Increasing numbers of elite British sports stars are falling victim to depression because of stress, leading psychologists warned this week. Pressure to perform at high levels, round-the-clock media attention and the huge amounts of money at stake have added to the mental and emotional toll, said Dr Barry Cripps, chairman of the sports and exercise division of the British Psychological Society.
"Stress-related illnesses are extremely common in professional sports, and they are becoming more so as the pressures on athletes increase. The expectations are enormous and sometimes people cannot handle it," Dr Cripps said.
Cricketer Marcus Tres-cothick, who last week abandoned England's Ashes tour because of a stress-related illness, was only the latest athlete to have suffered mental ill health. The snooker player Ronnie O'Sullivan once rang the Samaritans minutes before the start of the world championship, while boxer Frank Bruno was sectioned after a severe bout of depression.
The Olympic runner Kelly Holmes was diagnosed with clinical depression after being injured during training, and former Arsenal captain Tony Adams was treated for alcoholism.
When Trescothick left for home, his England team-mates were quick to offer their sympathy - and then swiftly returned their attention to the match at hand.
The episode, which may mark the end of Trescothick's international career, was seen as one man's personal tragedy. But it is unlikely to be the last of its kind, according to sports psychologist Carol Seheult. Tabloid tales of sportsmen behaving badly often mask deeper psychological problems, she said. "Alcoholism, gambling and promiscuity are all associated with depression and stress."
Ms Seheult said that the sporting world has failed to admit the scale of the problem. "It's recognised when someone gets caught drunk driving, but no one wants to deal with it," she said.
After he left the England cricket tour of India last year, Trescothick said he found it hard to discuss his illness with team-mates.
Macho attitudes still make many sportsmen unwilling to speak openly, Ms Seheult added. "When I see professional footballers they insist on complete secrecy because they fear it could get back to their manager," she said. "They worry that they'd be seen as wimps."
Outside of sports, stress-related illness is now the main cause of absence from work in the UK, said Cary Cooper, professor of organisational psychology and health at the University of Lancaster. "Sport and politics are perhaps the last bastions of a macho culture where it is difficult to admit that you can't cope," he said.
Creeping commercialisation means athletes can be unwilling - or contractually unable - to compete despite illness, said Christopher Connolly, a sports psychologist. "There are much higher expectations from a much wider range of stakeholders now. It's not just fans who want them to play, there are sponsorship and contractual obligations too," he said.
Team players face an added burden: the expectations of their colleagues. For the footballer who misses a penalty or the fielder who drops a catch, the sensation of failure back in the changing room can be excruciating, said former professional cricketer Richard Doughty. "You're not just playing for yourself, you're playing for the rest of your side," said Mr Doughty, who bowled for Gloucestershire and Surrey in the 1980s.
"If you've under-performed, a dressing room is a very small place to be. It can be a very isolating and lonely experience," he said.
Cricketers seem particularly prone to depression. According to The Silence of the Heart by cricket author David Frith, more than 150 top-class players have taken their own lives.
"Cricketers play for days on end and are on tour for months. There are few moments where you are not surrounded by the team and that can be hard to take when things aren't going well," said Mr Doughty.
Richard Bevan, chief executive of the Professional Cricketers Association, said sporting bodies are obliged to ensure that athletes are both mentally and physically fit to play. "You will always have individuals with problems, but you prepare for that and you make sure that you have the right people to advise them," he said.
Most British teams and squads now employ sports psychologists, but only a handful are qualified clinical practitioners, said Sheelagh Rodgers, an independent psychologist who has worked with the UK athletics team.
"Sports psychologists can deal with performance anxiety, but they're not trained to recognise mental health problems," she said. "We're good at looking after sportsmen physically, but when it comes to psychological difficulties we are failing."
Sol Campbell, former Arsenal and England centre-back
Campbell has suffered from repeated bouts of depression. He walked away from an Arsenal-West Ham game in February at half-time, saying that he could not go on. But in August he signed a two-year contract with Portsmouth. Campbell says: "People like to put people in little boxes and if you don't fit you're odd. But they don't really know anything about me."
Graeme Obree, broke world hour record in 1993 and 1994; Individual pursuit champion 1993 and 1995
Obree attempted suicide four times after suffering from repeated bouts of depression. He first tried to kill himself at the age of 19 by sniffing acetylene gas. The cyclist, who still races occasionally for Fullerton Wheelers cycling club in Ayrshire, says: "When you're depressed, everything becomes distorted." A film based on his life premiered at the Edinburgh film festival in August.
Dame Kelly Holmes, middle-distance runner and double Olympic gold medallist
Holmes was diagnosed with clinical depression in 2003 following injuries while training. She later said: "I became depressed and I cut myself with scissors and stuff."
She also said that in the past she had considered suicide.
She retired from athletics in December 2005.
Scott Harrison, WBO featherweight champion
Harrison pulled out of a fight to defend his title in May after suffering problems with alcohol and depression. He was bailed by a Spanish court following an alleged assault on a policeman in October. Harrison says: "I've been to hell and back, and it hasn't helped that a lot of lies have been told about me in the process. But I'll rise above it all." He is currently waiting for WBO permission to defend his title against Nicky Cook.
Dean Robertson, 1999 Italian Open winner
Robertson lost two years of his career to depression in 2002 and 2003. He is still battling with the illness. But in August he won the Gleneagles Sottish PGA Championship, becoming the highest-earning golfer on the Scottish circuit. He says: "Depression is an illness that can affect anyone."
Marcus Trescothick, batsman, Somerset and England
Trescothick dropped out of the tour of India in February, initially citing family problems and a stomach virus, before admitting that stress had caused him to "fall out of love" with cricket. He said at the time: "Dealing with all the pressures of the illness and trying to compete at a high level of sport is not easy to do." On Tuesday he dropped out of England's Ashes tour in Australia due to "stress-related illness".
The rugby player
Richard Hill, flanker, Saracens and England
Hill suffered from severe depression after contracting an infection in 2005 following an operation to repair a damaged cruciate knee ligament. He was told by the specialist treating his leg that he should prepare for retirement from professional sport. But he rejected the medical advice to retire, and accepted a long-term staff-coaching contract with Saracens. Hill now says: "I didn't know how depressed I was. It was the people closest to me who could see it and that I wasn't handling it very well."