The Weight of Victory

Participating in physical activity and sports may seem protective against mental health disorders including depression and suicide; however, recently there have been increasing numbers of female collegiate athletes who have taken their lives. When caring for a patient who is also an athlete, it’s important to be aware of the below. 

It’s ingrained into an athlete’s mind to develop and embrace mental toughness. This allows them to minimize internal and external distractions, stay focused, push through adversity, and ultimately be successful. On the surface, these athletes may display smiles, achieve success in their sport and in other life endeavors, and be a positive influence to everyone around them; however, this positive exterior may not accurately portray their underlying mental and emotional health. They may suppress their mental health disorder due to the misconception that athletes admitting to imperfection or impaired mental health is a sign of weakness. 

There are risk factors that may make athletes more susceptible to depression. There’s tremendous pressure placed on athletes by themselves, coaches, teammates, and family. Furthermore, social media compounds these pressures. Student-athletes have to balance a demanding schedule between training for their sport (including practices, competition, weights, conditioning, rehabilitation, scouting, and studying their opponents), academic work, and maintaining a social life and relationships. In addition, perfectionism helps athletes achieve success, but it can set them up for the disappointments of an unattainable goal. 

While statistically collegiate athletes have depression at a similar rate compared to collegiate non-athletes and lower rates of suicide, it’s important to be aware that patients who are athletes aren’t immune to mental health disorders. 

Often, the diagnosis or realization that one is struggling with mental health occurs when the individual is in crisis. Early recognition of depression is helpful to prevent more severe illness. Screening must be conducted to determine who is at risk for depression and suicide. Initially, depression may not be obvious in this sub-group and the presenting symptoms may be more atypical. It’s important to monitor for a lack of focus, a decrease in performance, or a change in sleep patterns or mood. This can be particularly challenging in college student-athletes, as these young adults are away from home for the first time and adjusting to their new normal with varying sleep behaviors, home sickness, and increased stress, which may mimic signs of depression and should not be discounted. 

Helping athletes with mental health issues requires an interdisciplinary team approach consisting of the athlete, physicians, athletic trainers, psychologists, and with permission, the athlete’s family, teammates, and coaching staff. We must remind athletes that “it’s ok to not be ok” and that it’s acceptable and beneficial to take time away from their sport for their mental wellness. Education is necessary to allow athletes to recognize early signs in themselves and their teammates, and to know the available resources and when to seek help. The most important thing that the medical team can do is create a supportive environment. This may encourage someone to speak up and ask for help. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.