Mental health in endurance running: Beyond the prevalence of mental health symptoms toward understanding underlying mechanisms.

Endurance runners appear to experience a higher prevalence of several mental health symptoms, including anxiety, exercise addiction, sleep disorders, and suicidal ideation. Existing evidence suggests that this pattern is multifactorial and cannot be explained by a single mechanism. In this commentary, we highlight the complex interplay among self-selection processes, sport-specific demands, and broader biopsychosocial factors that may contribute to these outcomes. We also emphasize that demographic characteristics may interact with training-related and psychological factors to shape mental health. To advance the field, we outline key priorities for future research, including longitudinal studies, clinical diagnostic assessments, investigations of pre-existing mental health conditions, and qualitative approaches to better understand athletes' lived experiences and the role of endurance running in mental health.