By Katie Ostrovecky, MS, ATC
Even though exercise and sport are often viewed as positive impacts on mental health, Athletic Trainers (ATs) must be aware when it comes to potential patients suffering from mental illnesses. One of the most extreme and dangerous effects of mental illnesses or other traumatic events can be suicidal ideations or attempts.
Suicide is defined as a death caused by self-inflicted injury or behavior with an intent to end one’s own life. A suicide attempt is a non-fatal result from an intent to end one’s own life.1 According to the Centers for Disease Control and Prevention (CDC), over 44 thousand Americans die by suicide each year, with 123 reported suicides per day. While ATs are not trained mental health professionals, it is still our responsibility to keep our patients safe to the best of our abilities.
One way we can protect our patients regarding suicide prevention is pre-season screening. Screening can allow ATs to identify any individuals at risk for suicidal ideations. The CDC breaks down risk factors into 4 different levels:
- Individual– history of depression or other mental illnesses; substance abuse; certain health conditions (such as chronic illnesses, surgeries, traumatic brain injury, etc.); previous attempts
- Relationship– unhealthy relationships (physical or verbal abuse); sense of isolation or lack of social support; financial or work stress; family history of suicide
- Community– lack of community connectedness; barriers to healthcare (lack of access to providers, therapy, medications)
- Societal– availability of lethal means of suicide (guns, prescription drugs, etc.); unsafe media portrayals of suicide; mental illness stigma
Some of these risk factors may be harder than others to identify in a pre-season screening, but an AT may be able to flag certain patients if they see one or more factors listed above. One example of a simple change that could aid in pre-season screening would be asking the individual if they have any history of anxiety, depression or other mental health-related illnesses. While they may not always feel comfortable sharing, these questions can open the door for conversation in the future.
Aside from risk factors, there are also signs and symptoms an AT can look for when identifying at-risk individuals. The American Foundation for Suicide Prevention (AFSP) provides the following “Talk, Behavior, Mood” guideline for signs and symptoms of suicidal individuals.2
If a person talks about:
- feeling hopeless
- having no reason to live
- being a burden to others
- feeling trapped
- unbearable pain
Behaviors that may signal risk:
- increased use of alcohol or drugs
- looking or searching online for methods to end their lives
- withdrawing from activities
- isolation from family or friends
- sleeping too much or too little
- visiting or calling people to say goodbye
- giving away prized possessions
They may often display moods such as:
- loss of interest
- relief/sudden improvement that seems odd
If any of the above signs or symptoms are recognized in an individual, the AT should help the athlete by talking to them and/or referring to them to the proper medical professional. Sports psychologists, school psychologists and counselors are all good options for referral. If your team, institution or organization does not have access to one of the above, then you can refer the athlete to their primary care physician. In the most extreme cases when an athlete may be a danger to him or herself, call 911 for immediate aid.
ATs often put injury prevention plans in place for their athletes or patients, and suicide prevention is no different. The following strategies are simple changes an AT can make to implement suicide prevention in their setting.
- Strengthen access to treatment – advocate for school psychologists at your campus or create relationships with local mental healthcare professionals for referral
- Create a protective environment – make sure your treatment area and office are a safe space for athletes or clients
- Promote connectedness – encourage those who may be struggling to get involved in programs, support groups or social activities
- Identify and support people at risk – know the signs and symptoms; know where to refer patients; provide suicide prevention training for staff and employees
With the information provided in this article, we can help decrease the prevalence of suicide deaths. For more information on suicide prevention and other mental health-related questions, please refer to the American Foundation for Suicide Prevention or the Centers for Disease Control.
- Stone, D., Holland, K., Bartholow, B., Crosby, A., Davis, S., & Wilkins, N. (2017). Preventing suicide: A technical package of policy, programs, and practices. Centers for Disease Control and Prevention. Retrieved from www.cdc.gov
- American Foundation for Suicide Prevention (2018). Risk factors and warning signs. Retrieved from www.afsp.org/about-suicide/risk-factors-and-warning-signs
About the Author
Katie Ostrovecky, originally from Northern Virginia, graduated with her Bachelor of Science in Athletic Training in 2014 from Nova Southeastern University. She then went on to receive her Master of Science in Kinesiology with a concentration in Exercise and Sports Psychology from A.T. Still University. She currently works as an Athletic Trainer with the youth population in Southern California. Katie is also a recent self-published author and an advocate for suicide prevention awareness.