Abstract
<title>Abstract</title> <p>Background Esports has rapidly evolved into a globally prominent competitive activity, yet mental health support structures within the ecosystem lag significantly behind those in traditional sports. Despite growing evidence of psychological distress among players, limited research has directly explored how players themselves experience and interpret mental health challenges or evaluate existing support structures. This study aimed to examine player perspectives on mental health in competitive esports, including perceived challenges, barriers to support, and recommendations for improvement. Results Nine semi-structured focus groups were conducted with 40 esports players (mean age = 27.5 ± 5.3 years; 11 women, 29 men) from five countries, representing various levels of experience. Data were analysed using a realist approach to thematic analysis, grounded in a critical realist philosophical position. Five themes were generated: (1) competitive esports as a psychologically demanding environment, (2) unequal and stigmatised access to mental health support, (3) esports participation as a conditional protective factor, (4) shared responsibility across an uncoordinated ecosystem, and (5) the need for contextually grounded mental health support. Players described substantial psychological demands associated with competitive play, including performance pressure, toxic online environments, and burnout, alongside a ‘grind culture’ that normalised emotional suppression and discouraged help-seeking, sustained in part by the precarity of competitive opportunity and the visibility of performance to fans and sponsors. Access to support was described as uneven, shaped by competitive level, geography, and financial resources. Participants frequently stated that support needs to be informed, context-specific, and tailored to the digital and online demands of esports. Despite these challenges, participants identified esports participation as a source of social connection, skill development, and psychological resilience when environments were structured and supportive. Conclusions Findings highlight the need for coordinated, context-specific mental health frameworks developed in collaboration with players and distributed across multiple stakeholders within the esports ecosystem.</p>