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Wilson GA, Smith JM, New KJ. Risk Factors for Suicide Among Professional Athletes. J Psychiatr Pract 2024; 30:314-324. [PMID: 39357012 DOI: 10.1097/pra.0000000000000806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2024]
Abstract
BACKGROUND Suicide is a major public health concern that affects all demographics. Risk factors for suicide in professional athletes are poorly understood compared with the general population. The goal of this study was (1) to explore the current literature on risk factors for suicide in the population of professional athletes and (2) to formulate a proposed suicide risk identification tool as the first step in the production of a validated screening method specific to this population. METHODS A comprehensive literature search for relevant publications was carried out through 7 databases. RESULTS There is some evidence to suggest that retirement, anabolic androgenic steroid use, sexual abuse victimization, health problems, financial issues, relationship issues, having immigrant parents, having a financially disadvantaged childhood, using self-blame or behavioral disengagement as a coping strategy, changes in appetite or weight, sleep problems, reduced competitiveness, and thinking about a career after retirement are potential risk factors for suicide in this population. There is limited evidence to suggest that having a career in elite or professional sports, participation in contact sports, and participating in specific sports that are not associated with a higher suspected prevalence of performance-enhancing drug use are potential risk factors. CONCLUSIONS This study identified potential risk factors for suicide among elite and professional athletes. These findings were used to help formulate a proposed suicide risk identification tool. Future research is recommended to explore and clarify specific risk factors for suicide in this population and to test the validity of the proposed tool.
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Affiliation(s)
- George A Wilson
- Faculty of Life Sciences & Education, University of South Wales, United Kingdom
| | - Joshua M Smith
- High-Performance Department, AmaZulu Football Club, South Africa
| | - Karl J New
- Faculty of Life Sciences & Education, University of South Wales, United Kingdom
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2
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Gill VS, Sullivan G, Stearns H, Tummala SV, Haglin JM, Economopoulos KJ, Marks L, Chauhan M. Mental Health in Elite Athletes: A Systematic Review of Suicidal Behaviour as Compared to the General Population. Sports Med 2024; 54:1-18. [PMID: 38407749 DOI: 10.1007/s40279-024-01998-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024]
Abstract
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.
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Affiliation(s)
- Vikram S Gill
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
- Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ, 85054, USA.
| | | | - Hunter Stearns
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Jack M Haglin
- Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Lisa Marks
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Mohit Chauhan
- Department of Psychiatry, Mayo Clinic, Jacksonville, FL, USA
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Kader M, Pasternak B, Lim CE, Neovius M, Forssblad M, Svanström H, Ludvigsson JF, Ueda P. Depression and anxiety-related disorders and suicide among Swedish male elite football players: a nationwide cohort study. Br J Sports Med 2024; 58:66-72. [PMID: 37857446 PMCID: PMC10804025 DOI: 10.1136/bjsports-2023-107286] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVE To assess whether male elite football players, during and after their active career, were at increased risk of depression and anxiety-related disorders and suicide, as compared with the general male population. METHODS We included male football players active in the Swedish top division 1924-2019 and general male population (matched to football players based on age and region of residence) aged <65 years in 1997. Using nationwide registers, we followed the football players from their first season in the top division (or the date of their first registered residency in Sweden) or 1 January 1997, and compared the risk of depression and anxiety-related disorders (captured through diagnoses from hospital admissions and outpatient visits, and use of prescription drugs) among football players versus controls. In a secondary analysis using data from death certificates, we compared the risk of suicide between football players and general population males who were alive in 1969 (when cause of death became available) . RESULTS During follow-up through 31 December 2020, 504 (13.6%) of 3719 football players and 7455 (22.3%) of 33 425 general population males had a depression or anxiety-related disorder. In analyses accounting for age, region of residence and calendar time, the risk of anxiety and depression-related disorders was lower among football players versus general population males (HR 0.61, 95% CI 0.55 to 0.66). The protective association was attenuated with increasing age, and from around age 70 years the risk was similar in the two groups. The risk of suicide was lower among football players versus general population males (HR 0.48, 95% CI 0.32 to 0.72). CONCLUSIONS In this nationwide cohort study in Sweden, elite male football players had a lower risk of depression and anxiety-related disorders and suicide as compared with the general population.
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Affiliation(s)
- Manzur Kader
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Björn Pasternak
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Carl-Emil Lim
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Martin Neovius
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Forssblad
- Department of Molecular Medicine and Surgery, Stockholm Sports Trauma Research Center, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Svanström
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Kobenhavn, Denmark
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Örebro University Hospital, Orebro, Sweden
| | - Peter Ueda
- Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
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Pichler EM, Ewers S, Ajdacic-Gross V, Deutschmann M, Exner J, Kawohl W, Seifritz E, Claussen MC. Athletes are not at greater risk for death by suicide: A review. Scand J Med Sci Sports 2023; 33:569-585. [PMID: 36648386 DOI: 10.1111/sms.14316] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 11/21/2022] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Eva-Maria Pichler
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland
| | - Simon Ewers
- Klinikum Fünfseenland, Fachklinik für Psychiatrie und Psychotherapie, Wallerfangen, Germany
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Markus Deutschmann
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Jan Exner
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Wolfram Kawohl
- Department of Psychiatry and Psychotherapy, Psychiatric Services Aargau, Windisch, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Clienia Schlössli AG, Oetwil am See, Switzerland
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland
| | - Malte Christian Claussen
- Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Zurich, Switzerland.,Private Clinic Wyss AG, Münchenbuchsee, Switzerland.,Psychiatric Services Grisons, Chur, Switzerland
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Forys WJ, Tokuhama-Espinosa T. The Athlete's Paradox: Adaptable Depression. Sports (Basel) 2022; 10:105. [PMID: 35878116 PMCID: PMC9320389 DOI: 10.3390/sports10070105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/22/2022] [Accepted: 06/27/2022] [Indexed: 02/01/2023] Open
Abstract
We proposed that an athlete's depressive symptoms may be different from the general population in etiology if considered from the context of a depressive disorder. By shifting focus from a limited notion of symptoms onto a comprehensive model of depression, the full scope of the phenomenon becomes clearer. This paper investigated the relationship between neurotransmitters and allostatic load to explain the incidence of depression among elite athletes. This literature review extensively analyzed exercise-induced neurohormonal imbalance resulting in depressive states among athletes. The research revealed that 5-HTTLPR polymorphism, brain-derived neurotrophic factor (BDNF), extensive psychological demands, social stigma, and overtraining syndrome (OTS) may all contribute to a unique version of depression. The research revealed that the biological standards of athletes differ from those of non-athletes, to the point that the new model may be useful, thereby introducing the new term "Adaptable Depression (AD)" to the literature. This framework suggests a new direction for future research to precisely measure the neurotransmitter-related brain changes that result in "Adaptable Depression" in athletes and to establish a better understanding of the depressive tipping point.
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Affiliation(s)
- Weronika Jasmina Forys
- Division of Continuing Education, Harvard University, 51 Brattle Street, Cambridge, MA 01238, USA
| | - Tracey Tokuhama-Espinosa
- Faculty of Arts and Sciences, Extension School, Harvard University, 51 Brattle Street, Cambridge, MA 01238, USA;
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Grasdalsmoen M, Clarsen B, Sivertsen B. Mental Health in Elite Student Athletes: Exploring the Link Between Training Volume and Mental Health Problems in Norwegian College and University Students. Front Sports Act Living 2022; 4:817757. [PMID: 35178515 PMCID: PMC8844557 DOI: 10.3389/fspor.2022.817757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives To examine mental health problems among elite athletes in a student population, compared to the general student population, and to explore the association between weekly hours of training across mental health indicators. Methods Data are from a national study from 2018 of all college and university students in Norway. Participants indicated if they considered themselves to be an elite athlete, and how many hours per week they trained. Mental health problems were assessed using several well-validated questionnaires. Results Among 50,054 students, 1.3% identified themselves as elite athletes. Both male and female elite athletes had generally better mental health across most health outcomes, reporting fewer mental health problems, less loneliness, higher satisfaction with life, more positive affect, and fewer alcohol problems. Elite athletes in team sports had slightly better mental health compared to athletes of individual sports. Increased hours of weekly exercise was associated with better mental health. However, there was generally little to be gained from increasing the amount of training from 7–10 hours/week to 14+ hours per week. Female athletes who trained 14 or more hours per week reported poorer mental health across most outcome measures. Conclusion This study showed that both male and female elite athletes generally had better mental health across a range of health outcomes, when compared to the general student population. The study also found a positive dose-response relationship between weekly hours of training and mental health, but also a worsening of mental health for females at the extreme end of exercise continuum. The self-report nature of this student sample means that care should be taken when generalizing to other studies of elite athletes.
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Affiliation(s)
- Michael Grasdalsmoen
- Department of Sport, Food and Natural Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Benjamin Clarsen
- Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Disease Burden, Norwegian Institute of Public Health, Bergen, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research & Innovation, Helse Fonna HF, Haugesund, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- *Correspondence: Børge Sivertsen
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Affiliation(s)
- Ashwin L Rao
- Department of Family Medicine and Section of Sports Medicine, University of Washington, Seattle, WA
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8
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Yamazaki M, De Larochelambert Q, Sauliere G, Toussaint JF, Antero J. Heads-Up: Risk-Specific Neurodegenerative Mortality and Years-Saved Analysis on the US Olympian Cohort. Front Physiol 2021; 12:705616. [PMID: 34566678 PMCID: PMC8458956 DOI: 10.3389/fphys.2021.705616] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/20/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose: This study aimed to identify the risk of neurodegenerative death (ND) that former Olympians endure due to their participation in sports grouped based on presumed repeated shocks to the head, and to understand the impact of their participation in such elite sports on their total longevity. Materials and Methods: The cohort included all former US Olympians, who participated in the Olympic Games (OG) between 1948 and 1972, and whose vital status and causes of death were verified (n = 2,193). Olympic sports were classified into three categories of exposure: Collision (the highest presumed risk of repeated shocks to the head), Contact, and No-Contact. The Fine-Gray competing risk regression model was used to compare the risk of ND where the No-Contact category was a reference group. The years-saved analysis was performed to quantify the number of years saved or lost to ND and total longevity compared with the US general population. Results: A total of 65 NDs were identified. Collision sports Olympians had a 3.11 (95% CI: 1.31–7.40) higher risk of ND while the Contact group showed a risk of 0.56 (95% CI: 0.21–1.48) compared with the No-Contact sports Olympians. Compared with the general population, the Collision group lost 0.61 (95% CI: -1.16—0.06) years of life from ND, while the Contact group saved 0.4 (95% CI: 0.26–0.54) and the No-Contact group saved 0.09 (-0.09–0.28) years of life up to the age of 90. Regarding the total longevity, Collision, Contact, and No-Contact groups saved 4.67 (95% CI: 3.13–6.22), 5.8 (95% CI: 4.93–6.67), and 6.24 (95% CI: 5.57–6.92) years of life, respectively, from all causes of death. Conclusion: There is an elevated risk of ND among US Olympians, who engaged in sports with the highest presumed risk of repeated shocks to the head compared with those exposed to no such hazard. Such risk does not jeopardize the total longevity among Olympians in Collision sports.
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Affiliation(s)
- Moi Yamazaki
- Institute of Biomedical and Epidemiological Research in Sport (IRMES), National Institute of Sport, Expertise, and Performance (INSEP), Paris, France
| | - Quentin De Larochelambert
- Institute of Biomedical and Epidemiological Research in Sport (IRMES), National Institute of Sport, Expertise, and Performance (INSEP), Paris, France
| | - Guillaume Sauliere
- Institute of Biomedical and Epidemiological Research in Sport (IRMES), National Institute of Sport, Expertise, and Performance (INSEP), Paris, France
| | - Jean-François Toussaint
- Institute of Biomedical and Epidemiological Research in Sport (IRMES), National Institute of Sport, Expertise, and Performance (INSEP), Paris, France.,Sorbonne Paris Cite, University Paris Descartes, Paris, France.,CIMS, Hôtel-Dieu, AP-HP, Paris, France
| | - Juliana Antero
- Institute of Biomedical and Epidemiological Research in Sport (IRMES), National Institute of Sport, Expertise, and Performance (INSEP), Paris, France
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Morales JS, Castillo-García A, Valenzuela PL, Saco-Ledo G, Mañas A, Santos-Lozano A, Lucia A. Mortality from mental disorders and suicide in male professional American football and soccer players: A meta-analysis. Scand J Med Sci Sports 2021; 31:2241-2248. [PMID: 34416791 DOI: 10.1111/sms.14038] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine the risk of mortality from mental disorders and suicide in professional sports associated with repeated head impacts. METHODS A systematic search was performed in PubMed, Web of Science, Scopus, and SPORTDiscus (since inception to June 8, 2021) to find studies comparing the incidence of mortality from mental disorders or suicide in former or active professional athletes of sports characterized by repeated head impacts vs athletes with no such exposure or the general non-athletic population. RESULTS Seven retrospective studies of moderate-to-high quality that included data from boxers and from basketball, ice hockey, soccer, and National Football League (NFL) players, respectively (total = 27 477 athletes, 100% male) met all inclusion criteria. Former male NFL players (n = 13 217) had a lower risk of mortality from mental disorders (standard mortality rate [SMR] = 0.30; 0.12-0.77; p = 0.012) and suicide (SMR = 0.54; 0.37-0.78; p < 0.001) than the general population. This finding was also corroborated in male soccer players (n = 13,065; SMR = 0.55; 0.46-0.67; p < 0.001). Male athletes participating in sports associated with repeated head impacts (n = 18,606) had also a lower risk of all-cause, cardiovascular disease (CVD), and cancer mortality (all p < 0.01) than the general population. CONCLUSIONS Participation of male athletes in American football or soccer at the professional level might confer a certain protective effect against mortality from mental disorders or suicide, besides its association with a lower risk of all-cause, CVD, or cancer-related mortality.
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Affiliation(s)
- Javier S Morales
- Department of Physical Education, MOVE-IT Research Group, Faculty of Education Sciences, University of Cadiz, Cadiz, Spain
| | | | | | - Gonzalo Saco-Ledo
- Bioenergy and Motion Analysis Laboratory, National Research Center on Human Evolution (CENIEH), Burgos, Spain
| | - Asier Mañas
- GENUD Toledo Research Group, University of Castilla-La Mancha Toledo, Toledo, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Alejandro Santos-Lozano
- Department of Health Sciences, i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain.,Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital, 12 de Octubre' ('imas12'), Madrid, Spain
| | - Alejandro Lucia
- Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.,Physical Activity and Health Laboratory, Instituto de Investigación Sanitaria Hospital, 12 de Octubre' ('imas12'), Madrid, Spain
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