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College Athlete Deaths by Suicide Have Doubled, and Researchers Want to Know Why | Psychiatry and Behavioral Health | JAMA | 西瓜视频

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Medical News & Perspectives
May 10, 2024

College Athlete Deaths by Suicide Have Doubled, and Researchers Want to Know Why

Author Affiliations
  • 1Northwestern Medill Journalism Residency Intern, Evanston, Illinois
JAMA. 2024;331(21):1792-1794. doi:10.1001/jama.2024.7895

Morgan Rodgers was a beloved sister, daughter, friend, and a highly accomplished Division I lacrosse player at Duke University. Long-time friend and teammate Clare Kehoe, MSN, RN, recalls her upbeat, infectious energy and days spent dancing along to music blasting in the locker room.

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Under the surface, Rodgers was struggling. On July 11, 2019, she died by suicide at the age of 22.

鈥淪he thought she was really the only one going through what she was dealing with,鈥 said Kehoe, cofounder and education program director for , an advocacy group that promotes mental health in student athletics. 鈥淪he didn't feel comfortable that she could be honest with the people around her about the depths of her pain.鈥

Though Rodgers felt isolated, she was not alone.

A recent found that suicide is a growing cause of death among US collegiate athletes. Between 2002 and 2022, 1102 college athletes died overall and 128, or 11.5%, of these fatalities were identified as death by suicide. While the overall mortality for this population remained relatively stable during this 20-year period, the proportion of deaths by suicide doubled from just over 7.5% in the first decade, when 40 suicides occurred, to just over 15% in the second decade, when 88 occurred.

Meanwhile, other causes of death declined among college athletes during the same time frame. The study identified suicide as the second leading cause of death for student athletes after accidents in the second decade, supplanting cardiac arrests.

鈥淲e had seen a lot more cases of suicide being reported in the media, and we were not sure if that was a true rise in the incidents or if it was just being reported more,鈥 said lead author Bridget Whelan, MPH, a research scientist in family medicine at the University of Washington School of Medicine. 鈥淯nfortunately, what the study shows is that it is rising.鈥

The researchers used 4 databases reporting on National Collegiate Athletic Association (NCAA) student athlete deaths between July 1, 2002, and June 30, 2022, looking at age, race, sport, and cause of death. When these records were incomplete, they used media reports and other official documentation such as autopsy findings. The results, published in the British Journal of Sports Medicine, expand on a previous that looked at the first decade of data.

Whelan and her colleagues found that the overall incidence of death by suicide significantly varied by division, with higher rates for Division I and II athletes than Division III. Male athletes were involved 77% of the time, and their number of deaths by suicide increased from 31 in the first decade to 67 in the second. Deaths by suicide among female athletes increased from 9 to 21 between the first and second decade.

These increases are not unique to this group, said clinical psychologist Jill Harkavy-Friedman, PhD, senior vice president of research at the American Foundation for Suicide Prevention.

Harkavy-Friedman, who was not involved with the study, said it鈥檚 important to consider the numbers within the broader context. Deaths by suicide are on the rise. people in the US died by suicide in 2022, a startling 36% increase from 2000. A separate NCAA database also found that the rate of suicide among collegiate athletes appears to be lower than that of college students in general as well as the overall US population of a similar age.

Whelan said the rates appear to be increasing in parallel. She also noted the actual incidence for college athletes may be higher than the study鈥檚 estimate, as the analysis relied on third-party reports in the absence of a mandatory national reporting system.

An important takeaway was that this population is 鈥渏ust as susceptible,鈥 Whelan said, despite the protective factors people often assume athletes have.

A deeper understanding is necessary.

鈥淎 hard part of doing these epidemiological studies is that really what we're doing is just presenting the numbers, but not a lot of information as to why,鈥 Whelan said. 鈥淗opefully, it's a starting point.鈥

Understanding the Increase

The analysis also found that death by suicide occurred most frequently at age 20, in the middle of a typical college career, and slightly more often on Mondays and Tuesdays than during the rest of the week.

鈥淚t's hard to know what that represents,鈥 said psychiatrist Lindsey Mortenson, MD, MS, chief mental health officer of student life at the University of Michigan, who was not a part of the study. 鈥淚'd like to better understand if, in those 2 days, there really is a unique vulnerability there.鈥

The study鈥檚 findings have sparked conversation among colleagues, according to Mortenson, who is also the school鈥檚 executive director of university health and counseling and an assistant clinical professor of psychiatry.

鈥淏eing involved in athletics and being a part of a team is generally considered to be protective, but obviously, this article has raised some interesting questions about why the rate doubled,鈥 she said.

Harkavy-Friedman emphasized that suicide is complex and that there鈥檚 no single known cause. 鈥淚t's not the thing we see. It's not the event that happened. It's not the loss of a partner or a business or being bullied鈥攍ots of people have those experiences and they don't die by suicide. But rather, a person who鈥檚 at risk has a number of factors that increase their risk.鈥

Some of the potential factors contributing to student athletes鈥 risk are timeless: the academic and social stressors, the performance pressures, and the stigma that keeps people from seeking help for depression and other mental health issues. Kehoe pointed to a perfectionist mentality fostered by a competitive environment. She said athletes feel as though 鈥渨e must be mentally tough; we must put on this game face and show up to compete.鈥

Kehoe saw this mentality in Rodgers as she 鈥減ut on a brave face鈥 and continued giving her all, despite a knee injury sophomore year that dramatically affected and eventually ended her Division I athletic career.

鈥淐ollege athletes are in a unique environment where it's a very intense culture and there often hasn鈥檛 historically been this priority on them as people,鈥 Kehoe said. In this setting, their identity can often grow intertwined with their performance and living up to expectations.

Factors that have emerged more recently include the advent of social media, legalized sports betting, and the monetization of athletic success in college through (NIL). Legalized in 2021, NIL opened the door for student athletes to become paid brand endorsers. Kehoe said these factors can exacerbate social pressures and further obscure athletes鈥 humanity as they are put on a podium open to public scrutiny.

鈥淣IL adds a great layer of opportunity but also can induce stressors,鈥 she said. 鈥淭hey鈥檙e managing themselves as a brand and if their teammates are having easy opportunities and they're not having those themselves, that can lead to a lot of self-doubt and questioning someone鈥檚 worth.鈥

The money-making potential accompanying NIL and sports betting may also introduce financial pressures, Mortenson said. Targeted sports betting advertisements and increasing participation in this age group are reason for concern and further study, she added.

鈥淭hey have control over the outcome of games in ways that I can imagine could create an astonishing amount of pressure for some students,鈥 she said.

For Mortenson, these factors stand out as feasible explanations for the recent increase in suicides among collegiate athletes.

鈥淲hen you layer on all these other complexities plus the pandemic鈥攚hich is in the last 3 years of the most recent dataset of this study鈥攖here are reasons to not be surprised,鈥 she said.

Beyond a search for explanations, she said these numbers should drive the dialogue toward finding effective solutions.

鈥淚t is incumbent on adults to ensure that campuses have a safety-first orientation and that we鈥檙e not inadvertently putting students at greater risk because of some of the systems, traditions, and policies that we have in place,鈥 she said.

A Turning Point

Kehoe views studies like the current one as a critical turning point. The numbers, she said, 鈥渟peak volumes to the need鈥 for change. She鈥檚 also hopeful about the increasing attention and outreach from coaches and university athletic departments she has seen in her work at Morgan鈥檚 Message.

鈥淭hey鈥檙e ready to educate themselves, they鈥檙e ready to make these changes,鈥 Kehoe said. 鈥淪o, despite the situation we face, I think we are at an exciting point where there is a huge opportunity to actually put these statistics and the sentiments now being recognized into action鈥攊nto resources that are going to directly support the students.鈥

At Morgan鈥檚 Message, Kehoe and her cofounders work to enact change through 2 main initiatives. The organization鈥檚 Mental Matchup podcast and blog series work to dispel stigma by featuring more than 150 athletes who share their own mental health stories. The organization also connects with more than 1500 high school and university campuses across the world through student athlete and at-large ambassadors as well as education programming.

The University of Washington鈥檚 Forefront Suicide Prevention program trains student athletes and university staff to recognize warning signs, approach an individual with supportive conversation, and connect them to help. Whelan took the training herself and said it鈥檚 a low-cost and relatively easy concept: 鈥淚t's just a matter of overcoming some of the uncomfortableness with the conversations.鈥

She also underscored the importance of screening for risk factors and preexisting mental health conditions and creating a comprehensive reporting system across the country.

鈥淓ven though it is a hard topic to discuss, it really is information that is helpful in the greater scientific community,鈥 Whelan said, adding that the research 鈥渨ill then go to help in clinical practice and then down to the care of individuals.鈥

At the University of Michigan, Mortenson said upstream screening and accessible mental health resources are critical to helping student athletes thrive. The university follows the latest and uses a unified care team approach across the athletic department, primary care, and psychiatry, she explained. The athletic department also incorporates athletic counselors and performance psychologists into team practices and competitions as an added support. But she acknowledged that such resources may be harder to come by at smaller universities with less funding.

As each university takes steps toward suicide prevention, Harkavy-Friedman points to a need for unified action on a national level. The 988 Suicide & Crisis Lifeline, signed into law in 2022, was one of the first national actions. However, she said many states still need to develop a strategy for funding and implementing 988.

鈥淲e have the will, we have the capacity, but we don鈥檛 have an action plan yet,鈥 she said in an April 19 interview.

Just days later, on April 24, the Biden-Harris administration and the US Department of Health and Human Services the 2024 National Strategy for Suicide Prevention and first-ever Federal Action Plan. The plan outlines a 3-year rollout and evaluation of 200 actions, including testing different strategies for suicide prevention that appear promising.

鈥淚t outlines very specific steps that can be taken at every level鈥攃ommunity, family, institutional, organizational, and for individuals at risk for suicide and those who love and support them,鈥 Harkavy-Friedman said of the plan in a follow-up email. 鈥淭he next step is to put this strategy to work鈥.鈥

As the national intervention unfolds, Whelan said it鈥檚 important to remember the main message from the analysis of college athlete deaths by suicide.

鈥淲e need to recognize that there are many people dealing with really heavy things,鈥 she said. 鈥淲e need to make sure that our eyes are open, and that we can connect with people to help them out of their dark place.鈥

If you or someone you know is in crisis, please call or text 988 for the Suicide & Crisis Lifeline, chat online at锘 , or contact the Crisis Text Line by texting HOME to 741741.

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Article Information

Published Online: May 10, 2024. doi:10.1001/jama.2024.7895

Conflict of Interest Disclosures: Ms Kehoe reported being on the board of directors for Morgan鈥檚 Message. Dr Mortenson reported being the volunteer chair for the American College Health Association鈥檚 Emerging Public Health Threats and Emergency Response Coalition. No other disclosures were reported.

3 Comments for this article
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A few observations from a former Div III coach
Robert Hupp, BA | Former Div III Assistant Coach
It is noteworthy that Div I and II athletes are at higher risk.

We are all aware (or should be) that certain top-tier (Div I) athletics programs are run as businesses (with multi-million dollar salaries for coaches and athletic directors); in many ways they are more closely akin to professional leagues. Success or failure may be openly viewed by the larger public, and that is a burden felt by all involved.

There is huge financial pressure on Div I athletes to succeed. Poor performance or injury can mean the end of one鈥檚 college academic career with
the loss of an athletic scholarship (even for minor sports), and - when the athlete is in a sport with potential for a post-collegiate professional berth - loss of a career.

NIL has both positive and negative aspects. While the current ruling may subject a player to new pressures, prior to NIL, severe injury could leave the athlete with nothing. The institution would have exclusive rights to any future monies made. The new ruling changes some of that.

Div III institutions are prohibited from providing certain academic support resources which would be available to athletes in Div I schools. This means Div III students must face their own conflicts between sports and academics (occasionally in a less sport-friendly environment). It is both naive and cruel to expect that student-athlete make an either/or decision (in the absence of financial incentive); for many collegians - sport is a vital and beneficial component in their overall wellbeing.

I think it would be instructive for the authors to examine the NCAA guidelines for each Division, if they have not already done so; different regulations create different mindsets.

All coaches are required to undergo regular training in how to support and prioritize the mental and physical health of our athletes, what to look for, and what resources are available. This training can be mandated by any or all of; the home institution, the NCAA, national and international governing bodies for the sport, state and federal agencies.
Lack of knowledge is not the problem. It comes down to attitude, and willingness to use that knowledge. The more big money drives collegiate athletics, the greater the risk to student health.
CONFLICT OF INTEREST: None Reported
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Suicide
Alfred Miller, M.D. | retired
Grassy sports exposure to Borrelia infections is very significant.

Depression and Suicide from Borrelia infection must be considered
CONFLICT OF INTEREST: None Reported
Athlete suicides
Daniel Krell, M.D. | Retired PCP
Not mentioned in the article is the possible role of performance enhancing drugs (PEDs), steroids and/or stimulants. There might have been consideration of this, but there was no mention of it. Over a decade ago, a local town had four of its graduates, all on the football team, end their lives in the year after graduation. In related articles, there was no mention of possible PED use, though they are recognized to cause depression, including depression with cessation of stimulant use (eg, after ending high school/sport participation) and/or affective dysfunction while being used. I notified the school and a local journalist about my concern, but received no reply from either. It is certainly reasonable that PEDs played no role in these tragedies but it would, at least, be reassuring that the possibility was considered.
CONFLICT OF INTEREST: None Reported
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