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

Prevalence of Chronic Traumatic Encephalopathy in Athletes With Repetitive Head Impacts: A Systematic Review and Meta-Analysis

Chronic traumatic encephalopathy (CTE) is a neurodegenerative disorder associated with repetitive head impacts (RHI), which is commonly observed in athletes participating in contact sports. This systematic review and meta-analysis aimed to provide a clearer elucidation of the prevalence, risk factors, and potential outcomes of CTE in athletes. Through a comprehensive search of PubMed, EMBASE, Web of Science, and Google Scholar (January 2015 to July 2024), we ultimately included eight eligible studies with a low risk of bias involving 1000 former contact sports athletes diagnosed by neuropathological methods. Data were analyzed in a random-effects meta-analysis. The results indicated that the pooled prevalence of CTE in contact sport athletes was 53.7% (95% CI: 37.6-69.5, I2 = 93.7%). Subgroup analyses revealed that rugby players exhibited the highest prevalence at 64.7% (95% CI: 48.5-79.5, I2 = 0%), followed by American football players at 53.0% (95% CI: 33.2-72.4, I2 = 92.9%). By participation level, the prevalence was estimated at 44.1% (95% CI: 29.6-59.1, I2 = 84.5%) in amateur athletes and 72.8% (95% CI: 50.9-90.5, I2 = 91.6%) in elite athletes. Notably, the suicide rate among individuals diagnosed with CTE was 39.0% (95% CI: 12.7-69.0, I2 = 94.4%), and the pooled prevalence of CTE in non-suicidal athletes was 30.1% (95% CI: 6.9-60.4, I2 = 97.8%). These findings reveal the high prevalence of CTE in contact sport athletes exposed to RHI, especially at elite-level competition, and emphasize suicide as a potential outcome. Further studies should incorporate more female athletes to comprehensively assess the risk factors, outcomes, and effective prevention strategies for CTE.

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.

Factors influencing sports performance: A multi-dimensional analysis of coaching quality, athlete well-being, training intensity, and nutrition with self-efficacy mediation and cultural values moderation

This study examines the dynamic relationships between cultural values, training intensity, nutrition, self-efficacy, and coaching quality on Chinese athletes' performance. Bandura's social cognitive theory and cultural psychology ideas enlightened the multi-faceted sports performance analysis. A detailed questionnaire was employed to obtain data from 880 athletes from various places and sports backgrounds. Structural Equation Modeling (SEM) was used for empirical analysis. The results show a significant positive association between coaching quality (β = 0.62, p < 0.001), athlete well-being (β = 0.48, p < 0.001), training intensity (β = 0.55, p < 0.001), nutrition (β = 0.42, p < 0.001), self-efficacy (β = 0.57, p < 0.001), and sports performance. Coaching quality appeared as a critical component. Athletes performed better when they felt their instructors were performing better. Diet, training intensity, and health affected athletes' performance, highlighting the necessity for athlete development. Athletes' confidence in their performance is mediated by coaching, well-being, training, nutrition, and performance. These correlations were further impacted by cultural values, highlighting the need to consider cultural context while attempting to enhance athlete performance outcomes. The study concludes that cultural values, self-efficacy, training, nutrition, coaching, and health are crucial to Chinese athletes' success.

Risk Factors for Suicide Among Professional Athletes

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.

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.

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.