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High hopes: lower risk of death due to mental disorders and self-harm in a century-long US Olympian cohort compared with the general population
  1. Stephanie L. Duncombe1,
  2. Hirofumi Tanaka2,
  3. Quentin De Larochelambert1,
  4. Julien Schipman1,
  5. Jean-François Toussaint1,3,
  6. Juliana Antero1
  1. 1Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France
  2. 2Kinesiology and Health Education, University of Texas at Austin, Austin, Texas, USA
  3. 3Centre d'Investigation en Médecine du Sport (CIMS), AP-HP, Paris, France
  1. Correspondence to Juliana Antero, Institute for Research in Medicine and Epidemiology of Sports (IRMES, EA7329), INSEP, Paris, France; juliana.antero{at}


Objective To determine the risk of death due to prominent mental disorders, substance abuse, and self-harm among US Olympians compared with the general population.

Methods All female (n=2301) and male (n=5823) US Olympians who participated in the summer or winter Games between 1912 and 2012 were followed until 2016. The National Death Index certified their vital statuses and causes of death. We performed a Standard Mortality Ratio (SMR) analysis for all causes studied and applied the years-saved (YS) method to quantify differences in the risk of death for (1) anxiety, depression and self-harm and (2) substance abuse and eating disorders. Additionally, we examined the YS across sports with greater than 100 total deaths and between medalists and non-medalists.

Results US Olympians had a 32% (SMR=0.68, 95% CI 0.49 to 0.91) lower risk of death compared with the general population, resulting in a longevity advantage of 0.21 YS (95% CI 0.14 to 0.29) for deaths by depression, anxiety and self-harm and 0.12 years (95% CI 0.08 to 0.15) for substance abuse and eating disorders. There were no significant differences between medalists and non-medalists, but findings varied by sports. Most sports (eg, athletics, swimming, rowing) had significantly lower risks of deaths than the general population with the exceptions of fencing and shooting. Shooting showed a trend towards a higher risk through suicide by firearm.

Conclusion Olympians have a lower risk of death, favouring an increased longevity compared with the general population for mental disorders, substance abuse and suicides.

  • olympics
  • suicide
  • psychiatry
  • elite performance
  • depression

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  • Twitter @stephduncombe

  • Contributors SD conceptualised the study, wrote the manuscript and finalised the manuscript. HT completed data collection and approved manuscript. QDL completed the data analysis and approved manuscript. JS reviewed and approved manuscript. J-FT conceptualised the study, supervised the process and approved manuscript. JdSA conceptualised the study, did data analysis and reviewed and approved manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This study received ethics approval from the Institutional Review Board at the University of Texas at Austin (2015-03-0035). Data analyses and protection strictly adhered to the confidential data control plan based on the specifications set by the NDI.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data may be obtained from a third party and are not publicly available. Data regarding death certification are strictly subjected to the confidential data control plan according to the specification set by the National Death Index.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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