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Whelan BM, Kliethermes SA, Schloredt KA, Rao A, Harmon KG, Petek BJ. Suicide in National Collegiate Athletic Association athletes: a 20-year analysis. Br J Sports Med 2024; 58:531-537. [PMID: 38575202 DOI: 10.1136/bjsports-2023-107509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To determine the incidence rate of suicide from 2002 to 2022 among athletes from the National Collegiate Athletic Association (NCAA) and assess for potential differences by, sex, race, division and sport. METHODS NCAA athlete deaths over a 20-year period from 2002 to 2022 were identified. Poisson regression models were built to assess changes in incidence rates over time. Linear and quadratic fits between year and suicide incidence for males and females were evaluated. RESULTS Of 1102 total deaths, 128 (11.6%) deaths by suicide were reported (male n=98, female n=30). The overall incidence was 1:71 145 athlete-years (AYs). Over the last decade, suicide was the second most common cause of death after accidents. The proportion of deaths by suicide doubled from the first 10 years (7.6%) to the second 10 years (15.3%). The suicide incidence rate for males increased linearly (5-year incidence rate ratio 1.32 (95% CI 1.14 to 1.53)), whereas a quadratic association was identified among female athletes (p=0.002), with the incidence rate reaching its lowest point in females in 2010-2011 and increasing thereafter. Male cross-country athletes had the highest suicide incidence rate (1:29 815 AYs) and Division I and II athletes had a higher suicide incidence rate than Division III athletes. No significant differences in suicide incidence rates by sex, race or sport were identified. CONCLUSION Deaths by suicide among NCAA athletes increased in both males and females throughout the 20-year study period, and suicide is now the second most common cause of death in this population. Greater suicide prevention efforts geared towards NCAA athletes are warranted.
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Affiliation(s)
- Bridget M Whelan
- Family Medicine, University of Washington, Seattle, Washington, USA
| | - Stephanie A Kliethermes
- Department of Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Ashwin Rao
- Family Medicine, University of Washington, Seattle, Washington, USA
| | | | - Bradley J Petek
- Division of Cardiology, Oregon Health & Science University, Portland, Oregon, USA
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Hamstra-Wright KL, Coumbe-Lilley JE, Bustamante EE. Preventing Suicide and Promoting Mental Health Among Student-Athletes From Diverse Backgrounds. J Sport Rehabil 2024:1-6. [PMID: 38335951 DOI: 10.1123/jsr.2023-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/16/2023] [Accepted: 12/20/2023] [Indexed: 02/12/2024]
Abstract
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.
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Affiliation(s)
- Karrie L Hamstra-Wright
- Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - John E Coumbe-Lilley
- Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
| | - Eduardo E Bustamante
- Applied Sport Psychology and Injury Research and Education (ASPIRE) Lab, Department of Kinesiology and Nutrition, University of Illinois at Chicago, Chicago, IL, USA
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Veliz P, Mutumba M. Assessing the Role of Sports Participation on Depression, Suicide Ideation, and Suicide Behaviors Among Adolescents Before and During COVID-19. J Phys Act Health 2024; 21:197-208. [PMID: 38109876 PMCID: PMC10996914 DOI: 10.1123/jpah.2022-0635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/03/2023] [Accepted: 11/03/2023] [Indexed: 12/20/2023]
Abstract
PURPOSE To assess the association between sports participation, depression, suicide ideation, and suicide behaviors in a nationally representative sample of US adolescents before COVID-19 and during COVID-19. METHODS Data from the 2019 Youth Risk Behavior Survey (n = 13,526) and the 2021 Adolescent Behaviors and Experiences Survey (n = 7677) were used to analyze the association between past-year depression/suicide ideation/suicide behaviors and past-year sports participation. RESULTS The analysis found that 57.4% of adolescents indicated participating in at least 1 sport in 2019; this dropped to 47.7% in 2021. Furthermore, 36.7% of adolescents indicated feeling sad or hopeless almost every day for 2 weeks or more in a row in 2019; this increased to 44.2% in 2021. The percentage of adolescents who indicated considering suicide, making a suicide plan, attempting suicide, and attempted suicide that lead to an injury was similar during 2019 and 2021. Multivariable analysis found that participation in 2 or more sports in 2019 was associated with lower odds of each of the outcomes for depression, suicide ideation, and suicide behaviors, whereas in 2021, participation in 2 or more sports was only associated with lower odds of indicating being sad or hopeless (an indicator for depression) for a 2-week period (adjusted odds ratios = 0.70; 95% confidence interval, 0.58-0.85). CONCLUSIONS Participation in 2 or more sports lowered the risk of feeling sad or hopeless, suicide ideation, and suicide behaviors in 2019, but this effect was absent in 2021. Given the presence of multiple stressors during the COVID-19 pandemic, sports participation alone may not offer sufficient protective effects against suicide behaviors as it did pre pandemic.
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Affiliation(s)
- Philip Veliz
- Center for the Study of Drugs, Alcohol, Smoking and Health, School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, Michigan 48109, USA
- School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, Michigan 48109, USA
| | - Massy Mutumba
- School of Nursing, University of Michigan, 400 North Ingalls Street, Ann Arbor, Michigan 48109, USA
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Risch N, Alacreu-Crespo A, Khan S, Caceda R, Teismann T, Rogers ML, Courtet P, Olié E. Pain tolerance and threshold in suicide attempters: A systematic review and meta-analysis. Psychiatry Res 2024; 331:115618. [PMID: 38071878 DOI: 10.1016/j.psychres.2023.115618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 01/02/2024]
Abstract
It has been hypothesized that individuals less sensitive to pain could be at higher risk of suicide. However, data on pain sensitivity in suicide attempters (SA) obtained using experimental procedures are heterogeneous. The aim of this systematic review and meta-analysis was to investigate and compare pain tolerance and threshold in SA (patients with lifetime history of suicide attempt), non-attempters (psychiatric controls, PC), and healthy controls (HC). A random effects meta-analysis was used to estimate the standardized mean differences using data from 16 studies that compared physical pain tolerance and threshold in SA and PC or HC. Pain tolerance and threshold were not significantly different in SA and PC. However, pain tolerance, but not threshold, was higher in SA than HC. Our findings do not support the hypothesis of an altered pain perception related as a trait for suicidal vulnerability, but rather suggest altered pain perception related to psychiatric vulnerability.
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Affiliation(s)
- Nathan Risch
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier 34094, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier 34295, France; Clinique de la Lironde, Clinea Psychiatrie, Saint-Clément-de-Rivière 34980, France.
| | - Adrian Alacreu-Crespo
- Department of Psychology and Sociology, Area of Personality, Assessment and Psychological Treatment, University of Zaragoza, Teruel 44003, Spain
| | - Shazma Khan
- School of Medicine, Texas Tech University Health Sciences Center (TTUHSC), Lubbock, TX, USA
| | - Ricardo Caceda
- Department of Psychiatry, Northport VA Medical Center, Northport, NY 11768, USA
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum 44799, Germany
| | - Megan L Rogers
- Department of Psychology, Texas State University, San Marcos, TX 78666, USA
| | - Philippe Courtet
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier 34094, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier 34295, France
| | - Emilie Olié
- Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier 34094, France; Department of Emergency Psychiatry and Post-Acute Care, CHU Montpellier, Montpellier 34295, France
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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: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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:sports10070105. [PMID: 35878116 PMCID: PMC9320389 DOI: 10.3390/sports10070105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [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
- Correspondence:
| | - Tracey Tokuhama-Espinosa
- Faculty of Arts and Sciences, Extension School, Harvard University, 51 Brattle Street, Cambridge, MA 01238, USA;
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