US gymnastics superstar Simone Biles sent shockwaves through the Olympics on Tuesday, tearfully citing concerns for her mental health after a dramatic withdrawal mid-competition during the women’s team final.

The 24-year-old four-time Olympic gold medallist – one of the faces of the Tokyo Games – got off to a shaky start at the Ariake Gymnastics Centre with a lacklustre opening vault.

Stunned onlookers watched as Biles was led off the competition floor before returning wearing a tracksuit. Soon afterwards, USA Gymnastics confirmed she would sit out the remainder of the final with an unspecified medical issue.

She watched the action unfold alongside her teammates, clapping and even dancing, undercutting any suggestion of an injury.

The US quartet were pipped to gold by the Russians who claimed the Olympic women’s team title for the first time since the 1992 Barcelona Games. Britain took a surprise bronze medal.

After she collected her silver medal – Biles was eligible having at least started the final – the four-time Olympic champion confirmed her shock exit was due to her psychological state.

Speaking to reporters after the final – eventually won by Russia’s team – Biles said concerns for her mental wellbeing prompted her decision to withdraw.

“At the end of the day, I have to do what’s right for me and focus on my mental health and not jeopardize my health and my wellbeing,” she said.

“I just think mental health is more prevalent now in sports and it’s not just like we have to set everything aside, we also have to focus on ourselves.

“Because at the end of the day, we’re human too so we have to protect our mind and our body rather than just go out there and do what the world wants us to do.”

If Biles fails to recover in time for Thursday’s individual all-around competition, it would mark a stunning turn of events at a Games which she had been strongly expected to dominate.

No longer fun

Biles later began crying as she revealed a loss of confidence in her abilities.

“I just don’t trust myself as much as I used to,” she said, flanked by her US teammates. “I feel like I am also not having as much fun. And this Olympic Games I wanted it to be for myself and it felt like I was still doing for other people - and that hurts my heart that doing what I love has been taken away from me.”

“It just sucks that it happens here at the Olympics Games… with the year that it’s been, I’m really not surprised the way it played out.”

Biles has spoken openly about her battle with depression after revealing she was among the hundreds of gymnasts sexually abused by former US team doctor Larry Nassar, who is now serving a life prison sentence.

She said Tuesday that therapy and medicine had helped her, but had not been enough.

“I feel like that’s all been going really well but then whenever you get in a high stress situation you kind of freak out. You don’t really know how to handle all of those emotions, especially being at the Olympic Games.”

“Once I step up onto the mat it’s just me and my head, dealing with the demons in my head.”

Biles has qualified for all finals available to her in Tokyo. The next is the all-around event on Thursday.

“We are going to take it a day at a time and we’ll see what happens,” she said..

The 24-year-old American arrived in Japan as one of the headline acts of the pandemic-postponed 2020 Games, her diminutive frame shouldering an immense weight of expectation as she pursued a record-equalling nine Olympic titles.

In a candid Instagram post on Monday the 24-year-old said she was feeling the pressure during qualifying, admitting: “I truly do feel like I have the weight of the world on my shoulders at times.”

She is bidding to become the first woman in more than half a century to retain the all-around title, with Soviet gymnast Larisa Latynina’s record of nine Olympic gold medals in her sights.

(With AFP inputs)