In the opening paragraph of Indiana athletic director Fred Glass’ letter to IU athletes on March 16, he expressed what was on the top of his mind at the onset of the pandemic.

“I am so sorry” were the first four words, as he acknowledged the athletes who would no longer have a chance to compete. Their “personal sacrifice” was recognized. But then Glass touched upon an issue beyond just the games that would be lost.

“If you or someone you know is struggling with this emotionally, please reach out to us,” Glass wrote. “We will continue to do our very best to support you in every way possible during this challenging time.”

Mental health reaching the top paragraph of an athletic director’s letter was evidence of progress, the eroding of a decades-old stigma. It also just captured reality. Efforts to socially distance, while deemed necessary to slow the spread of the virus, would pull teammates apart. And their ability to compete — a thing that, for some, captures an oversized piece of their identity — would be compromised.

Sports psychologists and researchers are seeing the effects, which are only bound to multiply as fall sports cease. A sudden loss of competition, especially if it ends a career, can be something an athlete grapples with for a while.

“This is something that we can help them get control of the volume and turn it down, but it’s still there. It’s continuing,” said Jesse Steinfeldt, a sports psychologist and professor in IU’s department of counseling and educational psychology. “For many of them, it’s a ‘Groundhog’s Day’ dynamic. A baseball kid, it may have been ‘Holy crap, my season is over,’ and that moment has passed. But now it’s ‘What do I do? What does the future look like? Who am I?’”

“This is the crisis, and the crisis is mounting,” Steinfeldt added. “If we have continued fall cancellations, we’ll have a bigger group of students that’s impacted.”

This is understood on more than just an anecdotal level. In April and May, the University of North Texas surveyed 6,000 NCAA athletes, mostly in Division I, and found 22% were experiencing “clinical” levels of depression. Of the female athletes, 29% reported disordered eating.

In terms of stress, 68% of those athletes were dealing with “moderate” levels, while another 10% relayed severe symptoms.

A survey of high school athletes out of the University of Wisconsin found 68% of respondents had mild to severe depression as a result of the pandemic, a substantial increase over the baseline of 31% from past studies.

“We’re looking at that, and we obviously have our own touch points with our student-athletes and what they are going through,” said Dr. Troy Moles, IU’s director of counseling and sport psychology. “We’re just trying to account for all of that information from all different angles — to figure out where are our student-athletes, what do they need, and how do we meet those needs?”

The fact that these questions are being asked is progress. While the history of sports psychology is generally considered to stretch back to the late 19th and early 20th centuries, it’s only recently that these services have become woven into the fabric of athletic departments.

In 2008, a study of 122 D-I athletic directors found 75% utilized sports psychologists, though only 12 were employed full-time by the department. Now, more often than not, schools IU’s size will have a sports psychologist on staff, plus a social worker. IU also benefits from having one of the few doctoral programs with a sport psychology focus, adding to the number of hands on deck.

In less turbulent times, sports psychologists can offer athletes coping strategies for performance anxiety, improving on-field results. But they also help student-athletes balance the stress of everyday life, now in more complicated times than usual.

“It’s really COVID on top of everything the athletes face on a regular basis,” said Nicole Gabana, an IU grad and now the director of sport psychology at UMass-Amherst. “I have athletes dealing with injuries, I have anxiety, depression, relationships. And then just dealing with all the health and safety concerns, and all the uncertainty on top of all those challenging scenarios. It just compounds the anxiety.

“I always tell them, you are in a position that no other college athletes in the history of college athletics has ever had to be in before. If you are struggling at times, just know, that makes total sense.”

Keino Miller, another IU alum who now supports teams at Tulane, as well as retired NFL athletes, can attest to an increased caseload for mental health providers. Not only was the pandemic a stressor, removing a fair amount of structure from athletes’ lives, but the murder of George Floyd in May added another dimension for Black athletes, in particular.

“That’s why coaches, in a lot of situations, they are dying to get back to football, because it is a sense of quote-unquote ‘normalcy,’” Miller said. “We think about identity, it’s easier to see myself as an athlete than as a Black man. Because sometimes, being a Black man is very dangerous.

“There has been a 100% uptick of stress related to not only sports but transition, identity, and racial, historical trauma.”

There is a range of issues to grapple with, including anxiety about what’s been lost athletically to the pandemic and what’s still uncertain. Tulane competes in the American Athletic Conference, which has delayed fall Olympic sports but has yet to cancel football.

If athletes are sent home, the concerns change. In the spring and summer, Miller came across cases of food insecurity. Others struggled with substance abuse.

“I’ve got guys that fell back into old habits because self-medication is a reality,” Miller said. “Remotely, we had to advocate for these student-athletes, who were scattered across the country, literally. Those are things as a profession we struggle with while they are on campus, but the outbreak, the shelter-in-place order, it exacerbated it.

“We are looking at how we respond if something more significant happens in the next few months.”

One of the biggest hurdles for sports psychologists during the pandemic has just been meeting with athletes. Because of shelter-in-place orders, sessions had to shift to video chat or “telehealth” services. Those require psychologists to have licenses in the states where clients reside.

In some states, it was a quick process to gain a license. In others, it was more cumbersome.

“If I said it was helter-skelter, I don’t think I’d be too far off,” Miller said. “For folks out of state, you need an emergency license to work with them, or you have to connect them with someone in their area. If they have to find services in their area, that can be a little disconcerting.”

A worrying piece of the North Texas study was a decrease in athletes utilizing mental health services during this time. While 17% said they sought counseling prior to the pandemic, 8% reported they did so before and during — and just 2% said they only sought counseling after it started.

The study found comparable percentages of different racial groups utilizing counseling before COVID-19, but Black athletes were disproportionately affected in not utilizing services after the pandemic started. Researchers theorized it was a lack of available resources in their communities, as well as ongoing stigmas they were confronting back home.

That stigma isn’t new, of course. Miller, for one, played college football in the 1990s and knows how mental health was ignored then. “You toughed it out, talked to your girlfriend, talked to your mother,” Miller said, “and you got your (butt) back to practice.” Since then, pro athletes like the NBA’s Kevin Love and DeMar DeRozan, who have been open about their mental health struggles, have helped normalize seeking help.

But eroding that stigma is an ongoing process. Sports psychologists are mindful of being seen, talking to coaches and athletes whenever possible, reinforcing that services are available, and building a rapport.

“I might show up to practice and athletes see you around and say ‘That’s Doc Steinfeldt, he’s good people,’” Steinfeldt said, “as opposed to some guy that’s buried in a room, that’s in the bowels of the stadium, and that you encounter in this creepy way.”

Steinfeldt, who trains IU’s sports psychology students, likes to call himself a strength and conditioning coach for the mind. It isn’t weak for athletes to seek help. In fact, it’s a sign of resilience. And it makes a world of difference when that message is echoed by university leaders.

Gabana had the awkward task of beginning her new role at UMass-Amherst in June, mid-pandemic. But the coaches and AD at her new school were proactive about bringing her on virtual meetings and making a strong point.

“We brought our football team back in June and our head coach was consistently reinforcing the resources and talking to the guys, explaining ‘This is confidential. If you seek out support from Nicole, I’m not going to think you are weak on the field. We want you to utilize these services,’” Gabana said. “And these are not just if you are struggling. They are going to help make you better. All of that positive messaging from the coaching staff and athletic director, that makes a world of difference.”

Therein lies the importance of Glass putting mental health in the very first paragraph of his letter in March. It’s just incumbent on IU to make services available, both one-on-one and in groups, so athletes aren’t suffering in silence.

“Our student-athletes know we are there,” Moles said. “I think we get out to them all the time about ‘Here’s who we are, here’s what we do,’ and word travels. … Once they work with us more, that stigma continually decreases. They get to know us, they get to see how beneficial the services are, and it just continues to erode.”