Story by Kristen Rogers, CNN
Suicide rates among people of all ages in the United States have increased over the past two decades, making it a serious public health problem.
Among US college athletes, suicide is now the second leading cause of death after accidents — and rates have doubled from 7.6% to 15.3% over the past 20 years, according to a study published April 4 in the British Journal of Sports Medicine.
Suicide is the 11th leading cause of death in the US, but for Americans ages 10 to 14 and 25 to 34, it’s the second leading cause, and for those ages 15 to 24, it’s the third leading cause.
“Collegiate athletes are often thought to have protective factors like the sense of community with their team (and) support of coaches, trainers, doctors and others,” said the study’s first author, Bridget Whelan, a research scientist in the department of family medicine at the University of Washington’s School of Medicine, via email.
“Unfortunately, this study shows that collegiate athletes are just as susceptible to these mental health concerns,” Whelan said.
Suicide had previously been identified as a leading cause of death among athletes in the National Collegiate Athletic Association, which has put more emphasis on the well-being of athletes in the past decade by publishing a consensus document on best practices for mental health. Those recommendations include creating an environment that supports mental health by following a written plan that considers risk and protective factors in multiple areas of the students’ lives, and screening students for psychological distress using validated tools at least annually.
But past research on how these recommendations and participation in different sports affect suicide rates has been mixed, the authors of the new study said — so they looked into the rates of suicides by NCAA athletes from July 1, 2002, to June 30, 2022, by consulting NCAA memorial lists and insurance claims, the National Center for Catastrophic Sports Injury database, the Parent Heart Watch database and media reports.
The authors also studied how suicide rates were affected by factors such as age, sex, race, division, sport and time of year.
Of the 1,102 deaths that occurred during the 20-year time period, 128 were suicides among people who ranged in age from 17 to 24 and were predominantly male (77%) and White (59%). However, most suicides occurred at age 20, which is typically the middle of a collegiate athlete’s school career.
There weren’t significant differences when considering sex, race or sport, but there were contrasts among divisions — Division III athletes had a 59% and 66% lower rate than Division I and II athletes, respectively, Whelan said.
Male cross-country athletes had the highest rates compared with anyone else in the study — a finding that surprised the authors since previous research found higher rates in football, Whelan said.
“This trend highlights the need for better screening methods, prevention strategies and support systems for student-athletes, as well as continued training (and) education for those working with student-athletes,” said Dr. Jacob Kay, clinical research affiliate at the University of South Carolina’s Arnold School of Public Health, via email. Kay wasn’t involved in the study.
The study also found suicides were more common in months outside of June through August and on Mondays and Tuesdays.
“Understanding the timing of suicides may help inform targeted intervention efforts and support systems to better meet the needs of student-athletes, particularly during these windows of vulnerability,” Kay added.
MENTAL HEALTH RISKS AMONG ATHLETES
Both the authors and experts uninvolved in the study acknowledge some shortcomings of the research.
“The accuracy of determining the cause of death is particularly tricky with suicides (and) may vary depending on the availability of autopsy and even family reports surrounding circumstances,” said Dr. Urszula Klich, an Atlanta-based clinical psychologist who wasn’t involved in the study.
“Relying on media reports and public records to identify causes of athlete deaths will likely result in underreporting,” Klich added. “Not all suicides will be covered in media. Athletes from lower-profile sports will be less visible.”
However, experts have some ideas on the contextual factors that might explain the findings.
“Suicide is the tragic outcome of medical illness and multiple, often interacting, biological, psychological and social risk factors,” said Dr. Rebecca Bernert, a suicidologist and assistant professor of psychiatry and behavioral sciences at the Stanford University School of Medicine, via email. Bernert, who wasn’t involved in the study, is also founding director of the Stanford Suicide Prevention Research Laboratory.
There’s the pressure to perform both academically and athletically and balance the responsibilities of each, which can lead to anxiety and depression, experts said. This loaded schedule can leave less time for social connection, resulting in feelings of isolation even if they’re part of a sports team.
“Student-athletes routinely experience physical injuries or can wind up with chronic pain due to the physical requirements of their sport,” Klich said. This possibility is especially true for cross-country athletes.
“The psychological impact of injuries, including fear of losing scholarships or opportunities for advancement, can further amplify feelings of hopelessness and despair,” Klich added.
An athlete’s sense of value may also be affected by social media, according to the study.
“Athletes are competing during a time when levels of self-oriented perfectionism and socially prescribed perfectionism are at an all-time high,” the authors said. “Even though athletes are more likely to spend time on non-screen activities than their non-athletic peers, the perceptions or messaging around their performance on social media often leads to worse feelings of well-being.”
These issues are likely especially true for Division I and II athletes who, compared with Division III athletes, are more subject to media coverage, online criticism and stressors associated with the “recent emergence of name, image and likeness … deals in the NCAA, where athletes may earn payment for their personal brand,” the authors added.
REDUCING THE RISK OF SUICIDE
If you’re a college athlete and concerned about your mental health, experts want you to know you’re not alone and that the biggest step you can take is to reach out.
“There are people willing and wanting to help, and some really good treatments for mental health concerns. There is hope that things can get better,” Whelan said. “You can reach out to someone close to you that you trust, or if you feel like you want something more anonymous, you can reach out to the (988 Suicide & Crisis Lifeline) via call or text at 988.”
Make sure to also take time for self-care amid busy schedules, Kay said.
If you’re someone wanting to help, get to know these potential warning signs of suicide and how the way you talk about suicide can reduce stigma.
“Overall, it is important to remember that these individuals aren’t just athletes, but students as well,” Kay said. “A comprehensive approach that includes promoting mental health awareness, reducing stigma, providing accessible and culturally sensitive screening and support services, and fostering an inclusive athletic culture that prioritizes the well-being of all student-athletes is needed to address this critical issue.”
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