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

Pediatric suicide: Review of a preventable tragedy

Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.

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.

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.

Depressive Disorders in Athletes

Depressive disorders in athletes are thought to be at least as common as the general population. However, athletes have a unique set of risk factors that can affect the likelihood of developing depression. Screening tools have been developed specifically for athletes such as the Sport Mental Health Assessment Tool (SMHAT). The management of the depressed athlete should involve an individualized approach, with methods such as counseling, interpersonal therapy, or cognitive behavioral therapy being used. Some may require antidepressant medication. Depressive disorders are also linked to sucidality in athletes, and the team physician and sporting organisation should have a crisis management plan in place for mental health emergencies. Tackling the stigma that remains in sport is a key part to improving mental wellbeing for all athletes.