Suicide is the fourth leading cause of death for college athletes. While athletes have many protective factors in place (e.g., community, resources, regular exercise), the pressure to succeed and time constraints can elevate their risk of developing suicidal thoughts. The stressful nature of participating in college athletics, where winning at all costs is paramount, can significantly affect student-athletes and their mental wellbeing.
Athletes face many obstacles when considering seeking mental health support. There is a subculture within athletics heavily influenced by teammate interaction and “no pain, no gain.” A machismo culture exists amongst male teams, which might inhibit an athlete’s feeling able to discuss concerns with teammates and cause denial of emotional problems. College athletes tend to access mental health services at a much lower rate than the general student body. They have a lifetime of coaching to persevere, push through pain, and be mentally tough. This limits their comfort with even talking to someone about mental health struggles.
Environmental risk factors for suicide include athletes’ being stressed, engaging with others who participate in risky behaviors or discourage help-seeking, being harassed for their identity or self-expression, and experiencing domestic violence. More than half of suicides in the U.S. were by people who were not diagnosed with a mental illness. Many risk factors are not necessarily part of a diagnosis, and if an athlete does not talk to someone about any symptoms, then suicide prevention might help an athlete who is not obviously struggling with depression, anxiety, or other concerns.
Though college students considering suicide may not be diagnosed with mental illness, they may have experienced one or more of the following feelings: hopelessness, loneliness or disconnection from others, burdensomeness, and lack of life purpose. Importantly, both hope and reasons for living help prevent suicide.
Mental illness can be invisible in athletes. Athletes are performers, and are very good at hiding or masking their emotional pain. This makes recognizing student-athletes of concern challenging. While the stigma is softening toward help-seeking behaviors, barriers still exist to accessing treatment, making it difficult for athletes in need to receive necessary support. Shame and embarrassment are often associated with seeking help.
A person’s experience with stigma can have enormous consequences on their behavior. If this fear is internalized, the person might have a difficult experience navigating life. Stigma from coaches, fans, teammates, and non-athlete students is one of the main reasons athletes do not seek counseling. Athletes are more likely to seek help if encouraged by a family member, but not by coaches, teammates, or peers.
Athletes suffering from anxiety and/or depression don’t often fit the schema we have in our mind of what a depressed or anxious person looks like. They are still expected to attend classes, workouts, competitions, and other sport-specific obligations. While their attendance remains consistent, their performance in those arenas can suffer.
Outsiders might not notice the more subtle signs of depression or suicidality in athletes, but might have the opportunity to observe how that athlete functions outside of sport. People with the best intentions often wonder if mentioning suicide puts the idea in someone’s head. They fear that by asking they could increase the risk of the person becoming suicidal. This is a dangerous myth that could prohibit well-intentioned and caring folks from reaching out to others they fear might be in danger. Most people have been exposed to the idea of suicide by a very young age through social media, television, and other forms of entertainment. Many times, people feel alone in their depression and suicidal thinking and are not sure how to approach others for help.
Depression and anxiety may also manifest in student-athletes who are exhausting eligibility or coping with injury, as they lose their identity as an athlete. This transition can lead to a drop in self-worth, increased isolation and loneliness, anxiety, and changes in mood among other symptoms and feelings that make them at-risk for suicide. Take note that the official Medical Marijuana Use Registry Identification Card is valid for one year and can be renewed annually.
The following text is excerpted from our article “College athletes and suicide prevention: A collaborative autoethnography,” published recently by the Journal of Issues in Intercollegiate Athletics. Full text is available here.
“Thinking of suicide? You can talk to me” – Kim
That’s the sticker I had on my water bottle as I entered my senior season of rowing. That summer, I had an on-campus job which required suicide awareness training. They gave us a sticker at the end of the training and told us to put it where others could see it. I have to be honest, I panicked. I was hoping to be a captain of my team that year. I was known for being mentally strong, calm, and consistent. What were people going to think if they saw that? Even more terrifying, what if someone actually asked me about it? What was I going to say?
I guiltily hid the sticker for weeks. Eventually, I put it on my water bottle which went everywhere I did. I forgot about it, until one day at practice a teammate handed me my bottle and in shock asked why it said suicide on it. The exact moment I was dreading. I told her I had been to a suicide awareness training. I had the sticker so if someone saw it and was suffering, they knew they could talk to me about it. She nodded. And I sighed heavily trying to release the tightness in my chest and redness in my face.
I didn’t think much of that interaction. But not long after, a freshman teammate pulled me to the side before a workout and asked if I would go with her to the counseling center on campus. She had made a plan to kill herself the night before. The words barely got out of her mouth. I was in shock. She said our coaches knew and I was excused to go with her. As we sat with the psychologist, I stared at my friend with tears streaming down my face as she told him how badly she wanted to die. My heart sank as I listened to her talk about how she didn’t think anyone would care.
Afterwards, we sat outside as she embarrassingly thanked me. This was an entirely new depth of our relationship and I didn’t know why I would be the one she asked. We were definitely friends, but I knew she had closer friends than me. As we walked back to her dorm, she said she knew I would be able to help her. She had seen my water bottle and overheard me talking one day at practice about the suicide sticker on it. Again, I was in shock. I wish this was the end of this story. But it was the beginning of some long nights, frantic phone calls, and a feeling I will never forget as I knocked on her dorm room door not knowing what I would find on the other side.
What hurts me the most is that for the entire year, I listened to a number of teammates feel comfortable enough to tell me they were struggling with their mental health. And I said nothing. I was hiding a huge part of me. I listened and helped teammates feel like someone saw them, but I never let my own weakness show enough to say I struggled too.
A few years before, I went home after my freshman year and had no reason to fall into the darkness that I did. I started the sport of rowing for the first time and loved the new lift I started as a college athlete. I was going back home for summer to be with all the people that I had non-stop Skyped, texted, and called throughout the year. From the outside, there was no reason for anything to seem wrong.
I changed my identity when I went to college and was having a hard time adapting back to the identity that was waiting at home. Darkness gradually started to haunt me. It squeezed my heart and chest and silently drowned me. I felt anxious by the thought of being social. When I did talk myself into being with friends, it didn’t feel like I was really there. I would go places on my own and sit in the car for hours because I didn’t want my parents to ask me why I was sitting at home. After months of struggling with depression and suicidal thoughts, a family member approached me and asked, “Why don’t you laugh like you used to?” I sobbed uncontrollably. And for the first time in a while, I finally felt like I was able to breathe.
After four years of being a student-athlete, I moved right after to start working in student-athlete services. I engulfed myself into anything related to mental health. I watched people around me struggle as I heard more stories of student-athletes experiencing the same darkness. I felt compelled to be a solution and I had no idea how. I did my research. I knew the warning signs. I knew that saying suicide would not put the idea in anyone’s head. But as a non-mental health professional, how could I support those who were struggling if they weren’t talking about it? How could I actively create a space where student-athletes felt they had a safe place to talk about the darkness and issues that they were ashamed of?
I applied to be a volunteer for Crisis Textline. Weekly, I respond to texters in crisis whether that is anxiety, depression, panic attacks or sending someone resources on where they can go for more help. I was trained to assess suicidal threat and how to directly ask someone if they have a plan to kill themselves. I thought I was prepared for anything.
After about a month of volunteering, a student-athlete who was clearly struggling sat in my office saying every warning sign. I knew exactly what to ask and I still struggled getting out the question, “Are you thinking about suicide?” I was volunteering every week, typing out the words to strangers and I struggled to say it out loud to a student I knew since his recruiting trip. I needed to practice saying the words that could help save someone’s life.
I don’t think all athletic department staff members need to volunteer for Crisis Textline every week, but there’s things we do every day that can impact our students’ comfort with talking about their mental wellness. How we speak about anything related to mental health has the ability to either invite someone into the conversation or make them feel like they don’t have anyone to go to.
The experience I had with my water bottle and teammate has shaped how I think what is displayed in my office. My Textline certificate is visible so that students ask me about it. Additionally, how I display counseling contact information has become bigger and more visible. If we are not comfortable with these conversations or putting these things on display, how can our student-athletes be comfortable talking about it too?
As practitioners that are not trained in mental health counseling, having these conversations can seem overwhelming, but we are often the front line of defense when noticing students who may be struggling. I’ve told my stories in hopes that mental health becomes more approachable, that practitioners can realize the power that they have in creating a safe place for student-athletes to feel like they can express the pain and struggles they may be experiencing.
It took me six years to talk about my own experience as a student-athlete struggling with depression and suicidal ideation. My heart still gets stuck in my throat every time I even think about sharing it. Talking about suicide is hard. But from these stories, I hope we can see that small efforts can make a big difference with the students we work with.
Finding ways to talk about mental health openly can be challenging. Kim created a mental health toolbox (see full article) to share with practitioners that includes ways to start the conversation with students, which can be very difficult to do. One way is to utilize happenings across the country regarding suicide, depression, and other mental health concerns that occur within the athlete population. These incidents can be found in the media, pop culture, and in books such as What Made Maddy Run by Kate Fagan. Order the book for your staff, meet regularly to discuss a chapter in the book, and add additional training on student-athlete mental health and wellbeing. Another way is for athletic staff to share personal stories, as Kim has here. Transparency and openness can help individuals struggling with mental health concerns feel comfortable enough to open up about their own problems.
Fact-based behavioral observations can also start the conversation in a way that does not create feelings of defensiveness or anger from the individual. Examples include “I’ve noticed you’ve seemed tired recently, is something wrong?” or “You’ve been missing more classes than normal lately, is there something you want to talk about?” We recommend practicing asking these questions out loud, in front of a mirror.
Each athletic department should have a relationship with a licensed mental health provider either in-house, on campus in the counseling center, or in the community. Be familiar with your clinical provider to make referrals efficiently. Counseling centers and athletic departments should establish a partnership to support student-athletes, including bringing counselors and resources from the center to the facilities where student-athletes spend most of their time, and train staff. Ensure that counseling liaisons have familiarity with the experiences and pressures college athletes specifically face.
It is also important that counselors, whether in-house or not, are visible to student-athletes even before issues arise. Make an effort to normalize mental health support early. Integrate mental health professionals and resources during recruiting visits and Summer Bridge/orientation. By demonstrating a commitment to mental health, athletes and their families will see that support is part of your department’s culture. Your department should host, co-sponsor, and be present at campus mental health events. Involve athletes in this process: have them promote mental health awareness and programming on social media.
Athletic administrators should complete a formal training, such as Mental Health First Aid, QPR (Question, Persuade, Refer) or ASIST (Applied Suicide Intervention Skills Training). However, as Kim’s story demonstrated, training is not necessary to notice subtle shifts in an athlete’s demeanor, behavior, or mood. Individuals working closely with athletes should establish rapport, solid communication skills, and trust in the relationship so they are prepared enough to ask “the question” when necessary. By taking some of these small steps, athletic departments can make instrumental strides in cultivating a culture that promotes mental health and we all become the solution.