Risk factors for depression and suicide in athletes

Management of depression and suicidal ideation must involve a better understanding of risk factors. Male and African-American college athletes appear to be at increased risk of suicide.5 Female college athletes, on the other hand, are more likely to report depressive symptoms, though less likely to complete suicide.14 ,15 National Collegiate Athletic Association (NCAA) football athletes demonstrated the highest rate of suicide for unclear reasons, though a prior study found that athletes invested in violent sports show higher levels of violent behaviour outside of athletic participation.5 Ideally, student-athlete mental health, athletic trainer and physician resources should identify athlete and sport-specific risk factors and target high-risk groups for intervention. Steps should be taken to establish validated screening tools relevant to the athletic population. For example, injured athletes, especially those missing a prolonged period of participation, could be screened with mental health inventories (such as the Physical Health Questionnaire-9 and Generalised Anxiety Disorder-7) until they have successfully returned to full athletic participation to better gauge the mental health consequences of injury and restricted participation.

Improving management of mental health concerns

The sports psychology literature describes a multimodal approach involving ecological prevention, proactive prevention, early intervention and crisis intervention.16 The NCAA has begun to introduce these concepts through publications, including Managing Student Athletes’ Mental Health Issues and Mind, Body, Sport.17 ,18 The employment of a multidisciplinary approach, involving team physicians, athletic trainers, licensed mental health providers and campus mental health centres provides the depressed or suicidal athlete with a range of supportive resources. While much effort has been put into developing and maintaining emergency action plans to manage on-field medical emergencies, only preliminary efforts have been developed to assist the acutely depressed or suicidal athlete through an organised emergency mental health crisis plan. Each organisation should take inventory of its available mental health resources and develop a coordinated plan to direct athletes to necessary resources.

Other challenges face providers who care for athletes. A survey of 827 sports medicine physicians found that only 80% of respondents reported often or sometimes discussing psychological issues related to injury when treating an athlete.19 Most respondents noted a lesser degree of comfort in discussing the psychological issues compared to the injury itself. Providers and affiliated athletic staff who directly care for athletes benefit from established relationships, and such trusted associations can permit athletes to feel safe in disclosing their mental health concerns. However, providers must become more familiar and comfortable with exploring mental health concerns with athletes and related circumstances to facilitate discourse, disclosure and subsequent intervention.

As healthcare professionals responsible for athlete health and well-being, we must increase our attention to the mental health of athletes. A growing recognition of this concern will help drive identification, prevention and management strategies, while facilitating a better understanding of the scope of mental health disorders within the athletic culture and the challenges to proper management within the context of athletic participation. As a community, we have performed well to embrace the concepts of screening for health-related issues and managing medical conditions. The critically important issue of athlete mental health should be no different and deserves our attention now.