Nonsuicidal self-injury, suicidal ideation, and suicide attempt among collegiate athletes: Findings from the National College Health Assessment

Suicide and suicidality among collegiate student-athletes: A scoping review

Objective: Participation in college athletics has traditionally been presumed to counter poor mental health outcomes including death by suicide. While previously reported incidents generally involve male football players, recent incidents suggest changing trends in frequency, sport, and sex. This research aims to summarize the breadth and limitations of existing research on death by suicide among U.S. collegiate student-athletes. Participants and Methods: This scoping review followed Joanna Briggs Institute guidance. A final sample of 19 research studies were identified through a comprehensive search including APA PsychINFO, PubMed, MEDLINE Complete, SPORTDiscus, and CINAHL databases and Gray Literature sources. Results: Most studied outcomes were suicidal ideation and attempt. Research on assessment of suicide prevention interventions for student-athletes is lacking. Conclusions: The paucity of research found on suicidal behaviors among collegiate student-athletes, including a lack of intervention research, in conjunction with recent trends suggest the need for a renewed focus on this topic.

Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population

BACKGROUND AND OBJECTIVE

Previous systematic reviews on mental health in athletes have found athletes to be at a potentially increased risk for mental health diagnoses compared to the public. Multiple cross-sectional studies have examined suicide behaviour within different athlete populations, but there is a need for a comprehensive review to synthesize and identify risk factors and epidemiology regarding suicide behaviour in the elite athlete population, especially as it compares to the general population.

METHODS

A systematic literature search was performed in MEDLINE, EMBASE, Scopus, and Web of Science from 1990 to January 2023. Inclusion criteria included original peer-reviewed research articles examining suicidal ideation, suicide attempt, or suicide completion within elite athlete populations. Exclusion criteria included athletes participating in high-school or Paralympic level sports, studies that did not report results regarding elite athletes and non-athletes separately, and non-peer reviewed work. All studies were screened for inclusion by two independent reviewers. The primary outcome variables extracted from included studies included rates, risk factors, and protective factors for suicide behaviour. The study quality and risk of bias was evaluated for each study using the Joanna-Briggs Institute (JBI) critical appraisal tools.

RESULTS

Of the 875 unique studies identified, 22 studies, all of which were cross-sectional in nature, met the inclusion criteria. Seven studies evaluated previous athletes, 13 studies evaluated current athletes, and two studies included a combination of previous and current athletes. Seven studies involved varsity college athletes, nine involved professional athletes of various sports, and six focused on international or Olympic level athletes. The rate of suicidal ideation in professional athletes ranged from 6.9 to 18% across four studies, while the rate in collegiate athletes ranged from 3.7 to 6.5% across three studies. Ten studies compared athletes to the general population, the majority of which found athletes to be at reduced risk of suicidal ideation, suicide attempt, and suicide completion. Only one study found athletes to have increased rates of suicide compared to matched non-athletes. Risk factors for suicide behaviour identified across multiple studies included male sex, non-white race, older age, and depression. Player position, athletic level, sport played, and injuries showed trends of having limited effect on suicide behaviour risk.

CONCLUSION

This review suggests that elite athletes generally demonstrate reduced risk of suicidal ideation, suicide attempt, and suicide completion compared to the general population. Coaches should remain aware of specific factors, such as male sex, non-white race, and higher athletic level, in order to better identify at-risk athletes. Limitations of this review include the heterogeneity in the methodology and athlete populations across the included studies. Therefore, future targeted research is essential to compare suicide behaviour between sports and identify sport-specific suicide risk factors.

TRIAL REGISTRATION

PROSPERO Registration: CRD42023395990.

Depression, anxiety, and suicidal behaviors in a large-scale national survey of student athletes versus non-athlete college students: risk and protective factors

OBJECTIVE

This study investigates the prevalence and risk factors of internalizing disorders and suicidal behaviors in student-athletes and their non-athlete peers.

PARTICIPANTS

The sample consisted of 223,226 college students (69,404 student-athletes [31.09%]) who participated in the NCHA-ACHA II survey (Fall 2015-2018).

METHODS

Items from the NCHA-ACHA II were used to assess severity of depression, anxiety, and suicidal behaviors. Chi-squared Test of Independence and multinomial logistic regressions were used to examine self-reported internalizing symptoms, previous diagnosis, previous use of mental health resources, and suicidal behaviors within student-athletes and non-athletes.

RESULTS

Findings indicated high rates of internalizing symptoms. Student-athletes, both varsity and intramural/club, displayed decreased odds of internalizing symptoms, self-reported mental health diagnosis, and suicidal behaviors.

CONCLUSIONS

This study with a national sample expands previous studies showing concerning rates of mental health difficulties, student-athletes demonstrated lower odds. These findings highlight the importance of further research and need for targeted intervention within this population.

Preventing Suicide and Promoting Mental Health Among Student-Athletes From Diverse Backgrounds

Suicide and contributing mental health conditions in athletes are shared concerns within health care and society at large. This commentary focuses on suicide risk among athletes and the role of sports medicine professionals in preventing suicide and promoting mental health. In this commentary, we draw on the scientific literature and our clinical experiences to pose and answer these questions: Does suicide risk among athletes vary by sociodemographic factors (eg, sex, gender, race/ethnicity, family income, sexual orientation) or if injured? Do sociodemographic differences influence access to and benefits from services among athletes? How do I know my athletes are at risk for suicide? What do I do if one of my athletes shares with me that they have considered suicide? Within our commentary, we review the current literature and clinical practices regarding these questions and close with actionable suggestions and recommendations for future directions.

Maltreatment experiences and mental health indicators among elite athletes

This study explored the relationships between athletes' experiences of maltreatment and mental health indicators. Canadian National Team athletes completed an online, anonymous survey that assessed reported experiences of maltreatment (psychological, physical, sexual harm and neglect), and mental health indicators of well-being, eating disorders and self-harming behaviours. All forms of maltreatment had a significant, positive correlation with eating disorder and self-harming behaviours, and a negative correlation with well-being. The relationships between maltreatment and mental health indicators differed based on identity characteristics of the athletes. Further work is needed on the prevention and intervention of maltreatment in sport to reduce the behaviours associated with negative health outcomes.

Experiences of Current National Collegiate Athletic Association Division I Collegiate Student-Athletes With Mental Health Resources

CONTEXT

Collegiate student-athletes (SAs) experience psychological stressors due to rigid schedules, team conflict, and injury. These factors can result in symptoms of mental health conditions, decreased daily functioning, and suicidality.

OBJECTIVE

To explore National Collegiate Athletic Association Division I SAs' experiences with mental health and access to and experiences with mental health resources at their university.

DESIGN

Consensual qualitative research study.

SETTING

One-on-one interviews.

PATIENTS OR OTHER PARTICIPANTS

Twenty-three Division I SAs (18 women, 5 men; mean age = 20 ± 2 years).

MAIN OUTCOME MEASURE(S)

Participants completed a semistructured interview that focused on their experiences with mental health. The interviews were audio recorded and transcribed verbatim via Zoom. Credibility and trustworthiness were established via member checking, triangulation, and peer discussion among a 3-person coding team.

RESULTS

Two domains, increased expectations and resources and management, were identified. The participants shared how they balanced life as a college student, academic stressors, performance expectations, and a sport-first mindset they perceived from coaches and support staff. They discussed their experience with the internal support network of coaches, the athletic department, and sport psychology. Participants remarked on their external support network, which included their family, friends, and psychological services. The resources available at their institutions and their accessibility were perceived both positively and negatively. Some collegiate SAs described resources as helpful, whereas others portrayed a lack of timeliness for appointments, lack of advertisement, incomprehension by counselors of athlete demands, and no sport-specific counseling as barriers.

CONCLUSIONS

Collegiate SAs expressed mental health concerns due to stress and the demands of sport participation. Self-regulated coping strategies and support networks continue to be powerful and helpful resources for mental health, with or without a diagnosed condition. Barriers to mental health service use were a lack of sport specificity and lack of access. Institutions need to focus on creating athlete-centered mental health resources with annual advertisements to increase use.

What facilitates collegiate athletes seeking mental health care? Athletic trainers' perceptions

Objective: To assess athletic trainers' (ATs) perceptions regarding the importance of athletes' beliefs and athletic department stakeholders in facilitating help-seeking for mental health (MH) care.Participants: 534 ATs within collegiate athletic departments (M_age = 35.50 years; 64.2% women; 87.3% White).Methods: ATs were asked to indicate the extent to which they believed 10 student-athlete beliefs about MH (e.g. confidence MH treatments work) and 10 stakeholders (e.g. teammate) would facilitate student-athletes' help-seeking for MH care (1, Strongly Disagree, to 5, Strongly Agree).Results: We conducted separate two-way mixed design ANOVAs, one for each set of 10beliefs and 10 stakeholders; each was significant (p's < .002). The ATs perceived confidentiality as the most facilitative belief and viewed ATs as the most facilitative stakeholder.Conclusions: ATs differentiate among student-athletes' beliefs and stakeholders on how facilitative each might be in help-seeking, suggesting pathways for improving MH climate within athletic departments through education and policies.

Athletes are not at greater risk for death by suicide: A review

INTRODUCTION

Suicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society.

METHODS

A comprehensive literature search was carried out through PubMed and Embase databases for relevant publications.

RESULTS

Recent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high-performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance-enhancing medications, sport-specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement.

CONCLUSIONS

The findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide-related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance-enhancing substances, sports-related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.

Social Support and Post-Injury Depressive and Anxiety Symptoms among College-Student Athletes

Social support can positively influence both physical and psychological recovery from sport-related injury. However, few studies have examined the influence of the quantity, quality, and timing of social support on athletes’ psychological health following injury. This study examined the effects of changes in social support on post-injury depressive and anxiety symptoms among college-student athletes. We conducted a prospective cohort study among Division I college-student athletes. Participants completed surveys at baseline and at multiple time points post-injury until return to play (RTP). A total of 597 injuries sustained by 389 student athletes (n = 400 (67.0%) males; n = 238 (39.9%) football players; n = 281 (47.1%) freshman) were included. The overall amount of social support increased from baseline to 1-week post-injury (p < 0.05) and then remained unchanged until RTP. The overall satisfaction with the support received increased from baseline to 1-week post-injury (p < 0.05) but decreased (p < 0.05) from 1-week post-injury to RTP. Increases in satisfaction with the support received were associated with decreases in post-injury depressive (β = −0.404), p < 0.0001) and anxiety symptoms (β = −0.406), p < 0.0001). Interventions involving social support may help hasten college-student athletes’ psychological recovery from injury.

The Prevalence of Mental Health Conditions Among High School and Collegiate Student-Athletes: A Systematic Review

The physical impacts of overtraining, sport specification, and burnout are well documented in the literature; however, the state of the student-athlete’s (SA’s) mental health is something that needs to be investigated more comprehensively. Literature on SA mental health has gained prevalence within the last 5 years. The combination of pressure from sport and academics, as well as the stigmatization of clinical mental health treatment, can have a significant effect on the SA’s psyche. This review explores the prevalence of mental health conditions (MHCs) in high school and collegiate SAs. This includes signs and symptoms of mental health diagnoses to include substance- and alcohol-related addictive disorders and risk factors of such. A systematic review of the CINAHL, ERIC, SPORTDiscus, APA PsycINFO, and Rehabilitation & Sports Medicine resource databases was conducted. The initial search yielded 855 results. Following double screening, 22 studies were included, all of which were deemed medium to high quality. The findings indicate an alarming presence of MHCs ranging from risk factors of alcohol use and major depressive disorders among SAs. There was a high prevalence of mental health issues among SAs who are Black, Indigenous, people of color (BIPOC), and Lesbian, Gay, Bisexual, Transgender, Queer (LGBTQ). In most cases, participation in competitive athletics (varsity) did not contribute to additional MHCs for SAs. Sport psychologists should play a role in mental health programming within athletic departments. Athletic departments should develop proactive, targeted strategies to address MHCs for SAs.

Mental Health in the Young Athlete

PURPOSE OF REVIEW

The goal of the present paper is to provide a comprehensive overview of mental health concerns in young athletes, with a focus on common disorders, as well as population-specific risk factors.

RECENT FINDINGS

Athletes experience similar mental health concerns as non-athlete peers, such as anxiety, depression and suicidal ideation, ADHD, eating disorders, and substance abuse. However, they also experience unique stressors that put them at risk for the development or exacerbation of mental health disorders. Student athletes have to balance academics with rigorous training regimens while focusing on optimal performance and managing high expectations. Physical injuries, overtraining, concussion, sleep disorders, and social identity are some of the factors that also impact the mental health of student athletes. Existing literature highlights the need to develop proactive mental health and wellness education for young athletes, and to develop services that recognize the unique needs of this population.