Depression and Athletes: A Coaches Guide

The suicide of Robin Williams (and other great talents over the last years) is a frank reminder of how devastating depression can be. Depression doesn't care about how successful you are, how much people like you, or how great an athlete you are. It sneaks up on people, and most of us never know that someone was depressed until it is too late. Depression and athletes are a common pairing that coaches need to be aware of.

A study by Georgetown University of current and former college athletes revealed that 17% of those currently in an athletic program suffered from depression symptoms. This is a little below the estimate that 25% of all college students experience depressive symptoms. What's worse is the data that suggests that 75-85% of these students never seek any help. If you're a coach in a college athletic program, chances are high that several of your athletes are suffering from depression. And that's critical because not only can depression negatively affect them socially and academically, it almost certainly will have a major impact on that athlete's performance, possibly over a protracted period of time. This article will help you identify the signs of depression and what to do about it.

Who suffers from depression?

  • 20 Million People in US
  • 10% of those are under 18
  • Women are impacted twice as much as men

What are the symptoms of depression?

Depression can come in several forms but at the heart of the condition is a serious loss of energy that impacts every aspect of life.  This loss of energy can manifest in several ways:

  • Constant sense of fatigue
  • Increased desire to sleep
  • Loss of appetite
  • Loss of interest in activities that were previously enjoyed
  • Social isolation
  • Irritability
  • Low self-esteem
  • Low self-confidence
  • Hopelessness
  • Suicidal thoughts

It is important to note that while sadness may be a symptom, depression is more commonly recognized as a loss of energy. Sadness can accompany loss and be part of a grief reaction but it doesn't have to be present for a diagnosis of depression. Suicidal thoughts, which are different from suicidal intentions, are common in depression. Suicide is the third leading cause of death among 15-24 year-olds.

Timeframe: There is no set timeframe. A depressive episode can last days or even months.

What are the causes of depression?

Depression can be a reaction to a specific situation or life event (for example, bullying or the break-up of a relationship) or can seemingly come out of the blue. It is also influenced by genetic predispositions. The study conducted at Georgetown University mentioned above found that 17% of the current athletes were diagnosed with depression whereas 8% of the graduated athletes were. The expectation might have been that graduates would have greater rates of depression as they were no longer enjoying the benefits of competitive action but that obviously was not the case. The causes of depression amongst the athletes in this study were:

  • Pressure
  • Over Training
  • No Down Time
  • Feeling Overwhelmed
  • Pain
  • Injury

Pressure is part of any competitive sport and it is easy to see how it can influence a player's confidence, especially when a player is stepping up to a higher level, like from high school to college. Adapting to the demands of the game is part of the learning experience but sometimes that can create significant self-doubt. Feeling overwhelmed mentally or physically can deplete energy and lead to a cascade of negative thoughts and loss of confidence. Interestingly, physical activity is considered the lifestyle behavior that can most counteract depression.

Starting an exercise regimen, or stepping one up, is a common anti-depressant treatment recommendation for the general population. But with your athletes, they already have an exercise regimen and taken to extremes, exercise can have the opposite effect of draining energy and lowering mood. Anxiety is also common with depression as the brain oscillates between being significantly under-aroused to hyper-aroused. And as we all know, anxiety and the over-thinking that goes with it, will seriously affect any performance.

Sometimes a combination of these factors conspires to create significant mood disturbance.


 

Andrew's story

Andrew was an outstanding player on his college basketball team.  Entering his junior year, the coaches were expecting great things from him. In the early pre-season practices, Andrew looked a little lethargic. No problem, it was just the beginning of pre-season. But as the season approached, Andrew's energy levels didn't pick up.  One of the assistant coaches noticed that Andrew wasn't smiling or laughing as much as normal. In fact, the more the coach observed, the more he saw that Andrew wasn't interacting much with the other players and untypically was coming to and leaving the gym on his own.  Twenty-four hours before the season opener, the coaching staff finally realized that Andrew was significantly depressed. The causes? Increased pressure to perform and the break-up of a long term relationship.


  While many high school and college students (especially freshmen) will subsequently admit to depression, few actually talk openly about it or even seek help.  In one study, it was estimated that more than 10% of college freshmen were so depressed that they had suicidal thoughts but 85% of them were not receiving any help. We think this is driven by :

  • The stigma of seeking help
  • Lack of proactive support and the right environment to raise issues early. If you want anyone to confide in you, especially your players, it is necessary to provide a safe and respectful communication environment.

In addition to the shame that accompanies depression, athletes typically feel they should be tough and "suck it up," which further limits their willingness to seek guidance. Most people will only open up to you if they feel safe and are encouraged to do so.

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What Should I Do if I Suspect Depression?

  • Create a safe environment: It's possible that simply sharing their concerns with their coaching mentors will be a relief to athletes and help them, with your support and advice, put things in perspective.
  • Don’t create punishments: If your athletes come to you, they will be concerned about being benched or impacting their playing time. While there might be short term impacts, as a coach, you should lay out the long term benefits to getting help.
  • Involve other teammates: Let them talk to upperclassmen who have also struggled.
  • When in doubt, bring in an expert: If you have any doubt at all, it is important that you refer the player to a mental health professional for a proper assessment. However, don’t just send them to the outside help and assume that this will solve the problem. Talk with their parents, stay involved and supportive.

How is depression treated?

In the general population, treatment of depression typically consists of counseling and medication.

Counseling: This can provide support as well as an opportunity to examine negative thoughts that might be underlying the depression. Cognitive Behavior Therapy (CBT) uses this approach along with some behavioral interventions to lift energy and mood.

Medication: The common anti-depressant medications target the neurotransmitter serotonin, which has a significant role to play in emotional balance. These medications are effective at eliminating emotional lows but sometimes they do so at the expense of emotional highs.  For some, this narrowed emotional range might have little impact on performance or might even enhance it, for others a more muted emotional range might negatively impact performance.

Summary

Because of the stigma associated with a psychological illness, and the illness itself, which is associated with a sense of shame and helplessness, athletes are unlikely to reveal it. This means that the burden of detection falls on others, who therefore have a key role to play in directing sufferers to sources of professional help.

When it comes to mental health, we believe that an ounce of prevention is worth a pound of cure. So proactively investing in your athletes' mental skills will not only lead to higher levels of performance but will also prevent mental health issues. However, there is no magic pill and depression is a crippling reality among athletes.Therefore, as a coach, creating a safe, trusting environment where athletes can openly express their concerns and even get help is a key to minimizing the impact of depression on individuals and your program.


References:

  • Sabrina Weigand, Jared Cohen, and Daniel Merenstein. Susceptibility for Depression in Current and Retired Student Athletes Sports Health: A Multidisciplinary Approach May 2013 5:263-266; published online before print March 25, 2013, doi:10.1177/1941738113480464
  • Garlow SJ1, Rosenberg J, Moore JD, Haas AP, Koestner B, Hendin H, Nemeroff CB. Depression, desperation, and suicidal ideation in college students: results from the American Foundation for Suicide Prevention College Screening Project at Emory University. Depress Anxiety. 2008;25(6):482-8.
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