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When Isabella started playing lacrosse in the first grade, she would wake up before sunrise and count the minutes until she could hop the chain-link fence that separated her house from the field where her team practiced. Her deftness with a lacrosse stick made her an early standout, and she soon gave up basketball and soccer to focus on the sport. By the time Isabella was a high-school sophomore, she had already been recruited by an elite, Division I college and was signing autographs in her lacrosse-obsessed hometown. “Lacrosse was a way to get attention—it filled that need,” says Isabella, who is being identified by her middle name to protect her privacy.

But during the summer before her junior year, Isabella pivoted awkwardly during a game and fell to the ground in pain. She had torn her ACL. For eight months, she couldn’t return to the field. “It was my worst year ever,” Isabella told me. While her teammates competed in tournaments, she worried about falling behind in the sport. While her friends mingled after school, she was stuck at physical therapy. Without lacrosse, Isabella felt restless and out of sorts. She started eating more and soon developed an eating disorder. “I’d grown up playing lacrosse, and I had no other hobbies,” Isabella said. “So when you don’t have it, you’re like, What am I going to do?”

Mental-health challenges are not unique to competitive student athletes like Isabella, of course: Nearly half of American youths struggle with a mental illness before turning 18, while 12 percent have experienced a bout of depression. But even though playing sports on a regular basis can boost physical and mental health, for some serious high-school athletes—many who train year-round and might need an athletic scholarship to afford college tuition—sports can be a key contributor to depression and anxiety.

“The professional consensus is that the incidence of anxiety and depression among scholastic athletes has increased over the past 10 to 15 years,” says Marshall Mintz, a New Jersey–based sports psychologist who has worked with teenagers for 30 years. As one 2015 study by the National Athletic Trainers’ Association found, “Many student-athletes report higher levels of negative emotional states than non-student-athlete adolescents.” Though parents and coaches are often best positioned to remedy the problem, they also often make it worse.

One reason for this trend is that high-school sports have begun to copy the training methods and intensity levels of college sports. This “sports professionalization” says Timothy Neal, a professor of health and human performance at Concordia University Ann Arbor, is a trickle-down effect of big-time sports, from professional to college and now to high school. More students are specializing in only one sport and playing it beyond one season, sometimes competing on multiple teams throughout the year. The American Academy of Orthopaedic Surgeons found in 2017 that high-school, college, and professional athletes trained in a single sport for a comparable number of months each year. As “intensive parenting” has become the norm, parents in recent decades have pressed upon their kids the idea that endless practice is the route to athletic mastery. Private clubs and teams, which need income year-round to stay in business, have also urged this devotion to one sport.

This professionalization has led to overtraining and exhaustion, which is central to the mental-health problems of competitive high-school athletes. “The biggest problem is sleep loss—all these kids are sleep-deprived,” Mintz says, “and this becomes a major contributor to anxiety and depression.” Long practices and multiple daily workouts mean that athletes have less time than before for other activities, which can amplify the pressures of high school. “Do they need two and a half to three hours of practice?” asks Lonnie Sarnell, a sports psychologist in Millburn, New Jersey, who works with high-school athletes. “That extra hour of practice adds so much stress when you have four hours of homework to deal with.”

All that extra time practicing makes players more vulnerable to injuries, which can be another emotional challenge, especially for those whose identity is closely tied to the sport they play. Some athletes who drop other interests and activities to focus on a sport, and whose self-worth is linked to their performance, can feel lost when they’re sidelined; it’s the rudderless feeling Isabella experienced after tearing her ACL. On top of these strains, teenage athletes have to contend with ordinary frictions that come with being on a team—worries over playing time, making mistakes, and working with difficult coaches. These challenges are only more fraught for players with grand athletic goals.

Parents bear some responsibility for the tension kids feel. Children suffer when mothers and fathers insinuate that every competition or game is vitally important and that the only path to athletic excellence is through relentless training, says Lisa Damour, a psychologist and the author of Under Pressure: Confronting the Epidemic of Stress and Anxiety in Girls. “The situations where sports cause more stress than relief is when there’s a bad fit between the coach and the player or between parents and coaches,” she told me. High-school athletes can also sometimes feel the burden of their parents’ athletic history—what Damour called the “ghosts on the sidelines.” Some parents get their ego needs met through their kids. Fixated on their child’s athletic achievements, they can overlook the young person in front of them. For some parents, Mintz says, “it’s about getting A’s and making the all-star team.”

Parental pressure doesn’t have to be overt or heavy-handed for it to have an effect on a high-school athlete’s mental health. Aware of how much their parents have sacrificed in time and money, some teenagers will persist in playing a sport long past the time they enjoy it, even continuing to practice and compete while injured, says Jay Coakley, a sports sociologist at the University of Colorado at Colorado Springs. If players do finally quit, they sometimes feel like failures for letting their parents and teammates down, which can contribute to self-destructive behavior.

Apart from parents, though, belittling by coaches can be another strain. Riley, who is being identified by her middle name so that she can speak openly about her mental health, told me how her high-school coach erupted at runners when they underperformed, and sometimes ignored them for days as punishment. He encouraged teammates to compete against one another, shunned less talented athletes, and drummed in the need for “mental toughness,” she told me. “We accepted the intense anxiety before races and practice as a necessary side effect.” By her junior year, Riley was deeply depressed and struggling with suicidal thoughts. She ended up transferring to another high school.

But getting parents and coaches to chill out about high-school sports will only go so far in improving athletes’ mental health. Teenagers sense that the country has split into winners and losers, and believe that getting into the right college is a ticket to future security, says Victor Schwartz, the chief medical officer at the Jed Foundation, a nonprofit that works to protect the mental health of young people. Just as getting a B on a test can trigger panic, flailing on the basketball court or striking out during an important game can seem more consequential than it is. “Kids have come to feel that the stakes are higher and higher, and that there’s less room for mistakes,” Schwartz told me.

Colleges might give some insight into how to fix this problem. After the National Collegiate Athletic Association’s chief medical officer discovered in 2014 that mental-health worries topped the list of student-athlete concerns, college-sports programs started to address the problem by adding therapists to athletic offices, screening players for anxiety and depression, and educating staff about how to identify mental-health issues.

These steps could ratchet up the pressure on high schools to follow suit, says Shane Murphy, a sports psychologist based in Danbury, Connecticut. “What happens at the college level will trickle down to high school,” he told me. “Over the next decade, we’ll see much more priority given to the mental health of high-school student athletes.” For coaches, this might mean training in “mental-health first aid” so that they are better able to read and respond to signs of emotional distress among their players. Jolee Paden, a high-school cross-country coach in Washington, D.C., took an eight-hour class on addressing players’ mental health and told me that it helped her unpack the stereotypes surrounding mental illness and develop a vocabulary for addressing the problems she sees. Paden now feels confident that she’ll know what to do if one of her players starts to struggle. “I walked away with some actual tools for responding rather than far-off theories,” she said.

Now a junior in college, Isabella plays intermittently for her university’s lacrosse team. She’s no longer a star, but neither is she unmoored. The emotional turbulence she experienced during high school jolted her into thinking about what she wants out of life beyond success on the lacrosse field. “I still don’t know what I want to do career-wise,” she said. “Now I’m putting more emphasis on that. I’m trying to figure out what I like, and what kind of person I want to be.”

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