There is a complex and interrelated relationship between injury, performance, and mental health (Putukian, Br J Sports Med 50:145–148, 2016; NCAA Interassociation Consensus Document: understanding and supporting student-athlete mental wellness. Mental health best practices. 2018. Available from http://www.ncaa.org/sites/default/files/SSI_MentalHealthBestPractices_Web_20170921.pdf. Accessed 18 Feb 2018; Putukian, How being injured affects mental health. In: Brown GT, Hainline B, Kroshus E et al, (eds) Mind, body and sport: understanding and supporting student-athlete mental wellness. NCAA Press, Indianapolis, p 72–75, 2014; Herring et al, Med Sci Sports Exerc 49:1043–1054, 2017; Neal et al, J Athl Train 48:716–720, 2013). Participating in sport at a competitive level entails specific stressors that may increase the likelihood of injury or illness, including mental health disorders (Ivarsson et al, J Sport Rehabil 22:19–26, 2013; Ivarsson and Johnson, J Sports Sci Med 9:347–352, 2010; Ivarsson et al, Sports Med 47:353–365, 2017; Ardern et al, Br J Sports Med 47:1120–1126, 2013; Wiese-Bjornstal, Scand J Med Sci Sports 20:103–111, 2010; Wiese-bjornstal et al, J Appl Sport Psychol 10:46–69, 1998; Nippert and Smith, Phys Med Rehabil Clin N Am 19:399–418, 2008). There are certain physical and mental health disorders that may be more common in athletes compared with their nonathlete peers, including performance anxiety, disordered eating, menstrual dysfunction, and binge drinking (Glazer, Curr Sports Med Rep;7:332–337, 2008; DeSouza et al, Clin J Sport Med 24:96–119, 2014; Nattiv et al, Clin J Sports Med 7:262–272, 1997). There are several psychological symptoms that are reported in athletes including burnout and substance abuse as well as depression and anxiety, with ranges from 5% to 45% respectively (Beable et al, J Sci Med Sport 20:1047–1052, 2017; Drew et al, Br J Sports Med 51:1209–1214, 2017; Gouttebarge et al, J Hum Kinet 49:277–286, 2015; Gouttebarge et al, J Sports Sci Med 14:811, 2015; Gouttebarge et al, Occup Med 65:190–196, 2015; Gouttebarge et al, J Sports Sci 35:2148–2156, 2017; Gouttebarge et al, Phys Sportsmed 45:426–432, 2017; Gouttebarge et al, Eur J Sport Sci 18:1004–1012, 2018; Gulliver et al, J Sci Med Sport 18:255–261, 2015; Kilic et al, Knee Surg Sports Traumatol Arthrosc 26:946–954, 2018; Kilic et al, Eur J Sport Sci 17:1328–1334, 2017; Nixdorf et al, J Clin Sport Psychol 7:313–326, 2013; Schuring et al, Phys Sportsmed 45:463–469, 2017). In addition, there are increasing demands on athletes at all levels of play, most importantly youth athletes that may be of particular risk for overuse and overtraining (DiFiori et al, Br J Sports Med 48:287–288, 2014). (DiFiore AAP Overuse).