectators, and analysis of these documents helped to evaluate
the message communicated based on the paradigm of the conceptual framework (Bogdan &
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 74
Biklen, 2007). The analysis of popular culture documents contributes to the feminist, critical
theory, transformative worldview conceptual framework to understand the environment in which
the athletes exist and why and how they take action with a societal culture, university culture,
and team culture.
Organization of Data Analysis
The qualitative data analysis and interpretation for this study utilizes basic research to
gain increased knowledge about the phenomenon that contributes to female university athletes’
underutilizing mental health services and the coping strategies they utilize in the absence of
mental health services (Merriam & Tisdell, 2016). The data collection and ongoing comparison
and analysis of the data focus on answering the research questions by understanding the
contextual meanings and personal factors that determine the process and decisions participants
make related to mental health services and mental health issues (Merriam & Tisdell, 2016). This
data analysis is organized by research question, and, for each research question, the protocol
questions that elicited the responses are discussed. Then, the data are presented in a frequency
table which reports frequency of participant response to a priori and empirical categories.
Following the frequency tables, participant quotes are integrated into the analysis to
illustrate alignment to the a priori codes or empirical codes and resultant themes and assertions.
Conceptual themes are identified to determine a pattern in responses and the relationship
between responses to assist the researcher in developing a causal explanation for participant
knowledge, feelings, opinions, values, beliefs and behaviors (Harding, 2014). These conceptual
themes contribute to a middle-range theory and relate to each research question.
The analysis of the popular culture documents was categorized by the same procedure as
the participant interview data, and these data will be integrated into discussion for a specific
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 75
research question to illustrate societal and cultural implicit or explicit communication related to
the feminist or critical theory and transformative worldview.
Descriptive Characteristics
The descriptive characteristics include procedures for the two samples: the participants
and the popular culture documents. The participants, through the explanatory qualitative
methods, provide the descriptive voice to the phenomenon that affects their access to mental
health services and resultant strategies to cope with mental health issues, and the popular culture
documents provide the societal and cultural voice affecting women in sport. This study
facilitates disclosure of the specific factors that influence access and coping strategies, and the
popular culture documents facilitate disclosure of the media communication that results in
attributions to female athletes.
Interview Data Collection
The procedures for data collection included identifying a sample population and
implementing recruitment procedures. The criteria for participants specified knowledge and
experience as former female university athletes who attended a California university and
competed at the NCAA Division I level while enrolled as full-time students. The researcher
developed a recruitment letter to be forwarded to individuals who are California NCAA
Division I university athletic department staff members, university educators, former athletes,
mental health professionals, and professionals in sports related fields (Appendix A). This letter
outlined the purpose of the dissertation research, the researcher’s professional background, the
request for assistance in obtaining participants, the criteria for participants, data collection
procedures, and confidentiality of data.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 76
The letter resulted in four participants, two of whom referred two additional participants
for a total of six participants. All participants responded or were introduced by email to the
researcher, facilitating the purposeful sampling through snowball or network sampling (Merriam
& Tisdell, 2016). This sampling generated a population of six interviewees between the ages of
25 and 31 with participation in different sports. Each participant was emailed the participant
information sheet outlining the purpose of the study, participant involvement, confidentiality,
and contact information (Appendix B).
Once a convenient time and place were arranged for the interview, the researcher traveled
to meet each participant for a face-to-face interview with the exception of one participant who
lived out of state and completed a live video interview. Upon meeting with each participant, the
information sheet was reviewed, and each participant signed to indicate receipt and
understanding of the information. The interview began with the researcher reading the
participant interview protocol to explain the purpose of the interview and confidentiality, consent
for voice recording and transcription, freedom and flexibility in their responses, and the length of
the interview and any other logistical concerns (Appendix C). All participants gave verbal
consent to recording and transcribing the interview, and this consent was documented on the
audio recording.
The interview protocol was followed with each participant, and the interview questions
and probes corresponded to the research questions in an order that would deepen the relationship
and gradually request a higher level of personal disclosure from the former athlete (Merriam &
Tisdell, 2016; Patton, 2002). When posing each interview question, the researcher utilized
listening skills and probes based on Carl Rogers’ methods, which displayed unconditional
positive regard and acceptance of the former athletes’ responses and encouraged further
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 77
disclosure through the use of attentive body posture, encouraging voice tone, eye contact, brief
verbal acknowledgement of each response, acceptance of each response, and reflection of
emotional disclosures (Rogers, 1951).
The six interviews produced approximately 6 hours of collaborate interviews and 107
pages of transcription. The interview appointment was requested for 30 minutes, but the
interviews averaged 52 minutes and generated over 17 pages of transcription. Audio recordings
were verified by the researcher against the transcriptions and edited to maintain accuracy with
the participants’ audio recordings. All edited transcriptions were emailed to the participants to
verify accuracy, and no corrections were requested by the participants.
Table 1
Participant Interview Data
Participant Minutes of Interview Pages of Transcription
1 44:19 17
2 48:31 17
3 42:26 16
4 43:01 16
5 46:82 14
6 88:58 27
Mean 52:20 17.83
Interview Participants
Participants were selected through two-tier sampling by establishing criteria and
identifying participants and documents aligned with them (Merriam & Tisdell, 2016). The
researcher’s communication with NCAA Division I university athletic department staff and
educators, former athletes, mental health professionals, and professionals in sports-related fields
facilitated purposeful sampling, resulting in a snowball or network sampling focused on the
unique and rare characteristics of the female university athlete (Merriam & Tisdell, 2016). This
sampling generated a population of six interviewees of different ages and different sports
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 78
backgrounds who met criteria regarding knowledge and experience as females and former
university athletes who attended a California university and competed at the NCAA Division I
level while enrolled as full-time students. The participants were between 25 and 31 years of age,
they self-identified their race as White (n=5) and Asian (n=1), and they all self-identified their
gender as female, and their sexual orientation as heterosexual. The age range of the participants
meets the criteria for cognitive and emotional development for their reflection on the possible
barriers to mental health services and their strategies for coping with mental health issues during
their competitive years. In addition, because they are former athletes, they participated in the
study without the inhibitions or restrictions due to stigma, objectification and stereotyping, or
microaggressions from athletic staff or team members (Kaskan & Ho, 2016; López & Levy,
2013; Scott & Derry, 2005).
The initial interview questions served to identify the participants’ athletic experience
prior to NCAA Division I competition and the support network during this prior experience.
Each participant disclosed a history of athletic experience and an environment that fostered that
experience.
Table 2
Participant Characteristics of Athletic Experience Prior to Division I Competition
Participant Years of
Competitive
Athletic
Experience Prior
to University
Type of Sport
Experience
Prior Experience
in University
Sport
Experience with
Significant
Supporters
1 12 Basketball
Volleyball
No Family
2 12 Soccer Yes Family
3 11 Softball
Basketball
Volleyball
No Family
Friends
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 79
Table 2, continued
Participant Years of
Competitive
Athletic
Experience Prior
to University
Type of Sport
Experience
Prior Experience
in University
Sport
Experience with
Significant
Supporters
4 15 Figure Skating
Volleyball
Water Polo
Yes Family
5 11 Tennis Yes Family
Coach
6 10 Taekwondo
Water Polo
Yes Family
Table 3
Participant Characteristics as Former Division I Athletes
Participant 1 2 3 4 5 6
Current Age 27 31 25 28 31 26
Sport Rowing Soccer Rowing Water Polo Tennis Water Polo
Age Began
as DI Athlete
18 18 18 18 18 18
Years as DI
Athlete
4 4 4 4 4 5
DI
Conference
Big Sky Big Sky Mountain
West
West
Coast
Pac-12 Mountain
West
Scholarship Yes Yes Yes Yes Yes Yes
Interview Data Analysis
The participant interview data analysis was generated through a priori codes from the
research of the literature and empirical codes generated from new categories disclosed by the
participants. The a priori codes reflect previous research and generated the themes that contribute
to the conceptual framework for the study. The development of empirical codes from
participants’ responses and disclosures provided new knowledge about their knowledge, feelings,
opinions, values, beliefs and behaviors. The participants’ responses were evaluated through
comparison of similarities and differences with other participant responses to generate empirical
categories (Corbin & Strauss, 2008). The participant response analysis to the sensitizing
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 80
questions was compared to a priori codes and an analysis was made to determine the frequency
of responses that align with a priori codes from the review of the research literature. The
alignment of the participant responses and the a priori codes lends documentation to the research
literature categories. The analysis of participant responses to the sensitizing questions was also
compared to the empirical codes, producing a frequency of responses for these codes. The
researcher completed all a priori and empirical coding by hand, following the preference to
personally review and know and reflect upon the data for understanding of the context of the
responses and consistency of coding (Alkin & Vo, 2018).
Interview Data Presentation
The presentation of data followed the procedure of presenting the research question and
the correlation with the participant interview protocol questions. The responses from these
interview questions were categorized by on a priori or empirical categories and the frequency of
participant responses are displayed in tables (Alkin & Vo, 2018). The participant responses were
entered into a spreadsheet to display the categories and quotes for documentation of categorical
real-life description of experiences. Based on the categories and responses, a discussion of the
patterns, themes, assertions, and causal explanations is presented. Supporting quotes from
participants align with and support a priori categories and research literature or align with
empirical categories that relate to new knowledge about the participants’ lived experiences.
These participant responses were synthesized to participant response themes, popular culture
document themes, and the societal implicit and explicit communication to the female university
athlete that illustrates the feminist, critical theory and transformative worldview, and issues of
power and marginalization related to barriers of stigma, objectification and stereotyping, and
microaggressions resulting in lack of access or lack of equity.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 81
Popular Culture Document Data Collection
The documents selected are three popular culture documents: a transcript of a video
interview with Billie Jean King conducted hours prior to the 2018 U.S. Open Tennis Women’s
final match between Serena Williams and Naomi Osaka on September 8, 2018; a full transcript
of Serena Williams’ dialogue with the umpire and referee during the U.S. Open final women’s
tennis match on September 8, 2018; and the transcript of the Nike “Just Do It” commercial,
“Dream Crazier” aired on February 24, 2019. The interviews, dialogues and commercial voice
overs were recorded on a smart phone and utilizing a voice recording and transcription
application. The audio recordings were verified by the researcher against the transcription and
edited to maintain accuracy with the video, dialogues, and voice over recordings.
Popular Culture Document Participants
The three popular culture documents were all originally portrayed on television or video
productions. The interview with Billie Jean King included her interviewers. The television
taping of the 2018 U.S. Open final women’s tennis match included a clip of dialogue between
Serena Williams, the presiding umpire, referee, and event supervisor. The Nike commercial
included multiple video clips of professional and amateur female athletes with the voice over by
Serena Williams.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 82
Table 4
Popular Culture Document Data
Site Setting Participants Length of
Observation
Prime Video Set,
U. S. Women’s
Tennis Open 2018
Outside Center Court
Shinnecock Hills Golf
Club, Tuckahoe, New
York
Billie Jean King
Interviewed
Catherine Whitaker
Interviewer,
Annabel Croft,
Interviewer,
19 Minutes
Center Court, U.S.
Women’s Tennis
Open 2018
Women’s Final Match
Shinnecock Hills Golf
Club, Tuckahoe, New
York
Serena Williams,
Competitor, Umpire,
Carlos Ramos,
Referee, Brian
Earley, Grand Slam
Supervisor, Donna
Kelso
6 Minutes
Nike “Just Do It”
Media Commercial
“Dream Crazier” aired
February 24, 2019
Serena Williams,
Narrator,
Professional and
Amateur athletes
1 Minute 30 seconds
Popular Culture Document Data Analysis
The analysis of the popular culture documents was categorized as the participant
interview data, and these data were integrated into the presentation for each research question to
illustrate societal and cultural implicit or explicit communication related to the feminist or
critical theory and transformative worldview. The transcripts from the documents were compared
to the code categories to determine the frequency of participant disclosures or narrations aligned
with a priori or research literature categories or empirical or participant generated categories. The
researcher completed all a priori and empirical coding by hand, following the preference to
personally review and know and reflect upon the data for understanding of the context of the
responses and consistency of coding (Alkin & Vo, 2018).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 83
Popular Culture Document Data Presentation
The dialogue from the transcripts of the popular culture documents was categorized on a
priori or empirical categories and a display of frequency of responses illustrated on a table (Alkin
& Vo, 2018). The dialogue from the transcripts was entered into a spreadsheet to synthesize the
dialogue into a priori and empirical categories and supporting quotes to generate themes or
assertions that relate to new knowledge about societal and cultural explicit and implicit
communication that illustrates the feminist or critical theory and transformative worldview,
issues of power and marginalization related to barriers of stigma, objectification and
stereotyping, and microaggressions resulting in lack of access and lack of equity.
Popular Culture Documents Findings
Popular culture documents include communications that inform and influence the public
(Merriam & Tisdell, 2016). The communications in the study’s selected documents were
analyzed based on the communications that align with the a priori factors related to barriers to
access to services and coping strategies. Although the participants explored the barriers to access
to mental health services and their coping strategies in dealing with mental health issues, in these
documents, references of barriers to access can generalize to barriers to access or equity and
coping strategies can generalize to coping strategies in dealing with access or equity issues.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 84
Findings: Billie Jean King Interview
Table 5
Billie Jean King Interview Document Communications as Percentage of A Priori Factors
Related to Barriers to Access to Mental Health Services
______________________________________________________________________________
Document Communications
n = 23
Category Responses
Barrier to Access 13.0%
Negative Perception by Others 8.7
Objectification and Stereotyping 4.4
Performance 4.4
Coping Strategies 87.0
Seek Supportive Training Culture 4.4
Approach Strategies 4.4
Motivation 8.7
Goal Setting 61.0
Resilience 4.4
Self-Reliance 4.4
During Billie Jean King’s interview prior to the 2018 U.S. Women’s Tennis Open final
match, she discusses her experience and views as a leader, and her comments align with the
characteristics of transformational leadership as defined by Bennis and Nanus by defining her
vision, creating trust and utilizing her strengths (Northouse, 2013). The frequency of her
responses displays 87% of her communication is about utilizing coping strategies based on her
experience with barriers. The frequency of references to barriers was 13% and includes the
negative perception of others as 8.7% and objectification and stereotyping related to performance
as 4.4% of her communications. In relationship to her leadership responsibility to athletes of all
genders she comments,
My job is to support them and get them to try to carry on inclusion and do the right thing
and make the world a better place because we have a platform as an athlete. Athletes
really have a chance to be leaders in this world.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 85
This interview also contains communication from a historical perspective, aligned with the
research literature because King joined the legacy of athletes, coaches, and administrators to
open opportunities in sport for women by reducing gender division and increasing gender equity
(George, 1988). King discloses,
We were right there, alongside the women’s movement, you know sports are microcosm
of society where we’re really living through what was evolving and happening in politics
and all over, but you know even here at the open 50 years ago, Arthur Ashe, you know
the first black male player to win a major, and then Virginia Wade won the first US Open
being British. That was amazing. I know that because I lost to her, she beat me very
easily.
This statement relates to barriers and the research that verifies the ongoing negative perception of
women who competed in sports and identified with strength and power since the 1928 Olympics,
(George, 1998). King voices her view:
I am a feminist. It was just back in the early days if you said that word people didn’t
understand. Even when I played Bobby Riggs in 1973, they said are you feminist? And I
knew if I said yes that I would lose half the people or more, all men, and some women.
So, I found that I didn’t use that word. Now I can use it because it’s good now, people are
fine with it.
King displayed 61% of her communications related to goal setting and her communications align
with the research of Gollwitzer and Sheeran (2006) on goal intention. These authors discuss how
the athlete’s goal intention is a movement from thought about the event to the identification of
the action to be performed and the level of effort required. King discloses,
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 86
I always know that every generation always has to keep fighting for freedom and
equality. If you let up one moment, it can go backwards so quickly. We’re always in a
tenuous position, just like in a match you know you can be ahead; you can have match
point and still lose. So, you never take anything for granted.
This interview communicates themes of leadership, fighting for equity, and awareness of the
receptivity and limits of the population who are receiving the communication, as King states,
Sometimes you lead from the front. Sometimes you lead from the back, sometimes
actually great leaders have to know when they when they should be a supportive person
and just be quiet and support the leader or support the group so that just takes flexibility.
Findings: U.S. Women’s Tennis Open 2018
Table 6
U.S. Women's Tennis Open 2018 Document Communications as Percentage of A Priori Factors
Related to Barriers to Access to Mental Health Service
Document Communications
n = 23
______________________________________________________________________________
Barriers to Access 95.6
Negative Perception by Others 47.8
Administrators 47.8
Microaggression 47.8
Restrictive Gender Role 47.8
Coping Strategies 4.4
Prioritize Performance 4.4
This transcription of Serena Williams from the Daily Mail is entitled “Full Transcript of
Serena’s Sensational Outburst” and provides her responses to the penalties given by the umpire
and her comments to the referees. This conversation took place during the 2018 finals match,
after a series of penalties imposed by the umpire. The frequency of responses displayed her
communications as experiencing barriers to access to equity in treatment as 95.6% and within
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 87
that category indicating 47.8% as communications that relate negative perception by the umpire
and 47.8% as communications about the umpire and microaggressions in the form of penalties
based on restrictive gender roles. The coping strategy, 4.4% of her communications, utilized by
Williams is aligned with prioritizing performance by requesting the intervention of the referee.
The title of this transcript supports the literature review by Hall and Oglesby (2016).
These authors summarize articles that challenge the hegemonic views of masculinity and
femininity in sport and provide evidence that the model image of female can be changed by
reformulating gender stereotypes. Kaskan and Ho (2016) and Steinfeldt et al. (2011) discuss the
gender-based biases that take a subtle form and the implicit rules requiring conforming to gender
norms as lack of conforming can result in punitive actions. Kaskan and Ho (2016) also discuss
that, if a female athlete confronts the microaggressor, the athlete can be judged as over-emotional
or over-reactive, placing the athlete in a double bind that continues oppression of females.
Williams stated to the umpire after a penalty for throwing her racket, “I never got coaching. I
explained that to you and for you to attack my character then something is wrong. You’re
attacking my character. Yes, you are. You owe me an apology.” She responded to umpire again
after being down 4-3 in the second set, “You will never, ever, ever be on another court of mine
as long as you live. You are the liar. When are you going to give me my apology? You owe me
an apology.” The umpire then gave another penalty and docked her a game. Williams responded,
Are you kidding me? Are you kidding me? Because I said you were a thief? You stole a
point from me. I’m not a cheater. I told you to apologize to me. Excuse me, I need the
referee, I don’t agree with that.
Her request for the referee aligns with research that reports that athletes utilize strategies to deal
with psychosocial stressors and performance stressors that result in intrapersonal outcomes of
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 88
resilience, self-reliance and the interpersonal outcomes of seeking social support (Nicholls &
Polman, 2006; Rice et al., 2016).
When the referee arrives, Williams informs him,
There are men out there that do a lot worse and because I’m a woman you’re going to
take this away from me. That is not right. And you know it and I know you can’t admit
it, but I know you know that it is not right. I know you can’t change it but I’m just saying
that is not right. I get the rules but I’m just saying it’s not right.
Scott and Derry (2005) discussed that objectification denies equity in treatment for ability
because of expectations of femininity. This pattern in the transcript addresses the societal
pressure on female athletes to comply, as she expressed in her interview after the match,
I’m here fighting for women’s rights and for women’s equality and for all kinds of stuff.
For me to say “thief” and for him to take a game, it made me feel like it was a sexist
remark. He’s never taken a game from a man because they said “thief”. It blows my
mind. I just feel like the fact that I have to go through this is just an example for the next
person that has emotions, and that wants to express themselves, and wants to be a strong
woman.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 89
Findings: Nike Dream Crazier Commercial
Table 7
Nike Dream Crazier Commercial Document Communications as Percentage of A Priori Factors
Related to Barriers to Access to Mental Health Services
Document Communications
n = 19
______________________________________________________________________________
Barriers to Access
Social Stigma 15.0
Mentally Ill 15.0
Microaggressions 30.0
Restrictive Gender Role 30.0
Over emotional 10.0
Over reactive 10.0
Physical Form 10.0
Coping Strategies 55.0
Motivation 5.0
Goal Setting 50.0
Nike unveiled the “Dream Crazier” advertisement as part of their “Dream Crazy”
campaign, during the Academy Awards ceremony on February 25, 2019. This advertisement is a
90-second video of female athletes of historical significance as well as girl athletes challenging
gender norms in sport. Serena Williams narrates the video and the analysis of communications is
based on the transcription of the narration. The frequency of communications displayed 15%
related to social stigma due to crazy behavior which was aligned with the a priori category of
mentally ill. Additionally, 30% of the communications aligned with the category of
microaggressions based on restrictive gender roles, defining the athletes as over emotional, over
reactive or outside the norm of physical form. The transcript displayed 55% communications
related to the category of coping strategies, with 5% aligned with motivation and 50% aligned
with goal setting.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 90
The transcript is divided into two sections. The first section aligns with stigma and
microaggressions, and the second section aligns with intrapersonal coping strategies of
motivation and goal setting. The first part of the script reads,
If we show emotion, we’re called dramatic. If we want to play against men, we’re nuts.
And if we dream of equal opportunity, delusional. When we stand for something, we’re
unhinged. When we’re too good, there’s something wrong with us. And if we get angry,
we’re hysterical or irrational or just being crazy.
The patterns and themes of these communication reflect the research of the historical
objectification of female university athletes through reports of emotionalism and loss of control
as opposed to their performance and achievements (George, 1988). These themes are also
supported by late nineteenth century and early twentieth century beliefs that women were not
matched to athletic competition and that vigorous sport could undermine health and reproductive
ability (Dowling, 2001). Scott and Derry (2005) established that there is social pressure for the
female athlete to maintain a feminine appearance and that a muscular build and strength are
identified as masculine. When female athletes that do not exemplify the gender norm of
femininity, they are subject to microaggressions from society and the media (Kaskan & Ho,
2016). The next section of the script reads,
But a woman running a marathon was crazy. A woman boxing was crazy. A woman
dunking? Crazy. Coaching an NBA team? Crazy. A woman competing in a hijab,
changing her sport, landing a double-cork 1080 or winning 23 grand slams, having a baby
and then coming back for more? Crazy, crazy, crazy, crazy, and crazy. So, if they want
to call you crazy? Fine. Show them what crazy can do.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 91
These communications align with transformational leadership strategies and intrapersonal
coping strategies, with the implicit message fostering motivation and goal setting. Northouse
discusses characteristics of transformational leadership and the leader-follower relationship as a
reciprocal relationship which results in raising each to their highest potential and highest
performance (Northouse, 2013). These patterns and themes of motivation and goal setting find
support in the research by Csikszentmihalyi et al., (2007) which discuss the intrapersonal flow
experience from events being consciously processed which build on the individual’s mastery and
motivation to continue to increase mastery. The communications also align with motivation and
the intrapersonal question “how can I do it?” This alignment is parallel to goal intention and the
development of goal achievement and self-regulatory strategies (Maehr & Zusho, 2009). In
addition, attribution theory aligns with intrapersonal theory of performance success because
when athletes attribute success to effort, success viewed as due to effort increases self-esteem
(Graham & Williams, 2016).
Research Question Findings
Data analysis provided the identification of units of meaningful responses from the
participant interviews or popular culture documents to answer the research questions that guide
the study (Merriam & Tisdell, 2016). The findings are aligned with each research question and
display the frequency of participant responses from the semi-structured interview questions as a
percentage of a priori or empirical categories. Participant quotes are integrated to illustrate the a
priori or empirical categories and patterns of responses identify reoccurring themes. These
themes generated an assertion about the essence of the participants’ lived experiences, and
insights from these data contributed to a casual explanation of the phenomenon. The
characteristic all participants displayed was extensive athletic experience since childhood prior to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 92
Division I competition and all identified their significant supporters as family members. One
athlete included friends, and one athlete included her coach (Table 2). The influence of data from
the popular culture documents on societal and culture communication upon the assertions and
causal explanation were also in integrated into the discussion on the findings for each research
question.
Findings: Research Question 1
The first research question asked, “How do former female university athletes describe
their experiences in attempting to access or accessing mental health services in the university
setting?” The first research question generated a participant protocol of semi-structured interview
questions to elicit an experiential description of the athletes attempting to or accessing mental
health services, and these questions were designed to generate the participants’ feelings,
knowledge, and opinions (Merriam & Tisdell, 2016). In their seminal study in 1990, Selby et al.
found only 5% of student university athletes access services from a mental health practitioner.
National Collegiate Athletic Association (NCAA, 2016) research indicates only 36% of female
student-athletes strongly agree that they have access to mental health services within the athletic
department.
Pattern of responses. The participant responses are displayed as a percentage of the total
responses disclosed in the interviews that aligned to a priori or empirical categories. All of the
six former athletes’ highest frequency of responses to Research Question 1 was characterized by
lack of knowledge or lack of availability to mental health services. The responses showed that
57.1% of the responses indicated the participant’s lack of access to services with 31.0% based on
lack of knowledge of these services and 26.2% based on lack of availability of services. Athlete
disclosures provide supportive quotes to reflect the significant percentage of responses to these
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 93
athletes not having knowledge about mental health services and within this voice is the response
of not having availability to services.
The majority of the responses correlate with prior research categories, as four participants
stated they were not knowledgeable about mental health services or the availability of these
services at their university or athletic department. Two were aware of services, one had
experience with one required counseling session, and another sought support from her academic
counselor. All six stated, upon reflection about their athlete experience, they could have
benefited from increased knowledge and access. In addition, to these categories, three
participants reported lack of access to services because of the stigma of seeking mental health
services and the perception that they are weak; they did not seek services because of judgement
from others in terms of negative perception and compliance with their perception of coaches,
athletic staff, administration, and team members’ views on mental health services.
Table 8
Participants Responses as Percentage of A Priori Categories Related to Access to Mental Health
Services
Participant Responses
n = 40
Category Responses
Lack of Access to Mental Health Services 57.1
Lack of Knowledge 31.0
Lack of Availability 26.2
Barrier to Access 16.7
Social Stigma 2.4
Social Stigma of Weakness 7.1
Negative Perception by Others 7.1
Selected Coping Strategy 21.4
Selected Interpersonal Coping Strategy 19.1
Compliance with Coaches, Athletic Staff, Administrators, Team Members 11.9
Prioritizing Performance 2.4
Seek Supportive Training Culture 4.8
Selected Intrapersonal Coping Strategy 2.4
Approach Strategies 2.4
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 94
A priori themes and participant responses. In response to interview inquiry about
knowledge of mental health services, Athlete 1 stated,
Honestly, not a lot. People think it’s not a problem and that’s because they’re not talking
about it. If no one is talking about it, if it’s not out in the open, no one’s going to bring it
up. So, you just don’t think it’s a problem. No one was saying you might be depressed.
No one was talking even about signs that something was going wrong, or even talked
about what was available.
Athlete 2 continued with her experience,
Absolutely nothing. I didn’t really have much of an awareness about mental health or
issues while I was there. I think they had counseling services in general that they offered
through the health center, but I don’t know if there was anything specific for student-
athletes.
Athlete 5 included,
If I think back to my experience, had I wanted those services, I would start with my
coaches, they would direct me to services that were available. But to be proactive and say
to the team, if you’re ever struggling, it wasn’t something that they prominently put
forward.
These comments align with the research discussing reliance on the coaches, athlete staff,
administrators as possible gatekeepers to services. Their perceptions of coaches or staff as the
gatekeepers to athletic development can create a power relationship and limit access to services
unless the coach provides support (Norman & French, 2013). López and Levy (2013)
corroborate this finding and assert that student-athletes tend to rely solely on care from athletic
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 95
staff because they perceive a barrier to seeking mental health care from other providers because
of fear of violation of privacy.
These disclosures are aligned with Etzel et al. (2006) and their research and proposal to
educate administrators about the factors that place collegiate student-athletes at greater risk for
physical and behavioral health problems and propose useful practices to reduce these risk factors.
With further inquiry about the availability to mental health services, Athlete 4 disclosed,
I sometimes wish maybe they would have posted it throughout the year. I guess we
always got the beginning of the year talk or if you ever had to go in. But it would have
been nice to have something when you walked into your study table, posted there, if you
need to talk to someone, just so you see it.
Athlete 6 revealed,
We had our own medical everything, our athletic trainer, our own doctor in our
department, so we rarely ever went onto the campus. I don’t even know what they offered
on campus. And the sport psychologist wasn’t even there. It wasn’t like there was an
office where you could go in and see him, he showed up on some days before practice to
talk for like an hour before we got in the pool.
Again, these comments alignment with research on the athletic environment in that athletes look
to the athletic system for the knowledge and access to these services. Etzel et al. present a
transformative worldview for these athletes so they are not isolated in their athletic departments
and increase their access to services by a proposed educational program for athletic staff on
mental health symptoms, life stressors, advocacy for treatment by staff and student affairs
professionals.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 96
The following athletes’ disclosures related to barriers limiting access to services are
supported by López and Levy’s (2013) findings that barriers to student-athletes’ seeking
counseling is the perception of others, their coaches, athletic staff, and team members. The
authors found the student-athlete may conform to social norms to only receive assistance from
known athletic staff and may feel restricted from accessing professional psychological
counseling because of potential violation of privacy and confidentiality. Lack of knowledge and
lack of availability also included the aspect of the athletes’ receptivity to pursue knowledge and
availability. They indicated experiences that aligned with the a priori factors of barriers to access,
which resulted in the acceptance of lack of knowledge and lack of availability. Athlete 1 voiced
her perspective:
People aren’t comfortable talking about this, and we’ve built up this strength motto and
you have to be strong and everything supposed to be okay because you’re a student-
athlete and life’s good. But what’s going on in your brain? Is that good?
Athlete 3 collaborated, “Oh, absolutely, it’s such a stigma. It creates such a ginormous label.”
Further disclosure about the stigma was provided by Athlete 6:
It’s almost like, a joke. It’s not even a problem when you knew someone was failing a
class. It was so normal, like, this girl’s still failing that class, can anyone on the team can
help her? That’s no problem because that isn’t looked at as a weakness, which is so
weird. There’s no weakness in being dumb quote unquote, but there’s great weakness in
having emotions that you need to talk about.
Athlete 4 discussed how she sought services in her athletic environment, was encouraged by her
athletic department, and found mental health support through her academic advisor:
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 97
I remember every year, we had our beginning of the year meeting, and they always went
through resources. They were just like, if there’s anything you ever need, whether it’s to
go talk to somebody or if you need to be channeled out somewhere. It was definitely
there, and especially with my academic support, she was also a woman. I could go into
her and I could sit in there and cry some, she would either be able to help me or kind of
move me to someone else.
Then Athlete 6 commented on the restriction she felt:
As you graduate and your play time and scholarship aren’t dependent on it, that’s where
we’re like, let me tell you it all. But, because you still know your scholarship is still being
decided the next year, and what if the word gets back that you decided to start talking
about coach with anyone, about how you feel.
Table 9
Participant Responses as Percentage of Empirical Factors Related to Access to Mental Health
Services
Participant Responses
n = 2
Category Responses
Barrier to Access 4.8
Denial of Issue by Coaches 2.4
Denial of Issue by Athletic Staff 2.4
Empirical themes and participant responses. Athlete 4 disclosed issues as an
incoming freshman student-athlete but did not feel the coaches or athletic staff were not aware of
the significant impact of the personal relationship issues an incoming freshman could experience
and, therefore, did not consider the need for mental health services. She wished the staff could
have reinforced the availability of these services and encouraged access. Her comments further
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 98
support the need for additional research to facilitate the athletic staff to gain knowledge about the
relationship and developmental issues experienced by their athletes:
I was in a very committed relationship, and I left. That caused a lot of stress. It only
lasted so long, and there was a breakup, but then it was just this back and forth. And it’s
just because, when you’re a female and you want to get recruited, you’re going to go to
where you’re going. A lot of times, the female is the one that feels like maybe we should
make it work and maybe you shouldn’t because now you’re in this college environment
and dealing with that. That would have been something to talk about.
Assertion and proposition related to pattern of responses and themes. The pattern of
responses by these athletes contributed to themes indicating lack of knowledge about access to
services and a resultant lack of availability, but this experience was generated by an implicit
message from the athletic staff and system. This implicit message contributes to a belief by the
athlete, and this belief results in a behavior by the athlete: you do not seek help outside the
athletic system without explicit support from the athletic system. The researcher’s use of the
term athletic system includes coaches, athletic staff, administrators, and team members. Research
supports that female university athletes rarely seek mental health services and do perceive
barriers that impact their assess of services (Etzel et. al, 2006; López & Levy, 2013; Selby et al.,
1990).
Research further supports that student-athletes fear stigma as being unhealthy, weak, or
mentally ill, causing the athlete to remain within the team system for assistance (López & Levy,
2013). In addition, Norman and French (2013) discuss the perception of coaches as gatekeepers
to athletic development and this may create a power relationship that limits access to services
unless the athlete perceives the coach as supportive of these services. The pattern of disclosures
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 99
indicates upon entering the university as a student-athlete, the athlete has received little
information about mental health issues or mental health services or the availability of these
services. In addition, these athletes identify implicit messages based on the lack of knowledge
provided and the model image presented and that there is the potential for stigma and negative
perception by the athletic system if they seek mental health services. As Athlete 1 commented,
“If no one is talking about it, if it’s not out in the open, no one’s going to bring it up.”
The following assertion can be made based on the participant responses and from the
evidence from the research literature: female university athletes will access mental health
services with explicit support from the athletic system. This assertion can be rephrased as a
proposition: if female university athletes have explicit support from the athletic system, then they
will access mental health services. This assertion and proposition are supported by the
disclosures of Athlete 4 about the beginning of the year meeting discussing access to services
and her accessing support from her academic advisor.
Casual explanation of participants’ beliefs and behaviors. Maxwell (2013) encourages
the researcher’s development of a casual explanation by reflecting on “how does x play a role in
causing y, what is the process that connects x and y? This could be expressed in the questions:
How do the participants’ underlying beliefs play a role in causing their behavior? What is the
process that connects the participants’ beliefs and behaviors? The participants’ responses reveal
their development of an underlying belief about accessing mental health services and their belief
results in their behavior.
A casual explanation for lack of access can be attributed to the lack of knowledge of the
athletic system on the risk of mental health issues, identification of mental health symptoms, or
value of mental health services and the need and benefit of providing access and availability to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 100
mental health services. Therefore, in most of the athletes’ experiences, lack of explicit discussion
and education of the athletes by the coaches, athletic staff, and administrators contributed an
implicit message that shaped the athletes’ belief that they should not access services. During the
decision-making process to attempt to access or access mental health services, this perceived
implicit message contributed to the athletes’ seeking acceptance as they selected an interpersonal
coping strategy to comply with the athletic system or selected another coping strategy
independent of mental health services.
Illustration of transformative worldview. The research does collaborate issues of
power related to the athletic system and lack of knowledge which influences access and
availability or experiencing unique barriers that restrict access to mental health services. Seeking
mental health services may compromise the athletes’ model image and utility (Scott & Derry,
2005; Szymanski et al., 2011). The barriers of social stigma, objectification and stereotyping, and
microaggressions may result in lack of access to mental health services because of fear of loss of
support by coaches, athletic staff, administrators and team members. Objectification theory
asserts that a number of women are treated as objects and valued for their utility to others
(Szymanski et al., 2011). If the participants believe that access to mental health services will
compromise their utility to the athletic system and their behavior is to comply with their
perception of the athletic system, then this is an illustration of power and marginalization
resultant in lack of access.
Influence of popular culture documents. The popular culture documents also address
the issue of access and to open opportunities for women, as illustrated by Billie Jean King’s
discussion of access to equity in pay, Serena Williams’ discussion of access to equity in
penalties, and the Nike commercial’s encouragement to reach outside the gender norms for
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 101
equity in opportunity. Access to mental health care aligns with equity in opportunity.
Specifically, King emphasizes, “I always know that every generation always has to keep fighting
for freedom and equality. If you let up one moment, it can go backwards so quickly.” The
explicit message from these documents is to fight for equality, which opposes the implicit
message received by the participants that they should not seek services without the explicit
support the athletic system. Although King puts forward the visionary characteristic of
transformational leadership, her message of “keep fighting” is implemented by the participants’
disclosing their intrapersonal coping methods rather than disclosure of a transformational leader
in their athletic system that advocates for their mental health.
Findings: Research Question 2
The second research question asked, “How do former female athletes describe their
experiences with barriers to mental health services in the university setting?” The participant
protocol for this question focused on gaining knowledge, feelings, and behaviors to elicit
participant descriptive experiences with barriers to services. The term “barrier” was not utilized
in the inquiry and the focus was on participants reasons or factors that prevented them seeking
mental health services. The stereotype of the female university athlete as a model of physical
and mental toughness may contribute to attitudes and social norms which result in
underutilization of mental health services due to objectification, social stigma, protection of
privacy, and negative perception by coaches, athletic staff, and team members (López & Levy,
2013). Barriers to mental health practitioners by this underserved population do not align with
the NCAA mission to have structures and systems to meet the mental health needs of this
population and provide care for the mind, body, and sport (NCAA, 2013a, 2013b).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 102
Pattern of responses. The following tables display participant responses as a percentage
of the total interview responses that aligned to a priori or empirical categories. The highest
frequency of responses indicated 51.4% of participants experienced barriers to access in the
categories of social stigma, negative perception by others, and fear of violation of rights. The
most frequent response related to stigma at 8.1% specified the attribute of weakness. The
categories of lack of access to services due to lack of knowledge and lack of availability were
experienced as barriers in 16.2% of the responses. Participants indicated in 13.5% of their
responses that they selected a coping strategy which prevented them from seeking services and
acted as a barrier to services. In the category of coping strategies, 8.1% of responses indicated
an interpersonal coping strategy of compliance with the athletic system or prioritizing
performance. Participant responses of intrapersonal coping strategies displayed motivation and
positive self-talk. There is a distribution of small percentages of responses across the a priori
categories.
Table 10
Participant Responses as Percentage of A Priori Categories Related to Barriers to Access to
Mental Health Services
Participant Responses
n = 30
Category Responses
Lack of Access to Mental Health Services 16.2
Lack of Knowledge 5.4
Lack of Availability 10.8
Barrier to Access 51.40
Social Stigma
Help Seeking Behavior 2.7
Unhealthy 2.7
Weak 8.1
Mentally Ill 5.4
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 103
Table 10, continued
Participant Responses
n = 30
Negative Perception by Others 8.1
Coaches 5.4
Athletic Staff 2.7
Administrators 2.7
Team Members 2.7
Fear of Violation of Rights
Confidentiality 5.4
Selected Coping Strategies 13.5
Selected Interpersonal Coping Strategy 8.1
Compliance with Coaches, Athletic Staff, Administrators, Team Members 5.4
Prioritize Performance 2.7
Selected Intrapersonal Coping Strategy 5.4
Motivation 2.7
Positive Self-Talk 2.7
A priori themes and participant responses. The athletes’ description of their
experiences reflects the significant percentages of categories contributing to barriers to access to
services. Athlete 2 discloses,
I don’t think people are going to be as open to just volunteering or feeling like they have
something because I think, as a student-athlete, you want to feel like you’re all powerful,
there’s nothing that you can really do wrong. But you may be admitting failure in your
brain if you say I’m depressed or I’m anxious.
Athlete 2 continues to reveal her experience:
We were all riddled with anxiety. I think we had a really tough coach. I couldn’t describe
his personality, he was very totalitarian, which I find a lot of coaches can be. But he had a
hard time relating with us which made it even more difficult. Because you have to want
to please him to compete and that’s the daily battle.
This athlete’s responses align with the most significant frequency of responses that focus on
social stigma because of negative perception by others. This reflects the research literature in that
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 104
symptoms are demonstrated within a context of societal pressure to maintain a model image of
physical and mental strengthen and attain peak performance. She describes the desire to maintain
the model image and please the coach to maintain her competition time while “riddled with
anxiety.” This description supports a synthesis of research that demonstrates the relationship
between the social stigma of accessing mental health services, negative perception by others and
withdrawal of support that results in compromise of the model image and utility (López & Levy,
2013; Scott & Derry, 2005; and Szymanski et al., 2011). Then, Athlete 2, discloses her positive
self-talk to utilize an intrapersonal coping strategy to validate her experience and the experience
of others: “I try to influence others that it’s okay, it’s okay to not be okay, I say that all the time
it’s okay to not be okay.” Athlete 3 continues with comments about the impact of stigma:
I think that’s why a lot of people didn’t seek out it at our school because it’s, you know,
it’s a special area, the health and wellness center, you have to go to a different part of
campus. It can be very ostracizing.
Lastly, Athlete 4 elaborates on the cycle of seeking help and seeking play time: “As an athlete
you’re like, well, what are my chances now of playing. Like now what does this mean if I have
to go deal with this, so it’s just kind of that endless circle, what do you do.” She further states,
As the female athlete, don’t want to be, like, you had to go see somebody. And now is
coach thinking or your friends on the team, are they, mentally capable to play? You don’t
want to tell anybody because of that stigma, so it’s something you kind of hide away.
López and Levy (2013) make recommendations to educate athletic staff regarding
barriers to counseling, reduction of barriers, and protecting student-athletes’ privacy and this
study informs the current study in its finding that barriers to student-athletes’ seeking counseling
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 105
is the perception of others, their coaches, athletic staff, and team members. Athlete 6 discloses
her experience as the Division I model athlete:
I feel like part of being a DI athlete, you’re like bred to just know that even when you’re
not okay you have to say you’re okay and push through. That’s the mentality that has
gotten us to that position, that’s really what it is. So, I would say it would be looked at as
a weakness.
She also discloses her view on help seeking:
Unfortunately, when you’re not educated in anything psychology wise, you just deem
them as, oh, they’re crazy. You just get put in that big clump of crazy. For some reason
when you don’t know anything about it, you’re like, they’re going to be the crazy one the
team, they’re going and seeking help.
Because the range of age of the participants is between 25 and 31, they were DI competitors
between 2006 and 2012. To reflect on the dates of the research literature, the studies provided
by Scott and Derry in 2005 and Etzel et al. in 2006 on gender socialization and objectification of
females developed a course to provide education for female college students, and education for
administrators on specific student-athlete mental health issues. The participants did not report the
implementation of these studies that changed their perception to barriers to mental health
services.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 106
Table 11
Participant Responses as Percentage of Empirical Factors Related to Barriers to Access to
Mental Health Services
Participant Responses
n = 7
Category Responses
Barrier to Access 18.9
Denial of Issue 2.7
Coaches 2.7
Team Members 2.7
Time Restrictions
Competition 2.7
Health 2.7
Fatigue 2.7
Injury 2.7
Empirical themes and participant responses. The participant disclosures regarding the
empirical factors related to the athletes’ barriers to access to mental health services displayed
denial of the issue of mental health needs was a significant barrier, as 8.1% of responses. In
addition to these responses, there was a lower frequency of responses in multiple categories of
time restrictions and health issues. Athlete 3 comments on her perspective on receptivity of the
coaching staff to mental health training:
Well, my coach, had a very awful bedside manner, if that’s what you want to call it. I
mean, I think if you were to tell him there’s new trainings, we’re going to go through in
protecting our women student-athletes, I think he would laugh at the idea. It’s not worth
their time, kind of a thing.
She also discusses the team interactions:
I think that it’s mainly the stigma. Even we’re on such a large team, everyone has their
kind of a counterpart. And I think in those intimate relationships, you really get to hear
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 107
their insecurities or their trouble or their anxiety. I mean we’re all kind of family at that
point, then talk amongst each other, so and so was having a harder day.
She further discloses the factor of injury:
It’s very taxing, just trying to think, I’m going to work through it. I’m going to go out
there and I’m going to practice on this injury. And there was a lot of times that I had
friends that had stress fractures. It’s just, it’s not okay that it’s normal. It’s very cutthroat
in that way. And I think in those times there could have been more support.
And Athlete 4 discusses the concern related to presenting the issue of mental health support:
It’s something like that tends to get almost pushed aside because like I have said, that
6:00am to 11:00pm day and when am I going to fit that in, and do I feel comfortable
maybe telling Coach, can I come 30 minutes late to practice or leave 30 minutes early
because of this.
She elaborates, “You didn’t have time, that’s for sure, and not wanting to ask coach or just
overwhelmingness of I have a homework to do, so that trumps, taking care of myself.” These
disclosures by the athletes indicate a further need for additional research about the athletic
system and their recognition of stressors on the athletes related to injuries, academics, and team
culture.
Assertion and proposition related to pattern of responses and themes. The themes
generated by the pattern of responses of these athletes indicates there is an acknowledgement of
barriers to access to mental health services and an acceptance these barriers exist and that the
implicit message from the athletic system to accept barriers and develop an interpersonal or
intrapersonal strategy to cope with the barriers to services. To reduce the anxiety about stigma
and negative perception by other, the athletes utilized strategies independent of mental health
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 108
services. The overarching goal of these coping strategies is to facilitate the reduction of stigma
and negative perception to please the coach and continue to compete. As Athlete 2 stated, “You
have to want to please him to compete and that’s the daily battle.” The frequency of responses
was that 51.4% of the athletes’ experience barriers to mental health services and 13.5% of the
responses indicate the use of coping strategy to manage the existence of these barriers. This
pattern of responses is similarly supported by the research in that these participants perceive
coaches as gatekeepers to athletic development can create a power relationship and limit access
unless the coach provides support (Norman & French, 2013). The participant responses indicate
that coping strategies will be implemented by the individual athletes to manage barriers to access
to support and maintain access to competition.
The assertion based on the participant responses and research literature is: female
university athletes accept barriers to access to mental health services and utilize interpersonal or
intrapersonal coping strategies to maintain their competitive status. This assertion can be
rephrased as a proposition: if female university athletes want to maintain their competitive status,
then they will accept barriers to access to mental health services by utilizing interpersonal or
intrapersonal coping strategies.
Causal explanation of participant beliefs and behaviors. The development of a casual
explanation on how barriers to mental health services affect female university athletes’ access to
competition explores the underlying beliefs of the athletes and the athletes’ resultant behaviors.
The athletes can generate a belief based on their observations and perceptions of the athletic
system of coaches, athletic staff, administrators and team members. If the athletes adopt the
belief that accessing mental health services will result stigma and negative perception from the
athletic system and thereby compromise their competitive status, then the purpose of their
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 109
resultant behavior will be to maintain their competitive status. Behaviors will be selected to cope
with lack of access to services that could maximize their performance to maximize their access
to compete. The system of beliefs, behaviors, and coping strategies indicate the athletic system is
viewed as a gatekeeper or barrier to services and as a gatekeeper or barrier to the athletes’ access
to competition.
Illustration of transformative worldview. The concept of gatekeeper to access of
services or access to competition and action as an athlete is collaborated by the disclosures of the
participants and the research on the issues of power related to the athletic system’s perception of
stigma and negative perception and the participants’ belief that the athletic system could act upon
this perceived power relationship and limit their access to competition. The theme from Research
Question One which proposes that barriers of social stigma, objectification and stereotyping, and
microaggressions may result in lack of access to mental health services because of fear of loss of
support by coaches, athletic staff, administrators and team members, now expands to Research
Question Two to result in lack of access to competition because of fear of loss of support by
coaches, athletic staff, administrators and team members.
Influence of popular culture documents. The popular culture document describing the
dialogue of Serena Williams with the umpire provides an illustration of the explicit messages
that create an escalation of penalties for advocacy of what she perceives as fair and equitable
treatment. The implicit message from the umpire can be perceived as stating that, had she not
expressed her emotions and opinions, then she might not have received the penalties. At this high
level of competition, her advocacy had an impact on her success in competition. Therefore, an
implicit message from this event is received by female athletes and a belief may be generated
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 110
that influences their behavior. For athletes focused on the success of competition, further inquiry
about the impact of this type of event on their beliefs and behaviors would be required.
Findings: Research Question 3
The third research question asked, “How do former female university athletes describe
their experiences with mental health issues during their competitive years in the university
setting?” The participant protocol utilized semi-structured interview questions to facilitate the
athletes’ disclosure of knowledge, feelings, and experiences about their personal mental health
issues during their Division I competitive years. The characteristics being a female, a female
university student, and a female university athlete amplifies mental health risks for this
population. Female university students display twice the incidence of a major depressive disorder
than male students (Kruisselbrink Flatt, 2013). Selby et al. (1990) reported new knowledge that
female student-athletes demonstrate increased issues with diet, weight, and body image, which
result in negative emotional responses. Etzel et al. (2006) identified the female student-athlete
prioritization of performance, acceptance and praise from the athletic system as resulting in
higher rates of depression and potential irreversible health consequences of disordered eating.
Pattern of responses. The following tables display participant responses as a percentage
of the total responses disclosed in the interviews that aligned to a priori or empirical categories.
The pattern of responses aligned with a priori categories display 22.5% of emotional responses
are due to the same factors that create barriers to access services. These factors include negative
perception by team members and objectification and stereotyping and self-objectification. The
highest frequency of responses indicated 47.9% of the participants disclosed their mental health
issues and coped with these issues by interpersonal or intrapersonal coping strategies. The most
frequent response in the category of interpersonal coping strategies was the selection of 16.4% to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 111
comply with the athletic system. This response was followed by 10.5% selecting intrapersonal
coping strategies which included approach strategies, motivation, goal setting, resilience, and
self-reliance. The disclosure of the mental health issues or mental health symptoms is framed by
the athletes in their disclosures of anticipated judgement by others and judgement of themselves,
resulting in coping strategies to manage their mental health issues independent of access to
services.
Table 12
Participant Responses as Percentage of A Priori Factors Related to Mental Health Issues
Participant Responses
n = 49
Category Responses
Lack of Access to Mental Health Services 3.0
Lack of Availability 3.0
Barriers to Access 22.5
Negative Perception by Others
Team Members 1.5
Objectification and Stereotyping
Utility 3.0
Performance 3.0
Physical Form 6.0
Femininity 1.5
Self-Objectification
Body Image 7.5
Selected Coping Strategies 47.9
Selected Interpersonal Coping Strategies 35.9
Compliance with Coaches, Athletic Staff, Administrators, Team Members 16.4
Prioritize Performance 6.4
Prioritize Acceptance 4.5
Prioritize Praise 4.5
Seek Supportive Training Culture 4.5
Selected Intrapersonal Coping Strategy 10.5
Approach Strategies 1.5
Motivation 1.5
Goal Setting 3.0
Resilience 1.5
Self-Reliance 4.5
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 112
A priori themes and participant responses. Athlete 1 provides her experience of the
anxiety within the team environment related to maintaining her place to compete. The social
group of team members served a dual role as supporters during competition and then as
opponents threating her position on the team:
Rowing is unique, it’s like the ultimate team sport, but then you’re also competing
against each other every day to be in that top boat. It’s not like basketball where, if you’re
the sixth person, you’re still going to get 30 minutes of playing time. You’re either in the
top, or you’re not. And so that pressure was always there. And even if you were there,
someone was going to be right behind you try to get your spot.
Athlete 3 relates her experience of stress on her rowing team, also referring to the
microaggressions from a team member without a system of support: “I would tell you before I
even started, I had no idea what the sport was and I never even imagined, like the amount of
mental and physical stress and endurance that it requires.” She also comments on the stress of
lack of support:
I had an experience where I was getting bullied from another female athlete, and it had to
get addressed by the coaches and staff. It was just a weird process, but there’s no real
protocol of supporting the female athlete in that way, because it’s just not addressed at
all.
She also relates,
There were times, I did have an injury during my senior season. Coming back from it, it
was just me trying to get through the year. Instead of me being able to come back and
feel supported enough, even while I was out and injured. And I think that’s hard, because
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 113
in rowing, you’re injured and you’re out for a few practices, you’re easily replaced by 59
other people.
These athletes experience intra-team competition to maintain their position of access to
competition, and their comments align with the research regarding stress and lack of help
seeking due to negative perception by others and objectification for utility to the team. López
and Levy (2013) determined that barriers to student-athletes’ seeking counseling is the
perception of others, their coaches, athletic staff, and team members. These quotes describe the
interior stress and negative emotional response of the participants in their perceived absence of
support by coaches, athletic staff, and team members and their focus on intrapersonal coping
strategies of resilience and self-reliance. In viewing these responses, all the participants came to
university with 10 to 14 years of prior experience as athletes, from a family environment of
significant support, experienced in communicating about achievement and coping, and with a
history of interpersonal relationships in sport. There are multiple historical variables that
influence their processing of current experiences which contribute to the formation of beliefs and
the demonstration of behaviors.
Although all of the participants competed and maintained scholarships throughout their
years as Division I competitive athletes, they reported specific characteristics that align with the
symptoms of anxiety and depression. The research literature establishes the activators of
depression in female university students include insomnia, eating disorders, anxiety, and
intrusive thoughts (Field et al., 2012; Lombardo et al., 2014). The criteria for a majordepressive
episode lists symptoms of depressed mood as decreased interest in activities, insomnia or
hypersomnia, fatigue, and lower ability to concentrate present for most of the day (American
Psychiatric Association, 2013). Athlete 2 explained her anxiety:
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 114
I’ve been able to determine is the source of anxiety for me is my own pressures that I put
on myself. Where does that come from? The years and years of the pressure that I put
myself up to be the best athlete I could be, to perform to the best of my ability.
She elaborates,
It was a different lifestyle and I struggled a little bit with the exhaustion. I just was tired
all the time between traveling, then getting in late Sunday night from wherever we were,
and then having to be in class at 7:30 on Monday morning.
Athlete 6 revealed her anxiety about complying with the coach:
I remember I didn’t click with my coach, like she wouldn’t give me scenarios. The way
my brain works is give me five separate scenarios, so there’s more set answers, so I can
fill in the gray. But they were just like, you’re just going to know, it’ll just feel right.
Either this person will be open or this one. But when you don’t get that practice time and
you’re thrown in and you have to perform, I don’t know if she’s going to veer left and
then she’ll be open, because I haven’t played this play with her five times.
The seminal study by Selby et al., (1990) confirms sex differences and specific factors of
ideal weight, eating behaviors, and self-criticism and criticism of coaches affect university
female athletes’ negative emotions. Athlete 6 discusses the onset of her stressors:
My mom said the root of everything you’re going through now started as a water polo
player, and what you went through with college sports is literally the sum of it all. The
emotional eating, being anxious, things like that, she’s like you had none of that in high
school, none of that and nobody identified it or anything like that.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 115
She also provides her observations on the team: “There were so many head coaches telling their
athletes they need to lose weight, giving them zero support on how to get there, providing
horrible game meals, and still telling them basically they’re fat.”
Kaskan and Ho (2016), present the impact of microaggressions from society and the
media on the physical, psychological and behavioral health of the female athletes who do not
exemplify the model image of femininity. These authors discuss that these microaggressions
through the media’s support of restrictive gender roles, discount of female athletes’ abilities and
a focus on their sexual appeal (Kaskan & Ho, 2016). Athlete 1 discloses her experience of
objectification and self-objectification:
There is the body image of being a female student-athlete where you’re showing up in the
weight room every day trying to just kill it. But then, on the weekend, I’m getting all
upset because I’m trying to put normal clothes on, and I look different than all the other
girls.
She describes a specific experience which juxtaposes her motivation and goal setting with self-
objectification:
Me and two of my teammates went out and all of the guys would be like, whoa, you’re
jacked and come up to you and like feel your arms and like things like that. Part of you is
proud of it like, hell yeah, I’m so strong. But then the other part of you is like, damn, like
I’m supposed to be this cute, pretty, attractive person, and that’s not what I am.
She further describes her experience in the athletic system of self-objectification to maintain the
ideal weight: “I thought about I’m going to get weighed this morning after practice and because
of this I’m not drinking more water.”
Athlete 4 discusses her experience of self-objectification:
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 116
You’ve got to look a certain way and you had to make sure you were the certain body
type and everything. I look in the mirror, and I’m like, okay, how can I be better to be
better at this sport.”
She also discusses media publicity and her anticipation of objectification and microaggressions,
as well as her self-objectification:
I think there’s just so much now going on, especially with social media, especially with
women and athletes. Whenever there’d be action photos posted of yourself and you’re
just like, oh my gosh, is that what I look like in the water?
She continues, “I just remember, as a woman, an athlete, I would read everything that’s posted.
Why this photo and why did coach choose to do this? I feel like we think a lot more.”
Table 13
Participant Responses as Percentage of Empirical Factors Related to Mental Health Issues
Participant Responses
n = 18
Category Response
Barriers to Access 22.5
Consequence
Loss of Play Time 1.5
Loss of Scholarship 1.5
Time Restrictions
Training 1.5
Academics 1.5
Health
Fatigue 1.5
Injury 1.5
Mental Health
Depression 4.5
Anxiety 4.5
Stress 4.5
Selected Coping Strategies 4.5
Selected Interpersonal Coping Strategy 1.5
Present Personal Image
Strong and Tough 1.5
Selected Intrapersonal Coping Strategy 3.0
Overeat 1.5
Cry 1.5
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 117
Empirical themes and participant responses. The empirical categories that influence
the athletes’ emotional responses display 22.5% as the highest frequency in perceived barriers to
access to competing. Those multiple factors of consequences, time restrictions, health and mental
health contributed to the emotional responses of the athletes with the overarching theme of stress
on their ability to compete. The interpersonal and intrapersonal strategies selected to manage the
stress over maintaining their position on the first team was designed to cope but resulted in
additional personal stress and self judgement. The interpersonal coping strategy of portraying a
strong, unapproachable image also activated intrapersonal coping strategies of overeating and
crying.
Athlete 3 discussed the stress of maintaining her position in the top boat to compete and
to maintain her scholarship: “And I needed the extra financial support. I mean that’s always a
plus. I really counted on it helping me manage the finances.” She discloses her emotional
response to the mental and physical stressors in rowing: “Yeah, there was days that I was crying,
I was stressed, I was binge eating.” Athlete 6 comments on the anxiety related to attending
trainings over academics:
There are so many like, “wink-wink” optionals and captain’s practices and I know these
aren’t on the books, but I know that someone’s going to know if we didn’t show up. Like
the captain’s words will spread that so and so didn’t show up to that practice. So, you
didn’t want to be that girl had to study, sorry I can’t make it. And our coach was always
on deck. She was there for the lifeguard purposes.
She further discloses the stress to making the starting team:
First and foremost is making that travel roster. That was always such a stressful thing,
were you going to make the travel roster. I would say travel rosters would be a huge
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 118
stress point. In practice we had three sets of colors. Black was your starters, white was
like your second string, and then red like really doesn’t touch the ball. Which cap you’re
going to be in for practice was something you were fighting for.
Assertion and proposition related to pattern of responses and themes. The research
reports and supports that the athletes’ negative emotional responses are in anticipation of
negative perception of the athletic system, including team members and the resultant withdrawal
of support (López & Levy, 2013). These emotional responses can be displayed in eating
disorder, anxiety, intrusive thoughts, hypersomnia and fatigue (American Psychiatric
Association, 2013; Field et al., 2012; Lombardo et al., 2014). This negative perception elicits
negative emotional responses and is amplified when the athletes’ experience and anticipate
microaggressions to maintain the model image of femininity, demonstrating increased issues
with diet, weight, and body image (Kaskan & Ho, 2016; Selby et al., 1990). The pattern of
responses contributes to the theme of negative emotional responses related to seeking acceptance
by the athletic system to maintain their competitive position on the team. These athletes came to
the university to compete, they have been competing in athletics since they were children, and
they find productive and unproductive strategies to cope with threats to their competitive status.
Nicholls and Polman (2006) indicated in their literature review that athletes’ coping
strategies are related to performance stressors in sport rather mental health issues and coping
responses. The intersection of potential loss of their competitive position on the team due to the
negative perception of the athletic system and withdrawal of support, the intra-team competition,
objectification and self-objectification, and the selection of a coping strategy to prioritize
performance generate negative emotional responses. The reliance on the athletic system to
provide support may be the reliance on the system that activates self-objectification and negative
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 119
emotional responses (Selby et al., 1990). The highest frequency of a priori interpersonal coping
strategies shows compliance with coaches, athletic staff, administrators and team members is
35.9% of the responses, and intrapersonal coping strategies are 10.5% of the responses with the
most significant responses indicated as goal setting and self-reliance. In the empirical categories,
the highest frequency of responses activating negative emotional responses include the
anticipation of consequences, impact of training on academics, health and mental health, and
selected coping strategies to manage the stressors affecting the athletes’ team position.
The following assertion can be made from the a priori and empirical categorical
responses: female university athletes will not disclose their negative emotional responses and
stressors to the athletic system to maintain their competitive status on their team. This assertion
can be rephrased as a proposition: if female university athletes want to maintain their competitive
status on their team, then they will not disclose with their negative emotional responses and
stressors to the athletic system.
Casual explanation of participant beliefs and behavior. A casual explanation for the
athletes’ experiencing negative emotional responses and stress considers the experiences and
observations that the athletes have in their interactions with the athletic system and society. The
athletes perceive explicit and implicit messages about how to maintain their competitive status
and accept these communications from the athletic system. Based on their observations and
perceptions, they disclose the underlying belief that they need acceptance and comply with the
directives of the athletic system and society to maintain their competitive status on the team. As
the athletes process the impact the athletic system has on their ability to continue to compete,
they display anticipatory anxiety about their competitive status and their negative emotional
responses increase. As the athletes cement their beliefs about compliance with the athletic
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 120
system and anticipation of what the athletic system wants, their competitive status becomes
increasingly more stressful, and they begin processing how they can cope with their negative
emotional responses. They are identified as an at-risk population for mental health issues, but,
based on the explicit and implicit messages, they prioritize performance, acceptance, and praise
from the athletic system to ensure their competitive status. If the athletes disclose their negative
emotions, they do not have evidence they will maintain their competitive status, so they choose
to comply or cope in their own way, bypassing the athletic system, so their issues are not known.
Some of the coping strategies they utilize independent of the athletic system and accessing
services compromise their health and well-being.
Illustration of transformative worldview. The research does align with issues of a
power relationship related to the athletic system and the athletes’ focus on performance,
acceptance, and praise which comes from the athletic system (Etzel et al., 2006) The athletes,
after years of experience, understand competitive status on the team is based on ability and
performance and that they will be valued for their utility to the team. The issue they refer to in
their disclosures is their perception that there is lack of support from the athletic system for
disclosing their problems and emotional responses, which includes their team members
transitioning to opponents. The objectification from interpersonal relationships for utility to
others can result in the intrapersonal self-objectification, increase anxiety, and impact their
ability compete and perform (Kaskan & Ho, 2016). This lack of perceived support aligns with
issues of power and marginalized groups within the social structure of the athletic institution
(Merriam & Tisdell, 2016).
Kern et al. (2017) support that student-athletes can be marginalized because of the
stereotype of seeking help as weakness, which could result in coaches’ withdrawing support. As
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discussed in the sections related to Research Questions One and Two, the theme of reliance on
performance, acceptance, and praise from the athletic system additionally focuses on compliance
with the athletic system and now extends to the athlete’s coping with their negative emotional
responses and stressors without support from the system to maintain their competitive status on
their team. This perceived compliance to competition pathway further documents the athletic
system as the gatekeeper to access to competition (Norman & French, 2013). These messages
continue to support the research of the historical objectification of female university athletes
through reports of emotionalism and loss of control as opposed to their performance and
achievements (George, 1988).
Influence of popular culture documents. The popular culture documents that specify
the explicit and implicit communications to female athletes include Serena Williams’s dialogue
and the Nike Dream Crazier commercial. Both of these documents illustrate gender-based
biases, implicit rules to conform to gender norms, and lack of conforming as resulting in punitive
actions (Kaskan & Ho, 2016; Steinfeldt et al., 2011). These documents also support the research
by Kaskan and Ho (2016) that discusses that a female athlete can be judged as over-emotional or
over-reactive, which places the athlete in a double bind that continues oppression of females.
Considering the implicit messages in these documents, there is evidence that disclosing negative
emotions can compromise competitive status, so athletes choose to comply or utilize their own
coping strategies and bypass the athletic system, resulting in their issues not being known and
compromising their opportunity to compete.
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Findings: Research Question 4
The fourth research question asked, “How do former female university athletes describe
their experiences in coping with mental health issues in the university setting?” The protocol
questions for Research Question Four included semi-structured interview questions to elicit the
descriptions of the lived experience of the athletes’ coping with their mental health issues during
their years as Division I athletes. The questions invited disclosures about their knowledge,
feelings, and experiences with utilizing coping strategies in the absence of mental health
services. Kern et al. (2017) support that student-athletes can be marginalized because of the
stereotype of help seeking as weakness, which could result in coaches withdrawing support. Rice
et al. (2016) further explore mental ill health and mental health among elite athletes and report
on coping strategies utilized by these athletes, highlighting strategies focused on coping with
psychosocial stressors rather than coping with a mental ill health diagnosis (Rice et al., 2016).
Coping strategies identified in the review of the literature include approach strategies, mastery
climate, motivation and goal setting resulting in resilience, self-reliance, positive self-talk, and
seeking a supportive training culture (Rice et al., 2016).
Pattern of responses. The following tables display participant responses as a percentage
of the total responses disclosed in the interviews that aligned to a priori or empirical categories.
The pattern of responses aligned with a priori categories display the most significant frequency
of responses as 37.4% related to selected coping strategies, with 19.9% as interpersonal coping
strategies and 17.5% as intrapersonal coping strategies. There is a distribution of a variety of
strategies within each of these categories, with the most significant category of interpersonal
coping strategies as 7.0% of responses prioritizing performance and intrapersonal coping
strategies as 5.8% of responses in goal setting. There is a reduction in responses from the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 123
previous research questions to 4.7% indicating compliance with the athletic system as a coping
strategy. Other responses support the research by Rice et al. (2016).
Table 14
Participant Responses as Percentage of A Priori Factors Related to Coping With Mental Health
Issues
Participant Responses
n = 40
Category Responses
Lack of Access to Mental Health Services 2.4
Lack of Knowledge 1.2
Lack of Availability 1.2
Barrier to Access 2.4
Negative Perception by Others
Coaches 1.2
Objectification and Stereotyping
Utility 1.2
Selected Coping Strategies 37.4
Selected Interpersonal Coping Strategy 19.9
Compliance with Coaches, Athletic Staff, Administrators, Team Members 4.7
Prioritize Performance 7.0
Prioritize Praise 3.5
Seek Supportive Training Culture 3.5
Selected Intrapersonal Coping Strategy 17.5
Mastery Climate 3.5
Motivation 3.5
Goal Setting 5.8
Positive Self-Talk 4.7
A priori themes and participant responses. Athlete 4 discloses her acceptance of the
subjective decision by the coach for play time:
I mean, there’s not really too much quantitative while you’re practicing. You know
whoever’s the fastest on team but are they the best defender or are they this or that, and it
just kind of comes down to what he thinks and what he thinks is best for this trip.
Athlete 2 states the involvement with a supportive training culture:
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I never really felt homesick because you’ve had girls that you are with all the time. Even
after practice, we’re all living typically very close to each other, so you’re getting
together for dinners or taking classes together. Between that and the other teams, you just
built this kind of community and support for everybody. You always had friends, you’ve
always had a shoulder to cry on, it was really, really nice to have that family sense.
She also discusses the aspect of goal setting related to the stressors of being a student-athlete:
I think, getting the right schedule that was working for me also helped because it is a lot
of pressure between going to school for 15 hours a week and then you’re studying and
then you’re practicing and all the traveling.
And she also empathizes the intrapersonal strategy of goal setting and positive self-talk,
integrated into her interpersonal strategy of support in the training culture: “I should not, no one
should be going through that alone. But my biggest thing would be like, you don’t need to be
doing this alone.”
Athlete 4 also discusses her ability to seek support and utilize her positive self-talk:
Definitely as I got older and then was more confident with going and talking to my
support staff, it was a lot easier. Plus, you become more, you know who you are, so that
also became a little easier and just you know the stress maybe of, playing time and things
like that, you’re like, okay, I’m here I’m playing the sport I love.
These athlete disclosures align with the research literature that discusses that coping
strategies focus on psychosocial stressors and performance stressors in a strategic effort to
improve the relationships or their experiences with the athletic system and the social system
(Nicholls & Polman, 2006; Rice et al., 2016). Nicholls and Polman (2006) stated that athletes
generate a process of interpersonal and intrapersonal interactions between beliefs, goals, and
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 125
values to cope with stress. These authors also identify that females display more emotion-
focused coping, including seeking social support, venting, positive reframing, and positive self-
talk.
The athletes continued to provide specific coping strategies incorporating their beliefs
and values to generate goals and achieve goals. The intrapersonal strategies of Athlete 5
emphasize her motivation, goal setting and self-reliance: “Being in an independent sport, tennis,
and playing it from a very young age, it teaches you a level of like independent thinking, general
maturity that benefits you throughout your life.” Athlete 6 discloses her experiences in
motivation and goal setting to contribute to a mastery climate:
Well, I’m word. I always did everything. I think every single year you got like a personal
day and a couple other days, there was not a single practice I chose to miss, or I never
once took my personal day or anything like that. So, my coach knew my work ethic was
in line and I was willing to do anything and everything to show her that I wanted to play.
She elaborates her motivation and goal setting: “Every time it’s worked, I’m saying pour your
full heart into something, do extra practices, do whatever.”
These disclosures also align with the research on goal setting and coping strategies by
Gollwitzer and Sheeran (2006) and Locke and Latham (2002). Gollwitzer and Sheeran (2006)
identified a model to bridge the gap between goal intention and behavior or action, specifying the
formulation of an athlete’s goal intention to win a particular competition defines the movement
from thought about the event to determination of what action is to be performed and what level
of effort will be put forth. These authors discussed the athlete’s intrapersonal dialogue, which
contributes to imagining or visualizing the specifics of the intention and asking oneself the
questions of “when, where, and how one intends to achieve it” (Gollwitzer & Sheeran, 2006, p.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 126
82). Locke and Latham (2002), presenting an historical perspective on goal setting, stated
findings that support Gollwitzer and Sheeran’s (2006) intrapersonal theory by identifying that
communication from others does not increase performance, and that goal intention emanates
from intrapersonal self-instruction based on beliefs in the athletes’ ability, desire for the action to
be achieved, and the commitment to achieve this goal.
Table 15
Participant responses as Percentage of Empirical Factors related to Coping with Mental Health
Issues
Participant Responses
n = 46
Category Responses
Barriers to Access 11.8
Consequence
Loss of Play Time 1.2
Health
Fatigue 1.2
Injury 4.7
Mental Health
Depression 2.3
Anxiety 1.2
Stress 1.2
Selected Coping Strategies 46.6
Selected Interpersonal Coping Strategy 25.8
Present Personal Image
Strong and Tough 2.3
Unapproachable 2.3
Seek Social Support
Engage in Social Activities 1.2
Maintain Balance in Activities 1.2
Talk to family member 9.3
Talk to team members 4.7
Talk to friends 5.8
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Table 15, continued
Selected Intrapersonal Coping Strategy 18.6
Focus on life after sport 3.5
Exercise
Biking 1.2
Eating
Overeat 2.3
Journal 1.2
Sleep 1.2
Withdraw 2.3
Cry 2.3
Listen to Music 2.3
Detach 2.3
Empirical themes and participant responses. The participant responses related to
empirical categories of coping with mental health issues or psychosocial or performance
stressors indicated a frequency of 11.8% of coping strategies related to barriers to access to
competitive status. The athletes’ selection of coping strategies indicated a 46.6% frequency of
responses related to coping with barriers to access to competitive status. The frequency of
interpersonal coping strategies was 25.8% with talking to family members as the most frequency
strategy selected at 9.3%. The frequency of intrapersonal coping strategies was 18.6% with
multiple strategies selected by the athletes. The following disclosures illustrate the experiences
of the athletes. Athlete 6 described her feelings about selection of team members and loss of play
time:
I usually could like understand why, or like if I could put better reason to it, why
someone else is playing, in terms of, okay, they’re better this or that, and I get it. Some
players were better, but I got really frustrated with not being given the same opportunity.
Athlete 1 disclosures the impact of fatigue:
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And then I think what was really hard when I was struggling was usually working out
becomes like a coping, you know, like, you work through it, but like, I did not, I did not
have physical strength to work through it.
She elaborates about the interpersonal coping strategy to present an image of strength:
When I was going through that, everyone was afraid to ask me what was wrong because I
was the strong person that should never have a problem. And, so, it was like everyone
was walking around eggshells around me. And, so, the other part of me was like, I never
want that to happen to someone.
Athlete 2 reveals her strategy to seek social support: “But I think that it was just something
where you lean on your teammates they’re going through similar situations. I did lean on my
parents a lot, you know, I talked to my mom pretty much every day.” Athlete 3 collaborates
seeking social support:
I think looking back on it now, it’s kind of comical, because at the time I didn’t think that
I was stressed or anxious. And now I’m thinking, oh my gosh, like I don’t know how
some days I made it. I think I really leaned on those supports of family and friends. I have
a really big family which was helpful.
As the inquiry continued with the athletes’ disclosure of their intrapersonal strategies to
cope. Athlete 1 began to discuss the strategy of focusing on life after Division I competition:
So, then everything was just put into you being an athlete. I do think females are a little
bit better at knowing like sport is going to end. I mean, at least for rowing, like we all
knew we won’t make bank on rowing.
Athlete 2 also discussed the change in her mindset: “And, I also got to a point where my mindset
just shifted away from the sport and started focusing on life after soccer and school and looking
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 129
forward to that.” Athlete 5 also coped by looking to the future: “Having played tennis for so
many years, it was winding down for me for in tennis and I was excited about starting to plan for
my career and life post tennis.” Athlete 1 describes additional coping strategies: “I wrote a lot,
like journaling, and how I write is like me having a conversation with myself. Suddenly, so I was
afraid to talk to anyone else about it. So basically, that’s what that was a big thing.” During this
time, she also reveals, “All I wanted to do was lay in bed, which made it way, way harder on
myself. I was always by myself and that wasn’t good either.” Athlete 3 discussed another coping
strategy: “I just wanted to stay at home and kind of isolate for a while and not see anyone.”
Athlete 2 also utilized this strategy: “And then just really taking advantage of those downtimes,
don’t go to the school, don’t be around the athletic department building, really take that rest time
to detach a little bit.” Athlete 4 disclosed,
I think, definitely freshman year and then into sophomore year, I didn’t deal with it as
well as I probably could have. It was like more like, okay, I’m stressed out about
something or I’m dealing with the ex-boyfriend and now I’m coming home and I’m
blasting Taylor Swift and crying in my dorm room, which is like not the healthiest thing.
She elaborates on her other strategies:
And sometimes, I had a hard day at practice or coach yelled at me and I would get on my
bike put my headphones in didn’t matter what music and just ride. I would go to the mall
and then I would shop, and my dad would say, you’re doing retail therapy. The older I
got and the closer I got with my mom, I would call her and just let whatever I have out.
And she also reflects, “Especially as the female student-athlete, you are so competitive, so
driven, and you’re in your own lane, and sometimes you have to open those lanes and let other
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 130
people to know you need to go talk to someone.” Athlete 5 coped by finding balance in
activities:
I struggled with physical injuries particularly in my last two years. Anything that
paralyzing different parts of my life and I just tried to feel fulfilled or feel like I was
doing well in other parts of my life if it wasn’t tennis and not letting that drag me down
because I couldn’t participate or be as active.
Athlete 6 discussed her intrapersonal strategy of overeating:
When I would be studying or something, there would always be like a bag of something
and I usually like healthy food but my serving sizes of them were so ridiculous. So, I
gained a good amount of weight in college, very strong, still athletic, but it was just
rough. My coping mechanism, hundred percent was food.
She elaborates:
To be honest, I think the emotional eating thing was a good trend, there are a lot of girls
that for sure just gained weight, but I mean you’re just crying it out for sure. Tears, being
so bummed about it, there’s so many times I remember like just calling my mom being so
upset, not understanding why.
Assertion or proposition related to pattern of responses and themes. Research
literature focuses on multiple themes related to the female university athlete and the
understanding of the need for their coping strategies to manage stressors during their competitive
years. Student-athletes can experience stereotyping and marginalization because help seeking is
aligned with weakness and can result of withdrawal of support by the athletic system (Kern et al.,
2017). Scott and Derry (2005) discuss barriers to access to mental health services restrict support
to peak performance. The value of support by the athletic system and prioritizing performance is
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 131
documented by utilization of coping strategies to manage psychosocial relationships and
performance stressors (Rice et al., 2016). The pattern of responses aligned with a priori
categories display the most significant frequency of responses as 37.4% related to selected
coping strategies, with 19.9% as interpersonal coping strategies and 17.5% as intrapersonal
coping strategies. Locke and Latham (2002), introduce that goal intention emanates from
intrapersonal self-instruction based on beliefs in the athletes’ ability, desire for the action to be
achieved, and the commitment to achieve this goal. In development of an assertion and a
proposition, consideration needs to be given to the athletes’ disclosures that part of the goal is to
maintain support from the athletic system to continue to compete, which can be supported by the
most significant a priori category of interpersonal coping strategies as 7.0% of responses
prioritizing performance and intrapersonal coping strategies as 5.8% of responses in goal setting.
The empirical category frequency of interpersonal coping strategies was 25.8% with talking to
family members as the most frequency strategy selected at 9.3%. The frequency of intrapersonal
coping strategies was 18.6% with multiple strategies selected by the athletes.
There is an absence of disclosures about seeking support from coaches, athletic staff and
administration. Most of the athletes specify coping strategies independent of mental health
services, and of coaches, athletic staff, and administrators. Athlete 4 is the only athlete to state
that she sought support within the athletic department and received support, although she
additionally indicates she utilized multiple coping strategies independent of the athletic system.
Athlete 3 indicated that she attended one mandatory counseling session on campus, which was
beneficial. The athletes did not disclose that they received any other mental health services
during their competitive years.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 132
The following assertion can be made based on the a priori and empirical category
responses: female university athletes utilize strategies to cope with negative emotional responses
and stressors independent of the athletic system and mental health services to maintain support
from the athletic system. The assertion can be rephrased as a proposition: if female university
athletes utilize strategies to cope with negative emotional responses and stressors independent of
the athletic system and mental health services, then they will maintain support from the athletic
system.
Casual explanation of participant beliefs and behaviors. A pattern of beliefs and
resultant behaviors of the athletes emerges with the discussion of the findings from each research
question. The athletes hear explicit messages from the athletic system that include subjective
decisions about play time and training instructions from the coaching and athletic staff, but they
also perceive implicit messages from the athletic system that could affect their image and
competitive status on the team. The use of coping strategies independent of the athletic system
ensures protection from social stigma, protection of confidentiality and privacy, and protection
from negative perception from the athletic system. If the athletes have the belief that negative
emotional responses and negative reactions to stressors will compromise their position on the
team, then they will find a coping strategy they can implement to reduce that perception. The
strategies the athletes implement include behaviors held within the confidentiality of the
interpersonal relationships of family, friends, and team members or are intrapersonal behaviors
not observed by the athletic system that range from motivation, goal setting, self-reliance and
positive self-talk to overeating, sleeping, withdrawing, crying, and blasting Taylor Swift.
Illustration of transformative worldview. The coping strategies utilized by the majority
of the athletes include strategies discussed in the research literature: motivation, goal setting self-
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 133
reliance and positive self-talk aligned with the belief and values of the athletes so they structure
implementation of their goal (Locke & Latham, 2002; Rice et al., 2016). These strategies do
indicate many productive methods of coping that result in positive behaviors and include many
unproductive methods of coping that can result in negative behaviors. The behavioral goal of the
coping strategies appears to be to cope without disclosure of the issues to the athletic system.
Therefore, the athletes continue to demonstrate the belief disclosure to the athletic system of
their issues may compromise their model image and utility (Scott & Derry, 2005; Szymanski et
al., 2011). The continued barriers of social stigma, objectification and stereotyping, and
microaggressions now are perceived to limit access to competitive status and opportunity to play
due loss of support from the athletic system. This illustrates power and marginalization and the
belief that the athletes need to limit disclosure of issues and find strategies to cope independently
to maintain their image and utility to the team and their access to competition.
Influence of popular culture documents. Billie Jean King discusses that women need to
keep fighting, but “We’re always in a tenuous position, just like in a match you know you can be
ahead; you can have match point and still lose. So, you never take anything for granted.” This
hyperawareness of the tenuous position captures the experiences of the participants to determine
how they can stay ahead and continue to maintain their image and utility. As the analysis of
King’s dialogue illustrates research by Gollwitzer and Sheeran (2006) on the athlete’s movement
through event to action to be performed and the level of effort to be given. Based on the implicit
messages the participants experience and the beliefs generated on these messages, they decide on
the coping strategy they will use and give significant effort to the strategy. Athlete 6 displayed
this effort in motivation and goal setting when she said, “Well, I’m word. I always did
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 134
everything. So, my coach knew my work ethic was in line and I was willing to do anything and
everything to show her that I wanted to play.”
In the analysis of Dream Crazier, the statement “Fine. Show them what crazy can do.”
can carry the implicit message to take action independently, to anticipate and find strategies to
cope with stigma independently. This implicit message engenders motivation and the
intrapersonal question “how can I do it” as related to goal intention and the development of goal
achievement and self-regulatory strategies (Maehr & Zusho, 2009). The participants internal
belief system may result in independent action, which could be seen as the public influence of
the popular culture documents.
Summary
The research questions guided this qualitative phenomenological research and generated
experiential disclosures from the collaborative dialogue with the athletes about their knowledge,
beliefs, opinions, and behaviors related to access, barriers to access, mental health issues, and
coping strategies. The participants’ responses aligned with each research question were presented
in a format to display the frequency of responses related to a priori and empirical categories,
patterns and themes of responses as well as assertions and propositions related these themes and
casual explanations of the participant beliefs and behaviors. In addition, the collaboration of
themes from of the transformative worldview and the societal view of the popular culture
documents was discussed.
The highest frequency of responses to Research Question One aligned with factors from
the research literature and displayed 51% of participants indicating lack of access to mental
health with 31% stating the factor of lack of knowledge and 26.2% stating the factor of lack of
availability. The athletes also disclosed that that 16.7% did not seek access or availability due to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 135
stigma and negative perception by others, with 21.4 % revealing they selected interpersonal or
intrapersonal coping strategies to manage their lack of knowledge and lack of availability to
services. An empirical category displayed new knowledge, with the participant perceiving the
factor of denial of coaches and athletic staff of needs of incoming freshman student-athletes for
access and availability of mental health services.
Research Question Two indicated the highest frequency of participant responses, as
51.4% aligned with the a priori category of barriers to access to mental health services due to
social stigma and negative perception by others. Empirical categories generated by participants
displaying new knowledge indicated 18.9% experienced a barrier to access to services because of
their perceived factor of denial of coaches and team members of mental health issues or need for
services as well as time restrictions, fatigue and injury.
The responses to Research Question Three display the highest frequency of the
participant negative emotional responses and stressors, 22.5% aligned with a priori categories.
The factors activating the participant difficulties related to the same factors that created barrier to
access to services, such as negative perception, objectification and stereotyping, and self-
objectification. Additional responses indicated the negative emotional responses and stressors
activated coping strategies and 47.9% of the participants utilized interpersonal or intrapersonal
coping strategies during episodes of personal difficulty. There were empirical categories that
generated a new understanding of the factors that activated stress responses, with 22.5%
reporting barriers to access to services including consequences of loss of play time or
scholarship, time restrictions, health issues, mental health issues and with 4.5% selecting coping
strategies of presenting a strong image while coping by overeating and crying.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 136
Although the participants reference coping strategies in their responses to the previous
research questions, the focus of Research Question Four was to generate their disclosures on
coping with mental health issues. The highest frequency of responses aligned with the a priori
categories showed 37.4% of the responses indicating interpersonal or intrapersonal coping
strategies which ranged from prioritizing performance to utilizing motivation, goal setting and
positive self-talk. Empirical factors related to coping defined new knowledge and understanding
the athletes’ coping strategies. Of their responses, 46.6% disclosed and selected coping
strategies that illustrated very specific choices in coping. A significant interpersonal coping
strategy was to talk with family, friends, and team members, and intrapersonal coping strategies
were specific to the individual athletes coping with their specific issue and ranged from focusing
in life after sport to blasting music.
The synthesis of the assertions and propositions based on the pattern of responses and
themes indicates the athletes focused on maintaining support from the athletic system and their
competitive status by complying with the athletic system or utilizing interpersonal or
intrapersonal coping strategies to manage their issues independent of the athletic system.
The causal explanations for each research question can be synthesized by the athletes’
perception of explicit or implicit messages from the athletic system that contribute to their beliefs
and resultant behaviors. If they perceive an explicit message, they will act upon it, but, if the
messages are implicit, they will develop a belief and behavior that protects their image and
competitive status. Additionally, if they perceive an implicit message that disclosure of negative
emotions or stressors can compromise competitive status or support from the athletic system,
they will utilize strategies to cope with these issues that bypass the athletic system and maintain
their confidentiality.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 137
Throughout the inquiry process for each research question, five of the six participants’
disclosures provided observations, perceptions, beliefs, and behaviors which illustrated issues
with power and marginalization that aligned with the conceptual framework of transformative
worldview. These participants discussed their lack of access to mental health services related to
negative perception by the athletic system and resultant loss of support from the athletic system.
Additionally, they voiced their fear that expression of negative emotional responses or stressors
could also result in loss of support from the athletic system. As these athletes seek to cope with
difficulties independent of the athletic system and mental health services, they experience
potential loss of utility to the team and marginalization.
The application of the transformative worldview to this study illustrates the
analysis of the voices of these six participants joined with understanding of the need for
exploration of factors that influence female student-athletes’ access and equity within the athletic
system related to their culture, ethnicity, race, gender, and sexual orientation. The participants’
disclosures were within the context of their self-identification of race as White (n=5) and Asian
(n=1), their gender as female, and their sexual orientation as heterosexual. The demographics of
this sample did not give voice to the diversity of female student-athletes within the athletic
environment and the inter-relationship of these factors to access and equity.
The data from the popular culture documents provided a framing for the transformative
worldview through a current historical or current view and societal communications to female
athlete. The documents address issues of access and equity, illustrating restrictions in
tournament compensation, athletic opportunities, and expression of emotions and opinions. They
support that societal communication generates explicit and implicit message to girls and women
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 138
in sport, that explicit gender-based biases exist, and that there are implicit rules about
conforming to gender norms.
The presentation of the data through frequency of responses, patterns and themes of
responses as aligned with a priori and empirical factors, assertions and propositions, causal
explanations, illustrations of the transformative worldview, and the societal communication from
the popular culture documents all lend to the conclusions to be presented in Chapter Five.
Chapter Five will present a discussion of the results and findings as aligned to the research
questions that guided the study, presenting new knowledge and understandings of the
phenomena that contributed to the athletes’ lack of access to mental health services and the
coping strategies they utilized independent of services. These conclusions, through the voice of
the participants about their experiences and perceptions, will also inform practitioners on
strategies for access to mental health services, prevention of barriers, and opportunities for future
research to achieve these goals.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 139
CHAPTER FIVE: CONCLUSIONS
As female university athletes face the challenge of winning national championships, they
also face the challenge of accessing mental health services to reduce anxiety and depressive
symptoms and to support peak performance. As these athletes display an image of mental and
physical strength, they also display higher rates of mental health issues and lower rates of access
to mental health services (Etzel et al., 2006; López & Levy, 2013; Scott & Derry, 2005; Selby et
al., 1990). Additionally, barriers may prevent these athletes from acknowledging their mental
health issues and from seeking mental health services when needed (Kern et al., 2017). Prior
studies also indicate that female university athletes are treated differently because these barriers
are unique to this population (López & Levy, 2013; Selby et al., 1990). Research identifies
barriers to mental health treatment for female student-athletes as fear of social stigma,
objectification and stereotyping, and microaggressions, which lead to coping strategies to
improve performance rather than mental health (Daniels, 2009; Kaskan & Ho, 2016; López &
Levy, 2013; Nicholls & Polman, 2006; Szymanski et al., 2011).
Purpose of the Study
The purpose of the study was to gain knowledge of factors and phenomena that
contribute to female university athletes’ underutilizing mental health services and the coping
strategies they utilize in the absence of these services. The understanding of how and why
Division I female university athletes utilize coping strategies to manage lack of access to mental
health services, barriers to these services, and mental health issues can assist the athletic system
and practitioners facilitate physical and mental health for the athletes during competitive years.
This population’s experience with barriers to access to mental health services may generalize to
other populations who demonstrate leadership roles in our society. The participants’ experience
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 140
with coping strategies may provide practitioners with knowledge to align these athletes’ unique
mental health needs with evidenced-based psychotherapeutic methods for prevention and
treatment.
Research Questions
The following research questions guided the qualitative study and follow a progression in
eliciting phenomenological responses to explore the athletes’ lived experience during Division I
competition. The data collected through semi-structured interviews was summarized and
synthesized to provide understanding of the factors influencing the athletes’ access and barriers
to mental health services, mental health issues, and utilization of coping strategies in the absence
of these services.
Research Questions:
1. How do former female university athletes describe their experiences in attempting to
access or accessing mental health services in the university setting?
2. How do former female university athletes describe their experiences with barriers to
mental health services in the university setting?
3. How do former female university athletes describe their experiences with mental health
issues during their competitive years in the university setting?
4. How do former female university athletes describe their experiences in coping with
mental health issues in the university setting?
Major Findings
Significant findings are identified to summarize and synthesize the alignment of
participant responses with the a priori categories and the empirical categories that support
research literature and new knowledge. The assertions and causal explanations corresponding to
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 141
each research question provide the voiced experience of the athletes, ranging from their
compliance with the athletic system to their confidential coping strategies. In the participants’
disclosures, there is a sequence in their processing from observation of explicit and implicit
messages from the athletic system to their development of beliefs, emotional responses, and
decisions about behaviors.
For Research Question One, the responses supported the research literature in that 57.1%
of participants indicated lack of access to mental health due to lack of knowledge or lack of
availability. These data contributed to the assertion that female university athletes will access
mental health services with explicit support of the athletic system. In the causal explanation, a
lack of explicit discussion and education of the athletes by the athletic system contributed to an
implicit message that formed the athletes’ belief that they should not access services. The
symptom of anticipatory anxiety, exemplified by an increase in anxiety about future loss of
support from the athletic system, contributes to the athletes’ decision to select an interpersonal
coping strategy to comply with the athletic system or select another coping strategy independent
of mental health services (American Psychological Association, 2020).
These data in response to Research Question Two indicated 51.4% of participant
responses aligned with the a priori category of barriers to access to mental health services due to
social stigma and negative perception by others. These responses contributed to the assertion
stating female university athletes accept barriers to access to mental health services and utilize
interpersonal or intrapersonal coping strategies to maintain their competitive status. The casual
explanation is that, if the athletes believe accessing mental health services will result in stigma
and negative perception from the athletic system and compromise their competitive status, then
the purpose of their resultant behavior will be to maintain their competitive status. Their
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 142
utilization of coping strategies to maintain their competitive status reduces their anticipatory
anxiety regarding stigma and negative perception from the athletic system.
Results regarding Research Question Three were that 22.5% of participants’ negative
emotional responses and stressors aligned with a priori categories, and 47.9% utilized
interpersonal or intrapersonal coping strategies during episodes of personal difficulty. These data
contribute to the assertion that female university athletes will not disclose their negative
emotional responses and stressors to the athletic system to maintain their competitive status. The
causal explanation generated presents that the athletes, based on their observations and
perceptions of explicit and implicit messages, develop the belief that they need to comply with
the athletic system and society to be accepted and maintain their competitive status. This belief
contributes to the symptom of anticipatory anxiety about their competitive status, and they
prioritize performance, acceptance and praise from the athletic system to ensure their
competitive status. Their behavior results in the utilization of independent and individual coping
strategies to bypass the athletic system, so their issues are not known to the athletic system.
The results regarding Research Question Four demonstrate the highest frequency of
responses, 37.4%, are aligned with a priori categories indicating interpersonal or intrapersonal
coping strategies which ranged from prioritizing performance to utilizing motivation, goal setting
and positive self-talk. Empirical factors demonstrated new knowledge that 46.6% of participants
disclosed and selected coping strategies that illustrated individualized choices in coping. The
resultant assertion indicated that female university athletes utilize strategies to cope with
negative emotional responses and stressors independent of the athletic system and mental health
services to maintain support from the athletic system. The casual explanation proposes the
athletes’ utilization of coping strategies independent of the athletic system provides protection
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 143
from social stigma, violation of confidentiality and privacy, and negative perception. To reduce
the anticipatory anxiety of negative responses from the athletic system, the athletes implement
coping strategies that are held within the confidentiality of the interpersonal relationships of
family, friends, and team members or are intrapersonal behaviors that are not observed by the
athletic system, such as motivation, goal setting, self-reliance, withdrawing, crying, or blasting
music.
Although the inquiry process validated research literature assertions about this
population, new knowledge was gained about the factors and phenomena that contribute to
female university athletes’ underutilizing mental health services and the coping strategies they
utilize in the absence of mental health services. The participants provided new knowledge on
their beliefs about athletic systems communications, the resultant symptom of anticipatory
anxiety about their status in the athletic system, and how they select coping strategies to manage
their issues independent of disclosure to this system.
The athletes all report a 10- to 14-year experiential history in sports prior to Division I
competition. The researcher proposes that their history of observations of the competitive
environment, the variables in their sport, and their strategy to succeed and win contributed to
their anticipatory anxiety to read the environment of the athletic system to succeed and win
(Table 2). Their years of training to succeed are now applied to the Division I environment, the
maintenance of competitive status is entwined in the participants’ identity as athletes, and play
time is an indicator of their success through effort, which increases their self-esteem (Graham &
Williams, 2016).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 144
Findings and Transformative Worldview
The findings pertaining to each research question provide evidence that supports a
transformative worldview. The principles of this worldview provide a framing for the social
justice issue in this population’s access to services (Creswell, 2014). The focus on access to
mental health services by any marginalized population can be addressed collaboratively between
the organization and the informants to give voice to perceptions or experiences of inequity in
access due to power relationships (Creswell, 2014). The research literature collaborates that
seeking mental health services may compromise the athletes’ model image and utility (Scott &
Derry, 2005; Szymanski et al., 2011). There is a consistent theme of the athletes perceiving the
athletic system as the gatekeeper to access to mental health services as well as access to
competitive status (Norman & French, 2013). If the athletes’ beliefs about the athletic system
result in compliance, then this is an illustration of power and marginalization due to lack of
access and opportunity. The athletes may utilize coping strategies independent of the athletic
system, but this utilization can also be defined as compliance because, within the system, they
demonstrate acceptance of the implicit messages. They seek strategies to cope outside of the
system.
Findings and Popular Culture Documents
The communications in these documents align with the explicit and implicit messages the
participants received from the athletic system, and they also implicitly support the participants’
choice to manage their performance issues, negative emotions, and stressors through
interpersonal or intrapersonal coping strategies. The popular culture documents also address the
issue of access and opportunities for women. Although King consistently demonstrates the
visionary characteristic of transformational leadership, her message of “keep fighting” is
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 145
implemented by the participants’ disclosing their interpersonal and intrapersonal coping
strategies rather than their knowledge of a transformational leader in their athletic system who
advocates for their mental health. Williams’ dialogue with the umpire identifies the implicit
message from the umpire that can be perceived as her penalties resulting from her expression of
her emotions and opinions.
These documents also support the research by Kaskan and Ho (2016) that discusses that
female athletes can be judged as over-emotional or over-reactive, which places the athlete in a
double bind that continues oppression of females. Considering the implicit messages in these
documents, there is evidence that, if female university athletes disclose their negative emotions,
then their competitive status can be compromised. Therefore, these athletes chose to comply or
utilize their own coping strategies and bypass the athletic system, so their issues are not known.
During the interview with King, she states “We’re always in a tenuous position, just like in a
match you know you can be ahead; you can have match point and still lose. So, you never take
anything for granted.” The athletes’ anticipatory anxiety to tenuous positions captured their
experiences of how they could stay ahead and continue to maintain their image and utility.
Implications for Practice
This study informs the practice of the coaches, athletic staff, administrators, and team
members toward a transformational leadership atmosphere, collaboration, and reciprocal
relationships, resulting in raising each to their highest potential and highest performance
(Northouse, 2013). In addition, this study informs mental health practitioners with data to
determine evidence-based psychotherapeutic methods for prevention and treatment of this unique
populations’ mental health needs.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 146
The disclosures from the participants support their perception of the athletic system as a
power relationship as opposed to a transformational leadership relationship (Northouse, 2013).
King discusses her leadership responsibility to athletes of all genders as she comments,
My job is to support them and get them to try to carry on inclusion and do the right thing
and make the world a better place because we have a platform as an athlete. Athletes
really have a chance to be leaders in this world.
Throughout the journey of females into the competitive realm of sport, the founding female
athlete leaders demonstrated vision, strength and persistence. The athletes’ disclosures during
this inquiry identify the importance of support from transformational leaders in the athletic
system.
As athletic systems approach changing the organization to attain gender equity in sport
for access and opportunity to competitive status, the concepts of first order and second order
change have utility. Student-athlete mental health first order change is a reductionist point of
view: the parts are in place to implement a program, and student-athletes are diagnosed and
treated. This point of view can create barriers to access and becomes iatrogenic. Student-athlete
mental health second order change is a systems point of view that does not pathologize the
student-athlete. It creates a paradigm shift to creating health for the student-athlete and
normalizes the aspect that all living beings respond to stress and benefit from access to services
that reduce that stress (Waters, Marzano, & McNulty, 2003).
The research literature has consistently proposed interventions to educate administrators
and student-athletes on mental health issues and the benefits of access to mental health services
and the NCAA has published and distributed Mind, Body and Sport: Understanding and
Supporting Student-Athlete Wellness” and “Mental Health Best Practices” with recommendations
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 147
for supporting and promoting student-athlete mental health (Beauchemin, 2014; Etzel et al.,
2006; Kern et al., 2017; López & Levy, 2013; NCAA, 2013a, 2013b). NCAA Division I consist
of more than 350 universities and colleges, with over 6,000 athletic teams, and over 170,000
competitive student athletes (NCAA, 2018). These institutions are characterized by the largest
student populations and the largest athletics budgets.
Within these institutions, the implications for practice include structures and systems that
reflect the moral and professional accountability of the members of the institution (Firestone &
Shipps, 2005; Waters et al., 2003). Moral accountability aligns with the social justice issue of
access, and professional accountability aligns with the effectiveness of practice in services
(Firestone & Shipps, 2005). Implementing these types of accountability in access and services
for female university athletes begins with an understanding of the individual or entity most
capable of accomplishing this task (Firestone & Shipps, 2005). The student-athlete’s ability to
independently take responsibility and seek access to services is impaired by barriers perceived
and experienced. The moral and professional accountability of institutional staff can reduce
barriers to access and develop a shared value system for the athletic system and practitioners.
Part of the shared value system is to develop trust among the athletic system, mental health
practitioners, and student athletes so that student-athletes cannot perceive a determent to success
by seeking help. Education on mental health issues and mental health services is not a mental
health assessment or mental health intervention. Student-athletes’ confidence in the expertise of
their mental health practitioners results from their experience of the investment in the athletes’
well-being, which demonstrates the institution’s moral and professional accountability through
increased access to mental health services and evidence-based treatment.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 148
To access services, the student-athletes must have an efficient and effective system and
structure in place. Waters et al. (2003) present the descriptor of second order change as
facilitating a change by displaying a paradigm shift. The leadership paradigm would shift to the
whole person, utilizing a systems theory view which does not pathologize the student athlete,
because the student-athletes’ view of the social stigma of mental health contributes to the barriers
to access to services. The leadership of the university athletic system and the NCAA would
normalize student-athlete access to mental health skills and services. These leaders would
assume the role of second order change agents, challenging the model image of the student
athlete and normalizing the aspect that all individuals respond to stress (Waters et al., 2003). A
structure and system can provide access to services to reduce stress and create a paradigm shift
that is mutually beneficial for all involved (Waters et al., 2003).
These accountability factors would focus on the institutions’ investment in winning;
student athletes are the model image and make winning happen. The performance of these
athletes may benefit the university entrepreneurially and status-wise, but there may be a physical
and mental risk to the student athlete. As Childress, Elmore, and Grossman (2006) discuss, a
public university is not a business, and student-athletes are not meant to service the income
stream of the university. They are to be served as a customer of the university, and the customers
should not experience deterrents to their well-being. The moral and professional accountability
of the athletic system and mental health practitioners to student athletes can be assessed by
documenting an increase in utilization of mental health skills and services. This increase in
access would display the explicit message from the athletic system of supporting access and
eradicating barriers to mental health services. This documentation would then answer the casual
question “is it working for us?” (McKwan & McKwan, 2003, pp. 5–8).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 149
Sudano, Collins, and Miles (2017) recommended implementing the integrated care model
within an NCAA Division I athletic training room for alignment with NCAA Mental Health Best
Practices recommendations. These authors present a model they believe diminishes the stigma
of mental health services through integration of the mental health provider with accepted athletic
and medical interventionists. The authors state that their proposal is based on current efforts of
primary care physician groups to utilize a “biopsychosocial-spiritual foundation” that combines
medical and behavioral services on-site (Sudano et al., 2017, p. 78). This represents a movement
of sociocultural change and systems view as opposed to a reductionist view. This perspective
aligns with the life-span development concept of an individuals’ development and symptoms
being influenced by multiple factors and benefiting from treatment through biological,
psychological and social interventions. Moreland, Coxe, and Yang (2018) present their findings
on the developmental issues that university athletes face in the life stage of adulthood,
adjustment to academic studies, and the pressure to maintain peak physical and mental condition.
Their emphasis is on the athletic system partnering with NCAA to change norms related to
mental health services and present an alternative view of educational programs to assist athletes
to overcome barriers to mental health services. The authors indicate a movement of a second
order or sociocultural change and systems perspective, as opposed to an individual change and
reductionist view (Moreland et al., 2018).
Future Research
This qualitative study presented the voice of six former Division I female university
athletes who were representative of different ages, sports, and conferences. It also analyzed
popular culture documents to provide a context for the conceptual framing of the study. The
themes from the review of the research literature and the identification of new knowledge from
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 150
the lived experiences of the participants indicate areas where future research would be beneficial.
Research on additional factors and phenomena that contribute to this populations’ utilization of
mental health services and coping strategies should include
• identification of the influences of cognitive and social-emotional development of the
female university athlete upon decision-making in the university environment;
• exploration of the voice and perspective of the coaches, athletic staff, and administrators
related to mental health needs and mental health services within the athletic system;
• identification of mental health interventions within the university athletic system that are
characteristic of first order and second order change;
• exploration of mastery climates versus performance climates in university athletic
systems;
• exploration of the factors of culture, ethnicity, race, gender, and sexual orientation upon
access and barriers to access of female student-athletes and student-athletes of all genders
to mental health services; and
• exploration of data on access of female student-athletes and student-athletes of all
genders to mental health services.
Conclusions
The purpose of the study was to explore the underutilization of mental health services by
female university athletes and gain knowledge about the gap between non-professional help and
professional help for mental health issues. The study supported previous research showing
barriers to access to mental health services and that athletes perceive a power relationship of
constraint within the athletic system and do not reveal their issues to this system for fear of loss
of competition status and of their identity as competitive athletes.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 151
These data also identified new knowledge about the reliance of the female university
athletes on interpersonal and intrapersonal coping strategies to manage negative emotional
responses or stressors independent of the athletic system. The history of women in sport, the
voice of the athletes in the study, and the communications in the popular culture documents
display a reciprocal relationship between gender norms and objectification. The standard creates
objectification, and the athletes' response to objectification through self-objectification complies
with the gender norms. The athlete disclosures display a response to a perceived paradoxical
message from the athletic system. That message is “I want you to show physical and mental
strength.” Watzlawick et al. (1974) stated, “This rule therefore says that compliance with the
external rule is unacceptable behavior, since the same behavior should be freely motivated from
within…This result is paradox” (pp. 66–67). In this atmosphere of perceived paradoxical
communication, the receiver does and says the right thing within the norms while utilizing other
strategies for support. The exploration of these athletes’ coping strategies demonstrates
Coping is an organizational construct and involves the regulation of all the aspects of the
self that are influenced by stress, including physiology, emotion, behavior, cognition,
motivation and attention, as well as attempts to influence the environment, including the
action, thoughts and emotions of others. (Fingerman et al., p. 562)
In reviewing the pathway of compliance to competition, there is a pathway of processing
how athletes’ observation of the athletic system’s explicit or implicit messages generates beliefs
which activate an emotion, resulting in a choice of behavior (Maxwell, 2013). This processing
cycle is illustrated in Figure 1.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 152
Figure 1. Participants’ cycle of processing observations of the athletic system.
This example of the athletes’ processing is characteristic of the evidenced-based
psychotherapeutic model of Rational Emotive Behavioral Therapy, which can be summarized as
the participants’ perception of an internal or external event forms a belief that generates an
emotional and behavioral consequence (Ellis, 1998; Figure 2). There are multiple methods of
cognitive therapy and cognitive behavioral therapy, which were pioneered by Aaron Beck and
Albert Ellis that have provided specific psychotherapeutic skills to reduce negative emotional
responses and foster resilience and mental health (Beck, 1976; Ellis, 1998). These models can be
utilized as preventive skills for the athletes, thereby supporting the normalization that all living
beings are influenced by stress, and that the development of cognitive behavioral skill sets to
manage negative emotional responses and stressors results in productive coping strategies.
Observation
of Athletic
System
Perception of
Explicit or
Implicit
Messages
Develop
Belief to
Maintain
Competitive
Status
Anxiety About
Competitive
Status
Utilize Coping
Strategy to
Reduce
Anxiety
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 153
Figure 2. Rational emotive behavioral therapy process.
The application of the transformative worldview addresses the specific factor of lack of
access and opportunity due to power relationships and marginalization. The Division I female
university athlete who exemplifies the model of physical and mental strength to society would
benefit from a transformational leader within the athletic system. As Athlete 4 revealed, “as the
female student-athlete, you are so competitive, so driven, you’re in your own lane, and
sometimes you have to open those lanes and let other people know you need to go talk to
someone.” To utilize her analogy, the athletic system needs strategies to “open those lanes” to
reduce barriers and increase access and opportunity in mental health services and in competitive
status for all university athletes. Athlete 3 voiced her experience of coping and her identity as a
competitor: “Yeah, there were days that I was crying, I was stressed, I was binge eating” but she
also states, “but it was the most incredible time, I would do it again in a heartbeat. It was so fun.”
And Athlete 1 concluded, “I loved being a rower. The mental strength that I gained from that is
Activating Event Irrational Belief
Unhealthy
Emotional and
Behavioral
Consequence
Dispute Irrational
Belief
New Rational Belief
and Healthy
Emotion and
Behavior
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 154
something that I definitely did not know that I was building or working on there. In hindsight,
I'm so proud of myself.”
The access and opportunity to build skills for mental health contribute to the second order
change paradigm shift for all university athletes and places the NCAA proposal of “Mental
Health Best Practices” and support of wellness of “Mind, Body, and Sport” within reach to
maximize peak performance (NCAA, 2013). Female sporting role models in society can foster
the use of athletics toward the enhancement of self-efficacy, leadership skills, and social change.
(Meier, 2015).
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 155
REFERENCES
Albert, P. (2015). Why is depression more prevalent in women? Journal of Psychiatry &
Neuroscience, 40(4), 219–221. https://doi.org/10.1503/jpn.150205
Alkin, M. C., & Vo, A. T. (2018). Evaluation Essentials: From A to Z. 2nd Edition New York:
NY: Guilford Press.
Alschuler, K., Hoodin, F., & Byrd, M. (2008). The need for integrating behavioral care in a
college health center. Health Psychology, 27(3), 388–393. https://doi.org/10.1037/0278-
6133.27.3.388
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(pp. 160–168). Arlington, VA: American Psychiatric Publishing.
American Psychological Association. (2020). Anticipatory anxiety. Academic Medicine, 77 (9),
918-921.
American Psychological Association retrieved form dictionary.apa.org/anticipatory-anxiety.
Bateson, G., Jackson, D. D., Haley, J., Weakland, J. (1956). Toward a theory of schizophrenia.
Behavior Science, 1, 251-264.
Beauchemin, J. (2014). Student-athlete wellness: An integrative outreach model. College Student
Journal, 48(2), 268–280.
Beck, A. T. (1976). Cognitive therapy and the emotional disorders. New York, NY:
International Universities Press.
Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S.
(2015). The prevalence and correlates of depression, anxiety, and stress in a sample of
college students. Journal of Affective Disorders, 173, 90–96.
https://doi.org/10.1016/j.jad.2014.10.054
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 156
Bogdan, R., & Biklen, S. (2007). Qualitative research for education. Boston, MA: Pearson.
Childress, S., Elmore, R., & Grossman, A. (2006). How to manage urban school districts.
Harvard Business Review, 84(11), 55–68.
Cooky, C. & Dworkin, S. (2013). Policing the boundaries of sex: A critical examination of
gender verification and the Caster Semenya controversy. Journal of Sex Research, 50(2),
102–111. https://doi.org/10.1080/00224499.2012.725488
Corbin, J., & Strauss, A. (2008). Basics of qualitative research. Thousand Oaks, CA: SAGE.
Creswell, J. W. (2014). Research design. Thousand Oaks, CA: SAGE.
Csikszentmihalyi, M., Abuhamdeh, S., & Nakamura, J. (2007). Flow. In A. J. Elliot & C. S.
Dweck (Eds.), Handbook of competence and motivation (pp. 598–608). New York, NY:
Guilford.
Daniels, E. A. (2009). Sex objects, athletes, and sexy athletes. Journal of Adolescent Research,
24(4), 399–422. https://doi.org/10.1177/0743558409336748
Denler, H., Wolters, C., & Benzon, M., (2006). Social cognitive theory. Retrieved from
http://www.education.com/reference/article/social-cognitive-theory/
Dowling, C. (2001). The frailty myth. New York, NY: Random House
Educator 45 (2), 80-85.
Eisenberg, D., Gollust, S., Golberstein, E., & Hefner, J. (2007). Prevalence and correlates of
depression, anxiety, and suicidality among university students. The American Journal of
Orthopsychiatry, 77(4), 534–542. https://doi.org/10.1037/0002-9432.77.4.534
Ellis, A. (1998). How to control your anxiety before it controls you. New York, NY: Kensington
Publishing Corp.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 157
Etzel, E. F., Watson, J. C., Visek, A. J., & Maniar, S. D. (2006). Understanding and promoting
college student-athletic health: Essential issues for student affairs professionals. Journal
of Student Affairs Research and Practice, 43(3), 518–546. https://doi.org/10.2202/1949-
6605.1682
Field, T., Diego, M., Pelzez, M., Deeds, O., & Delgado, J. (2012). Depression related problems
in university students. College Student Journal, 46(1), 193–202.
field. Journal of Physical Education, Recreation & Dance, 59 (3), 37-41.
Fingerman, K. L., Berg, C. A., Smith, J., & Antonucci, T. C. (2011). Handbook of lifespan
development. New York, NY: Springer.
Firestone, W. A., & Shipps, D. (2005). How do leaders interpret conflicting accountabilities to
improve student learning? In W. A. Firestone & C. Riehl (Eds.), A new agenda for
research in educational leadership (pp. 81–91). New York: Teachers College Press.
Galante, M., & Ward, R. M. (2016). Female student leaders: An examination of transformational
leadership, athletics, and self-esteem. Personality and Individual Differences, 106, 157-
162.
George, J. (1988a). Discovering roots - Determining destiny: Athletic leadership among young
women. Physical Educator, 45(2).
George, J. (1988b). Mary Washburn Conklin: Pioneer in women’s Olympic track and field.
Journal of Physical Education, Recreation & Dance, 59(3), 37–41.
https://doi.org/10.1080/07303084.1988.10606221
Givens, J., & Tjia, J. (2003). Depressed medical students’ use of mental health services and
barriers to use. JAMA, The Journal of the American Medical Association, 289(23).
Glesne, C. (2011). Becoming qualitative researchers. Boston, MA: Pearson.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 158
Goldner, V. (1991). Toward a critical relational theory of gender. Psychoanalytic Dialogues,
1(3), 249–272. https://doi.org/10.1080/10481889109538898
Gollwitzer, P. M., & Sheeran, P. (2006). Implementation intentions and goal achievement: A
meta-analysis of effects and processes. Advances in Experimental Social Psychology, 38,
69–119. https://doi.org/10.1016/S0065-2601(06)38002-1
Graham, S., & Williams, C. (2009). An attributional approach to motivation in school. In K. R.
Wentzel & A. Wigfield (Eds.), Handbook of motivation at school. New York, NY:
Routledge.
Haddock, S. A., Weiler, L. M., Trump, L. J., & Henry, K. L. (2017). The efficacy of internal
family systems therapy in the treatment of depression among female college students: A
pilot study. Journal of Marital and Family Therapy, 43(1), 131–144.
https://doi.org/10.1111/jmft.12184
Hall, R. L., & Oglesby, C. A. (2016). Stepping through the looking glass: The future for women
in sport. Sex Roles, 74(7-8), 271–274. https://doi.org/10.1007/s11199-015-0572-z
Harding, J. (2014). Qualitative data analysis from start to finish. Thousand Oaks, CA: SAGE.
Hysenbegasi, A., Hass, S. L., & Rowland, C. R. (2005). The impact of depression on the
academic productivity of university students. The Journal of Mental Health Policy and
Economics, 8, 145–151.
Kaskan, E. R., & Ho, I. K. (2016). Microaggressions and female athletes. Sex Roles, 74(7-8),
275–287. https://doi.org/10.1007/s11199-014-0425-1
Kern, A., Heininger, W., Klueh, E., Salazar, S., Hansen, B., Meyer, T., & Eisenberg, D. (2017).
Athletes connected: Results from a pilot project to address knowledge and attitudes about
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 159
mental health among college athletes. Journal of Clinical Sport Psychology, 11(4), 324–
336. https://doi.org/10.1123/JCSP.2016-0028
Khanam, S. J., & Bukhari, S. R. (2015). Depression as a predictor of academic performance in
male and female university students. Journal of Pakistan Psychiatric Society, 12(2), 15–
17.
Kolb, S. (2012). Grounded theory and the constant comparative method: Valid research
strategies for educators. Journal of Emerging Trends in Educational Research and Policy
Studies, 3(1), 83–86.
Kruisselbrink Flatt, A. (2013). A suffering generation: Six factors contributing to the mental
health crisis in North American higher education. The College Quarterly, 16(1), 17.
Locke, E. A., & Latham, G. P. (2002). Building a practically useful theory of goal setting and
task motivation: A 35-year odyssey. The American Psychologist, 57(9), 705–717.
https://doi.org/10.1037/0003-066X.57.9.705
Lombardo, C., Battagliese, G., Baglioni, C., David, M., Violani, C., & Riemann, D. (2014).
Severity of insomnia, disordered eating symptoms, and depression in female university
students. Clinical Psychologist, 18(3), 108–115. https://doi.org/10.1111/cp.12023
López, R. L., & Levy, J. J. (2013). Student athletes’ perceived barriers to and preferences for
seeking counseling. Journal of College Counseling, 16(1), 19–31.
https://doi.org/10.1002/j.2161-1882.2013.00024.x
Maehr, M. L., & Zusho, A. (2009). Achievement goal theory: The past, present, and future. In K.
R. Wenzel & A. Wigfield (Eds.), Handbook of motivation at school (pp. 77–104). New
York, NY: Routledge/Taylor & Francis Group.
Maxwell, J. (2013). Qualitative research design. Thousand Oaks, CA: SAGE.
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 160
McEwan, E. K., & McEwan, P. J. (2003). Making sense of research. Thousand Oaks, CA:
SAGE.
Meier, M. (2015). The value of female sporting role models. Sport in Society, 18 (8), 968-982.
Merriam, S., & Tisdell, E. (2016). Qualitative research. San Francisco, CA: Jossey-Bass.
Miles, M., Huberman, M., & Saldana, J. (2014). Qualitative data analysis. Thousand Oaks, CA:
SAGE.
Moreland, J. J., Coxe, K. A., & Yang, J. (2018). Collegiate athletes’ mental health services
utilization: A systematic review of conceptualization, operationalization, facilitators, and
barriers. Journal of Sport and Health Science, 7(1), 58–69.
https://doi.org/10.1016/j.jshs.2017.04.009
National Collegiate Athletic Association (2013a). Inter-association consensus document: Mental
health best practices. Retrieved from www.NCAA.org/health-and-safety/sport-science-
introduction-mind-body-and-sport
National Collegiate Athletic Association (2013b). Mind, body and sport: Understanding and
supporting student-athlete mental wellness. Retrieved from www.NCAA.org/health-and-
safety/sport-science-introduction-mind-body-and-sport
National Collegiate Athletic Association. (2016). NCAA GOALS study of the student-athlete
experience Initial summary of findings. Indianapolis, IN: Author.
National Collegiate Athletic Association. (2020). Division I. Retrieved from
http://www.ncaa.org/about?division=d1
The National Institute of Mental Health (2010). Major depression among adults. Retrieved from
www.nimh.gov//health/statistics/prevalence/major-depression-among-adults.shtml
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 161
Nicholls, A. R., & Polman, R. C. J. (2006). Coping in sport: A systematic review. Journal of
Sports Sciences, 25(1), 11–31. https://doi.org/10.1080/02640410600630654
Norman, L., & French, J. (2013). Understanding how high performance women athletes
experience the coach-athletes relationship. International Journal of Coaching Science,
7(1), 3-24.
Northouse, P. G. (2013). Leadership. Thousand Oaks, CA: SAGE.
Patton, M. Q. (2002). Qualitative research & evaluation methods. Thousand Oaks, CA: SAGE.
Prime Video UK. (2018). Billie Jean King Interview, 09/08/2018.
Rice, S. M., Purcell, R., De Silva, S., Mawren, D., McGorry, P. D., & Parker, A. G. (2016). The
mental health of elite athletes: A narrative systematic review. Sports Medicine, 46(9),
1333–1353. https://doi.org/10.1007/s40279-016-0492-2
Rogers, C. (1951). Client Centered Therapy: Its Current Practice Implication and Theory.
London: Constable.
Rubin, H., & Rubin, I. (2012). Qualitative interviewing. Thousand Oaks, CA: SAGE.
Scott, B. A., & Derry, J. A. (2005). Women in their bodies: Challenging objectification through
experiential learning. Wom e n’s Studies Quarterly, 33(1), 188–209.
Selby, R., Weinstein, H., & Bird, T. S. (1990). The health of university athletes: Attitudes,
behaviors, and stressors. Journal of American College Health, 39(1), 11–18.
https://doi.org/10.1080/07448481.1990.9936208
Sudano, L. E., Collins, G., & Miles, C. M. (2017). Reducing barriers to mental health care for
student-athletes: An integrated care model. Families, Systems, & Health, 35(1), 77–84.
https://doi.org/10.1037/fsh0000242
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 162
Steinfeldt, J., Zakrajsek, R., Carter, H., & Steinfeldt, M. (2011). Conformity to gender norms
among female student-athletes: Implications for body image. Psychology of Men &
Masculinity, 12(4), 401-416.
Szymanski, D. M., Moffitt, L. B., & Carr, E. R. (2011). Sexual objectification of women:
Advances to theory and research. The Counseling Psychologist, 39(1), 6–38.
https://doi.org/10.1177/0011000010378402
U. S. Department of Education, 2005
Waters, J. T., Marzano, R. J., & McNulty, B. (2003). Balanced leadership: What 30 years of
research tells us about the effect on leadership on student achievement. Aurora, CA:
Mid-Continent Regional Educational Lab.
Watzlawick, P., Weakland, J. H., & Fisch, R. (1974). Change. New York, NY: Norton.
Weakland, J. H. (1960). The etiology of schizophrenia. New York, NY: Basic Books.
Weiss, R. S. (1994). Learning from strangers. New York, NY: The Free Press.
Winters, M. (2018). Full transcript of Serena’s sensational outburst. Daily Mail. Retrieved from
https://www.dailymail.co.uk/sport/tennis/article-6147775/FULL-TRANSCRIPT-Serena-
Williams-entire-outburst-Open-final.html
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 163
APPENDIX A
Participant Recruitment Letter
October 27, 2019
Dear [Network of University Athletic Department Staff, University Educators, Former Athletes,
Mental/Behavioral Health Professionals, Professionals in Sport Related Fields],
[Introductory sentence]. I am currently compiling research for my doctoral dissertation, Center
Court: Exploration of Access to Mental Health Services by Female University Athletes. I am a
student in the Doctor of Education in Educational Leadership Program at the University of
Southern California Rossier School of Education. My concentration is in Educational
Psychology. I have maintained a private practice in psychotherapy, educational psychology, and
clinical hypnotherapy over the last 30 years.
I would like to request your assistance in obtaining participants for this research study conducted
through USC. I am seeking voluntary participants that are former female student-athletes,
between the ages of 25-38, who competed at a NCAA Division I California university. This is a
qualitative study and the individuals would participate in an interview with me for approximately
30 minutes. Interviews would be arranged for the convenience the participant. I hope to learn
about the knowledge and experience of former female student-athletes in accessing mental health
services and coping with mental health issues during their competitive years in the university
setting.
I am reaching out to other professionals and would like to identify a total of six to eight
participants. I would greatly appreciate you considering your participation as a former student-
athlete or providing recommendations of individuals you may know through your network who
meet the criteria for the study. The collection and analysis of the data maintains all participants’
identifying information as confidential. I appreciate any assistance you can provide and welcome
any feedback you may have.
I am hopeful that this study may provide new knowledge to assist practitioners in aligning
female student-athletes’ unique mental health needs with methods for prevention and treatment. I
look forward to hearing from you.
Very sincerely,
Ann Golay, MS, LMFT, LEP
Principal Investigator
Licensed Marriage and Family Therapist No. LMFT15522
Licensed Educational Psychologist No. LEP2784
Certified Hypnotherapist No. 1190
1440 N. Harbor Blvd., Suite 800
Fullerton, CA 92835
Phone: 714-681-2355
golay@usc.edu
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 164
APPENDIX B
Participant Information Sheet
University of Southern California
Rossier School of Education
3470 Trousdale Parkway
Los Angeles, CA 90089
STUDY TITLE: Center Court: Exploration of Access to Mental Health Services by Female
University Athletes
PRINCIPAL INVESTIGATOR: Ann Golay, MS, LMFT, LEP
FACULTY ADVISOR: Rudy Castruita, Ed.D.
You are invited to participate in a research study. Your participation is voluntary. This
document explains information about this study. You are encouraged to ask questions to clarify
any information presented in this document.
PURPOSE: The purpose of this study is to gain knowledge about factors that may contribute to
female university athletes underutilizing mental health services and the coping strategies they
utilize in the absence of mental health services. This qualitative research will allow the
exploration of phenomena through descriptive voice of the athletes. The principal investigator
hopes to learn about the knowledge and experiences of female university athletes in accessing
mental health services and coping with mental health issues in the university setting. You are
invited as a possible participant because you are a former female university athlete between the
ages of 25-38 who competed at a NCAA Division I California university.
PARTICIPANT INVOLVEMENT: These former female university athletes will participant in
a 30-minute semi-structured individual interview with the principal investigator in a mutually
agreed upon public setting. Interview questions will explore the participant’s knowledge and
experiences in accessing mental health services and coping with mental health issues. With the
permission of the participant, the interview will be recorded and transcribed using a smart-phone
application. Interview transcriptions will be verified for accuracy with the participant. Study
results will be made available to the participant and a follow-up session offered for participant
questions or discussion.
CONFIDENTIALITY: The principal investigator, the faculty advisor, and the University of
Southern California Institutional Review Board (IRB) may access data. The IRB reviews and
monitors research studies to protect the rights and welfare of the research subject. All identifying
information of the participants will be disguised by numerical coding systems and pseudonyms.
Access to the audio recordings and transcriptions will solely by the principal investigator and the
faculty advisor. The collection and analysis of the data, publication of the results of the research,
or discussion of results at conferences will maintain participants’ identifying information as
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 165
confidential. Audio recordings and transcriptions will be maintained for the duration of the study
and destroyed within six months of publication of the results of the research.
INVESTIGATOR CONTACT INFORMATION: If you have any questions regarding this
study please contact:
Principal Investigator: Ann Golay, MS, LMFT, LEP
XXXXXXXXXXXXXXXX
XXXXXXXXXXXXX
XXXXXXXXXXXXX
XXXXXXXXX
Faculty Advisor: Rudy Castruita, Ed. D.
University of Southern California
Rossier School of Education
3470 Trousdale Parkway
Los Angeles, CA 90089
rmc1usc@outlook.com
Participant acknowledges receipt of the Participant Information Sheet:
_________________________ __________________________ __________________
Signature Printed Name Date
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 166
APPENDIX C
Participant Interview Protocol
Introductions
I appreciate you taking the time to meet with me, and I am looking forward to this
opportunity to learn from you.
Brief Explanation of Purpose of Interview
I want to tell you about the purpose of the interview; the purpose is to learn from you
about your knowledge and experience as a former female university athlete in accessing mental
health services and coping with mental health issues during your competitive years in the
university setting.
Explanation of Confidentiality
I want you to know our collaborative interview is part of a dissertation research study I
am conducting through USC. I am interviewing other former female university athletes as well.
This study will contribute to my dissertation and I want to assure you that your identity will be
confidential and not shared with any other individuals. I will, hopefully, share information from
this study, but will not share your identity.
Request to Utilize Voice Recording
So that I can give my full attention to our interview and not miss any of what you actually
say, I want to ask your permission to record our interview on my iPhone with an application that
will record and simultaneously transcribe our interview. Would this be agreeable you? Just as
your identity is confidential, this recording and transcription will also be confidential and will
not be shared with any other individuals. I would like to listen to the recording and read the
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 167
transcription of what you have said, and I will delete the recording and transcription after the
publication of the study.
Freedom and Flexibility in Responses
If you do not want to respond to any of my questions, please know you are free to choose
to not to respond any of the questions and you can choose to discontinue the interview. Also, if
you want me to pause or stop the recording, please let me know.
Length of Interview and Other Logistical Concerns
Our interview will be approximately 30 minutes. Does that seem workable for you? Is
this room and environment comfortable for you? Can I answer any other questions or concerns
you have? If you have any comments during the interview, please let me know. Thank you
again, and I’ll start our interview now.
Interview Questions for Background Information
I did want to ask you some questions to learn more about you:
What was your sport and what university did you attend?
What was your age when you were competing at the university level?
What is your age now?
What is your home state?
How many years did you compete at the university level?
How long were you an athlete before you entered the university?
How did you become involved in your sport?
Who have been significant supporters during your athletic experience?
What did you like about being a student-athlete at the university?
Tell me about a typical day of going to classes and going to practice and competing?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 168
Interview Questions for Research Questions
Research Question 1: How do former female university athletes describe their experiences in
attempting to access or accessing mental health services in the university setting?
How did you feel about attending classes and practice and competing?
What did you know about mental health or counseling services at the university?
What did you know about mental health or counseling services for student-athletes at the
university?
What were your experiences with mental health or counseling services at the university?
Mental health issues can range from mild to severe and can include such concerns as
stress related issues or performance related issues, or symptoms of anxiety or depression.
Some university administrators would say female university athletes do not access mental
health services. As a former female university athlete, what would you want to tell these
administrators about female university athletes accessing mental health or counseling
services at the university?
What would you describe as the ideal conditions for a female university athlete who has a
mental health issue to access mental health services at the university?
What is your opinion about whether or not female university athletes should access
mental health services at the university?
Research Question 4: How do former female university athletes describe their experiences in
coping with mental health issues in the university setting?
Considering again, mental health issues can range from mild to severe and can include
such concerns as stress related issues or performance related issues, or symptoms of
anxiety or depression.
How did you, as a female university athlete, feel about managing or coping with mental
health issues at the university?
Tell me what you did to manage or cope with a mental health issue at the university?
Some female university athletes would say female university athletes are capable of
coping with their own mental health issues. As a former female university athlete, what
you would want to tell them about managing or coping with their own mental health
issues at the university?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 169
What would you describe as the ideal conditions for a female university athlete who has a
mental health issue to manage or cope with this mental health issue at the university?
What is your opinion about female university athletes managing or coping with their own
mental health issues?
Research Question 2: How do former female university athletes perceive barriers to mental
health services?
What did you know about any reasons that would prevent female university athletes from
accessing mental health services?
How did you feel about female university athletes being prevented from accessing mental
health services because of these reasons?
What were your experiences with female university athletes feeling prevented from
accessing mental health services because of these reasons?
Research Question 3: How do former female university athletes perceive their mental health
issues?
What did you know about stressors that impact the mental health for female university
athletes?
How did you feel about your mental health as a female university athlete?
What was your experience with stressors that impacted your mental health as a female
university athlete?
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 170
APPENDIX D
Qualitative Interview and Popular Culture Document Coding Legend
A Priori:
Parent Code:
1 Lack of Access Mental Health Services
Child Codes:
2 Lack of Knowledge
3 Lack of Motivation
4 Lack of Availability
A Priori:
Parent Code:
5 Barrier to Access
Child Codes:
6 Social Stigma
7 Help Seeking Behavior
8 Unhealthy
9 Weak
10 Mentally Ill
11 Negative Perception by Others
12 Coaches
13 Athletic Staff
14 Administrators
15 Team Members
Child Codes:
16 Fear of Violation of Rights
17 Privacy
18 Confidentiality
Child Codes:
19 Objectification and Stereotyping
20 Utility
21 Performance
22 Physical Form
23 Femininity
24 Sexualization
25 Branding
Child Codes:
26 Self-Objectification
27 Body Image
28 Ideal Weight
29 Diet
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 171
Child Codes:
30 Microaggressions
31 Restrictive Gender Role
32 Over emotional
33 Over reactive
34 Physical Form
35 Femininity
A Priori:
Parent Code:
39 Coping Strategies
Child Codes:
40 Interpersonal Strategies
41 Compliance with Coaches, Athletic Staff, Administrators, Team Members
42 Prioritize Performance
43 Prioritize Acceptance
44 Prioritize Praise
45 Seek Supportive Training Culture
46 Intrapersonal Strategies
47 Approach Strategies
48 Mastery Climate
49 Motivation
50 Goal Setting
51 Resilience
52 Self-Reliance
53 Positive Self-Talk
Empirical:
Parent Code:
54 Barriers to Access
Child Codes:
55 Denial of Issue
56 Coaches
57 Athletic Staff
58 Administrators
59 Team Members
Child Codes:
60 Consequence
61 Loss of Play Time
62 Loss of Scholarship
Child Codes:
63 Time Restrictions
64 Training
65 Competition
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 172
66 Academics
Child Codes:
67 Health
68 Fatigue
69 Injury
Child Codes:
70 Mental Health
71 Depression
72 Anxiety
73 Stress
Empirical:
Parent Code:
74 Coping Strategies
Child Codes:
75 Interpersonal Strategies
76 Present Personal Image
77 Strong and Tough
78 Unapproachable
79 Seek Social Support
80 Engage in social activities
81 Maintain balance in activities
82 Talk to coach
83 Talk to academic advisor
84 Talk to psychologist
85 Talk to family members
86 Talk to team members
87 Talk to friends
88 Intrapersonal Strategies
89 Increase training
90 Focus on life after sport
91 Exercise
92 Running
93 Biking
94 Eating
95 Overeat
96 Restrict intake
97 Journal
98 Sleep
99 Withdraw
100 Cry
101 Listen to Music
102 Shop
FEMALE UNIVERSITY ATHLETES’ MENTAL HEALTH SERVICES 173
103 Detach
Abstract (if available)
Abstract
Research identifies barriers to female university athletes’ access to mental health services that are unique to this population. This qualitative study gained knowledge of factors and phenomena that contribute to female university athletes’ experience of barriers to mental health services and the coping strategies they utilize in the absence of these services. This study implemented explanatory qualitative methods through semi-structured interviews with six former NCAA Division I female university athletes between the ages of 25 and 31 who attended a California university. Popular culture documents were selected for analysis of communication to girls and women in sport and alignment with the conceptual framework. Significant findings included new knowledge about the participants’ observation of the athletic systems’ communication, their perception of explicit or implicit messages, their beliefs about maintaining competitive status, their resultant anticipatory anxiety about their competitive status, and their coping strategies to manage their emotions independent of disclosure to the athletic system. This study informs the university athletic system toward a transformational leadership environment and provides mental health practitioners with data to identify evidence-based psychotherapeutic methods of cognitive therapy or cognitive behavioral therapy for prevention and treatment of this unique populations’ mental health needs.
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Asset Metadata
Creator
Golay, Ann Foster
(author)
Core Title
Center court: exploration of access to mental health services by female university athletes
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Education (Leadership)
Defense Date
03/23/2020
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
barriers to mental health services,coping strategies,female university student-athletes,Mental Health,NCAA,OAI-PMH Harvest
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Castruita, Rudy (
committee chair
), Cash, David (
committee member
), Hinga, Briana (
committee member
)
Creator Email
anngolaymft@gmail.com,golay@usc.edu
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c89-301662
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Tags
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coping strategies
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