An individual’s mental health resources are likely to be tested by stressors at different moments in their life (Fletcher and Sarkar, 2016). Such stressors can be defined as «environmental demands encountered by an individual» (Sarkar and Fletcher, 2014, p. 8; Mellalieu et al., 2006, p. 359) and are usually more modest disruptions to our everyday lives than major catastrophes (Sarkar and Fletcher, 2014). They are multifactorial and experienced on personal, cultural, and environmental levels. In this respect, sports research has investigated stressors in relation to their different states and recovery processes, or categorized them as competitive, organizational or personal (Kellmann, 2010; Sarkar and Fletcher, 2014). One dance-specific study has further identified physical stresses related to dance training, such as a high physical workload, and requirements concerning technical skill and choreographic demands; as well as psychosocial stressors related to the environment, such as managing finances and obligations, interrelations, and major life events (Blevins et al., 2020). Yet, a clear picture of the range and relevance of dance specific stressors do not exist to date.

Mental health entails that individuals are affected by various factors such as context, situation and stressors but also encapsulates how they respond to and deal with these impacts and experiences (Lazarus and Folkman, 1984). Mental processes are therefore vital mechanisms that are often comprised of many steps towards a mental health outcome.

Sports research confirms that these processes are not linear but complex mechanisms that are comprised of many factors interacting with each other (Williams and Andersen, 1998; Fletcher and Sarkar, 2016). Personal qualities and the environment are essential overarching groups of resources in these mental processes. They can act in either protective or debilitative directions and increase or decrease mental health outcomes, respectively. They also represent and comprise several of the components identified to restore or strengthen mental health, such as the ability to relate to others, demonstrate psychological flexibility, and cope with challenging life events (Galderisi et al., 2015). Given the importance of these factors, it is vital to identify and map out an overview over these components to better grasp and address these complex mental processes in dance.

Personal qualities can be described as psychological factors that either protect or negatively influence individuals and must be distinguished from psychological skills (Fletcher and Sarkar, 2012, 2016). Personality, or personality characteristics, is a more stable, yet flexible, multilayered personal quality consisting of dispositional traits, characteristic adaptations, and self-narrative identities that “contribute to an individual’s distinctive patterns of feeling, thinking, and behaving” (Fletcher and Sarkar, 2016, p. 5). Psychological skills, on the other hand, are more adaptable cognitive and affective techniques and processes that are used to enhance and optimize an individual’s functioning or mental readiness in encountering stressors (Fletcher and Sarkar, 2016). A study in an academic setting, for example, has shown that students who become aware of the possibility of enhancing their personal qualities by training in psychological skills seem to enhance their flexibility and ability to cope with adversity (Yeager and Dweck, 2012). Therefore, an individual can train to acquire certain psychological skills that will enhance or improve their personality traits that thus act as protective factors against challenging life events.

Individuals are in a complex interaction with their environment. Consequently, their mental health is greatly influenced by different factors embedded in this climate. These can range from social and cultural circumstances or occurrences, such as auditions, transitions, injuries, deselection, and defeat (Fletcher and Sarkar, 2016), to stakeholders wielding power that influence the mental state of others. Therefore, environments can either be protective by nourishing a person’s mental health, or debilitative, by jeopardizing the balance of an individual’s mental health components and thus causing mental health challenges and disorders (Henriksen et al., 2020).

Mental processes can lead to either positive or negative mental health outcomes. Positive outcomes indicate the presence of mental health (flourishing; Keyes, 2002). In this case, the individual has enough personal resources to be protected from, adapt to, withstand, or swiftly rebound from an encounter with a stressor to avoid a permanent decrease in one’s mental health (Fletcher and Sarkar, 2016; Keyes, 2002). Consequently, this can lead to, increased task engagement and optimal performance. Negative outcomes can imply that stressors have exceeded available resources, leading to that the individual moves on a spectrum between the absence of mental health (languishing) and the presence of mental illness (Keyes, 2002). This can result in either mental health challenges, like distress, loneliness and exhaustion or mental illness as for example, depression, self-harm, and/or substance abuse (Howells and Fletcher, 2015). Yet, it is important to acknowledge the dynamic state of mental health and that individuals can thrive in one area of life and struggle in another (Henriksen et al., 2020). That means that individuals might sometimes succumb to a stressor but still experience states of mental well-being or that they benefit from the psychological and behavioral changes induced by this experience (Collins and MacNamara, 2012; Fletcher and Sarkar, 2016). Therefore, a negative outcome is not a permanent sentence of doom. Rather, it can lead to growth required for re-evaluation and reflection, and stimulate learning (Galderisi et al., 2015). To date, several studies in dance research have highlighted prevailing negative outcomes such as eating disorders, fatigue and trauma following injury occurrence (Schluger, 2010; Dantas et al., 2018; Kenny et al., 2019; van Winden et al., 2020). Yet, there exists, to our knowledge, no overview over positive and negative outcomes in dance research and little insight into which of these are prominent or obscure.

Several studies in this review describe how individuals encountered various environmental demands, also called stressors. They are organized as situational, interpersonal, or cultural. Each group of stressors is presented in turn in the following paragraphs (see Table 2).

Situational stressors (20 studies) in general include career uncertainty, time management issues, limited economic means and injuries. Only a few articles in this category describe how limited financial means and career uncertainty represent issues negatively affecting dancers’ development and potential future (Sanchez et al., 2013; Lopez, 2019). On the other hand, injuries are a much more discussed topic (Liederbach and Compagno, 2001; Kenny et al., 2019; van Winden et al., 2020; Pentith et al., 2021). Injuries negatively affect dancers in many ways, hindering training and performance, and thus, hampering the learning and development process (Macchi and Crossman, 1996). Also, dealing with an injury is mentally tough, and dancers’ mental states appear to influence how effectively these are coped with (Macchi and Crossman, 1996; Mainwaring et al., 2001; Kenny et al., 2019). Therefore, several studies stress the importance of therapists, sport psychologists, medical professionals, and teachers to provide a holistic approach to injury management (Macchi and Crossman, 1996; Mainwaring et al., 2001; Pollitt and Hutt, 2021).

Interpersonal stressors (26 studies) are related to asymmetric power exerted by authority figures, perceived pressure and expectations from others, and body image pressure from peers and teachers. Several studies describe that these factors place tacit and rigid demands on the dancers (Benn and Walters, 2001; van Staden et al., 2009; Dantas et al., 2018; Haraldsen et al., 2021a). Power exerted by authority figures, such as teachers and choreographers, seem to influence dancers’ outward agreements with a set cultural system (Benn and Walters, 2001; Parker, 2011; Pickard, 2013; Dantas et al., 2018). Peers are often part of this system and influence, alongside the teachers, dancers’ body image, eating attitudes and overall ideals (Table 3).

Cultural stressors (42 studies) describe factors inherent in dance culture, such as cultural hegemony, set physical ideals, narrow minded identity ideals, cult-like behavior expectations, traditional gender roles, and hierarchical and top-down organizations. Ballet is described as an authoritarian, hierarchical, cult-like power achievement culture where dancers accept abuse and unreasonable behavior in a state of «silent conformity» (Benn and Walters, 2001; Parker, 2011). Part of this culture are set, physical ideals which affect dancers to strive for thinness to attain a ballet physique or ideal dancers’ body (Benn and Walters, 2001; Dryburgh and Fortin, 2010; Pickard, 2013; Mitchell et al., 2020). Other studies describe narrow minded identity ideals inherent in the dance culture. That means that dancers are expected to possess and display certain personality characteristics, such as being docile, humble, hard working, dedicated, mentally tough and persistent (van Staden et al., 2009; Parker, 2011; Aujla et al., 2014, 2015; Haraldsen et al., 2019, 2020). Finally, male adolescent dancers appear seven times more likely than the general public to be bullied, teased or harassed – regardless of their sexual orientation (Risner, 2014). Negativity, stereotypes, bias, and harassment are accepted as commonplace and thus expected, negotiated, and endured (Risner, 2014). In particular, male ballet dancers report engaging in a system that is characterized by gendered rules in both technique and performance, highly stigmatized as effeminate and gender codified (Haltom and Worthen, 2014).

The processes of handling stressors described in the studies are broadly categorized either as facilitative or debilitative. Facilitative processes comprise proactive and more robust personal qualities on the one side and protective aspects of the dance environment on the other. Together, these factors appear to either restore or strengthen mental processes and thus act as protective factors in coping mechanisms. Debilitative processes comprise dysfunctional personal qualities and unrelenting features in the dance environments that seemingly jeopardize or imbalance mental health processes. The results of how each of these were identified in the data will now be presented in turn.

Depending on the number of perceived stressors, as well as the features and interaction of the personal qualities and environment at hand, diverse mental health outcomes seemingly increased or decreased (see Figure 4).

The results identified a range of stressors comprised of situational, interpersonal, and cultural. In the context of Western dance theatre, cultural stressors appear to be the most influential, followed by interpersonal stressors. The extent to which of these stressors manifested themselves varied among the dance genres dissected in the data. This became especially apparent when analyzing the reviews’ cultural stressors. This revealed that genres such as jazz are more concerned about body image, gender identities, and commercialization of the body than contemporary and modern dance, which seem more progressive in the cultivation and reflection of positive body image (Heiland et al., 2008; Pollatou et al., 2010; Alexias and Dimitropoulou, 2011; Swami and Harris, 2012). Interpersonal stressors identified many aspects of pressures. It appeared, for example, that not only teachers but also peers exerted pressure on dancers’ body image and perceived expectations (Dantas et al., 2018). Classical ballet especially seemed irrevocably connected to deep-running traditions and a fostering of cultural and interpersonal stressors, which various participants in several studies reported to be “part of the deal” and as an aspect that is tacitly expected, accepted, and cultivated (Benn and Walters, 2001; Risner, 2014; Cahalan et al., 2019; Haraldsen et al., 2019). Other challenges and factors, such as situational stressors, are underrepresented across the scoping review and could therefore not provide a much-needed understanding of factors such as dancers’ financial means, support systems, and environments (Sanchez et al., 2013). Several studies describe injuries as a central stressor that jeopardizes dancers’ mental health (Macchi and Crossman, 1996; Backlund and Wallén, 2016; Cahalan et al., 2019; Haraldsen et al., 2021a). Although injuries are characterized by physical challenges, the findings highlight the importance of interconnecting dancers’ physical and mental needs when dealing with an injury. Furthermore, dancers in all dance genres generally appear to possess or receive little knowledge about how to attend to injuries, rest, deal with mental health issues, and build a life outside of the dance environment (Macchi and Crossman, 1996; Aujla et al., 2014; van Winden et al., 2020). Overall, there is a need to further the understanding of the interaction between physical and mental health in dance and test out the effect of mental health education as part of dance education and dance teacher training.

Findings in the literature suggest that dancers’ mental health is influenced by both protective and debilitative factors. However, tendencies in the identified studies seem to indicate, that dancers are either languishing or are showing signs of thriving and flourishing. This appearance of a little nuanced picture of dancers’ mental health seem to be underpinned by several factors. First, that there is little rigorous conceptualization of mental health in dance; second, that there is a prevalence of quantitative studies in the field that might not capture the more complex, in-depth aspects and dynamic states of mental health; and third, that research on mental health is generally not practically applied in interventions or other experimental designs.

The evidence relating to protective personal qualities revealed that buffering attributes, such as confidence, were presented as suggestions for further research rather than practically applied and explored (Kveton-Bohnert, 2017; Blevins et al., 2020; Carattini, 2020; Kim et al., 2022). Therefore, protective personal qualities should be seen as useful suggestions and indications for further research, rather than established evidence in the dance context. Facilitative environment, on the other hand, are underpinned by more in-depth endeavors that uncover which elements are likely to contribute to dancers thriving in their environment. The majority of these investigations focus on motivational climates and imply that awareness of the three basic psychological needs from self-determination theory and motivational quality in general can make a positive difference in dancers’ lives (Quested and Duda, 2009; Hancox et al., 2017; Haraldsen et al., 2020). However, while motivational quality and climates appear to be researched to some degree in dance, there is still limited knowledge about dancers’ motivational states in different dance genres. Also, to date, other important aspects, such as psychological safety, have been little explored and require further investigation.

In general, there was a prevalence in studies describing debilitative aspects inherent in an unrelenting environment (such as performance pressure and ego-involving climate), that, in turn, were linked to certain debilitative personal factors such as perfectionism or obsessiveness. Even though research on perfectionism conceptualizes the term and examines it contextually (Nordin-Bates et al., 2011, 2014; Stornæs et al., 2019), both ego-orientation and obsessiveness lack conceptualizations and contextual approaches. We know, for example, little about the dimensions of obsessiveness and how aspects, such as compulsive striving, look like in different dance genres. So far, these debilitative personal qualities seem inextricably linked to an unrelenting environment that appears to enable peers and teachers to influence dancers’ body image, eating attitudes, and overall ideals, which in turn hamper dancers’ development and well-being (Critien and Ollis, 2006; Lacaille et al., 2007; Harper, 2012; Stanway et al., 2020; Haraldsen et al., 2021a). Several of the studies offer valuable advice how to address and change debilitative aspects of the particular cultural features of the dance environment (Bonbright, 1995; Mainwaring et al., 2001; Batur et al., 2003; van Staden et al., 2009; Schluger, 2010). However, to date almost none of these plans have been put into action and tested for viability and effect.

Overall, the findings in this scoping review indicate that we possess little knowledge about the mental processes in dance. For instance, no study, to date, has investigated concepts of resilience in dance. However, sport psychology studies have conducted investigations into coping strategies, stress and recovery as well as resilience processes. They highlight that gaining knowledge about whether an individual appraises a stressor as a threat or challenge is decisive in the process of how the stressor is perceived and dealt with (Fletcher and Sarkar, 2016). Future research needs to address and reflect whether different components such as appraisals and responses might further the understanding of mental health processes in dance. Furthermore, research should capture the dynamic nature of dancers’ mental health processes. These should investigate whether, and in which way dancers’ protective and debilitative personal qualities coexist and how they interact and adapt during different time periods.

This review captured both positive and negative mental health outcomes. Findings identified the presence of mental health by means of increased life quality, positive emotional states, establishing a work/life balance, and using psychological skills to increase confidence, self and career management. (van Staden et al., 2009; Nordin-Bates et al., 2011; Kveton-Bohnert, 2017; Hopper et al., 2020; Kim et al., 2022). The most frequent indications for the absence of mental health were stress, distress and tiredness related to burnout. The presence of mental illness was indicated by negative outcomes such as anxiety and eating disorders. Of these, eating disorders and psychological trauma following injury occurrence especially, seem to be deeply influenced by dance environments’ ingrained power culture and ballet aesthetics, as well as by factors of significance such as mirrors (Liederbach and Compagno, 2001; Kenny et al., 2019; van Winden et al., 2020; Pentith et al., 2021). Thus, the strong indications for both the absence of mental health and the presence of mental illness, point to a most warranted change in the dance world to address these issues.

Prevalence has been difficult to identify, but would be needed in order to gain a more precise overview of prevalence in mental health outcomes. Studies examining, for example, how dancers compare to the general public or other athletes, would aid the understanding of mental health and the debilitative impact of mental health issues in dance. Overall, positive and negative outcomes appear to exist side by side, despite endeavors to study them as separate entities. That means that dance research needs to look at the holistic picture, modeling and testing the sum of stressors, resources available in the process and the composition of the individual’s health situation, in order to understand these outcomes (see Figure 4). However, to date dance research still lacks replication studies and more experimental designs that test and verify mental health components. It is important to consider how these could compose a more holistic picture of dancers’ mental health.