Teenage Male Athletes and Suicide - Case Study Example

Teenage male athletes and suicide Insert Name of the Student Insert Name of the Instructor Insert Name of the Course Insert Code of the Course Insert Submission Date Abstract This study covers the male athlete aged 13-19 and the risk factors of suicide, symptoms, barriers to change, negative outcomes of health risks, prevention, and the handling of such individuals. This age group is mostly in high school and they are faced with increased pressures to perform in athletics and school. This is in addition to the challenges of the adolescent life. Such challenges predispose the athlete to abuse of anabolic-androgenic abuse, substance abuse, and eating disorders that may lead to suicide. In addition, homosexuals in this age bracket may contemplate suicide because of fear of exposition. Unintentional injuries such as head concussions may also predispose the teenage to suicide. The study also covers symptoms that may show suicide ideation or actualisation, and the prevention of suicidal behaviours such as education for all stakeholders involved in the athletes life. Such patients should be handled with care and precaution before professional help is sought. However, there may also be barriers to behaviour change such as culture and lack of professional counselling. Contents Abstract 2 Introduction 5 Risk Factors 6 Anabolic-androgenic steroid (AAS) abuse 6 Injuries 6 Substance abuse 7 Eating disorders 8 Sexual orientation 8 Negative outcomes of health risks 9 Key specific symptoms/features 10 Aggression and violence 10 Mood disorders 10 Increased substance abuse 10 Increased self-harm 11 Restrictive emotionality 11 Previous suicidal attempts 11 Depressive symptoms 12 Prevention 12 Barriers to behaviour change 13 Handling 14 Conclusion 14 CHECKLIST 15 Fig. 1 Checklist for medical health practitioners 15 References 17 Introduction Teenage male athletes like any other athletes are reputable for their goal setting and determination to accomplish them, the aggression on the field, and the commitment towards physical health to an almost overall state of perfection. It is thus in sharp contrast that they are not only at risk of psychological illness but also suicide. Freud described suicide among athletes as originating from anger towards a love object that turns into self-hate that often leads to suicide. He further adds that suicide is also an expression of an earlier desire to kill someone else turned into one-self. Teenage athletes who have attempted suicide range between 2%-10% and the risk is significantly higher in males compared to females. Suicide is the cause of 1.8% of all deaths. 15% commit suicide due to a major depression while 25% are due to untreated bipolar disorder (Baum, 2005). Various risk factors such as low self-esteem, pressure to win, anabolic steroid abuse among others may cause teenage male athletes to contemplate or actualise suicide. Famous sports men have reported various attempts of suicide during their teenage years. The U.S. diver Greg Louganis attempted three suicides in his teen years due to teen-age depression, dyslexia, an abusive father, and discrimination because of his minority heritage (Samoan). The California physical fitness pioneer, Jack La Lanne, attempted suicide at age 14 due to constant bullying for his small size then (Baum, 2005). This paper will focus on the male athlete aged 13-19 and the link to suicide. It will explore the risk factors, symptoms, negative outcomes of health risks, barriers to change, prevention, handling of the suicidal patient before seeking professional help, and a checklist for the medical practitioner. Risk Factors Anabolic-androgenic steroid (AAS) abuse Anabolic-androgenic steroids are performance-enhancing drugs with elevated levels of testosterone hormone and other related chemicals that aid in muscle building and related physiological effects. The adolescent years are marked with elevated levels of body consciousness and most teenagers want to look or perform better to fit a pre-conceived image. It is this desire that prompts the elite male teens to use these drugs because when taken in high doses, they heighten muscle development and at a faster rate than natural foods. The increased level of muscularity culture especially in western countries has only worsened the situation. From a young age, children are exposed to toys such as Action Man, comic books, magazines, and movies with muscular characters and as they grow into their teens, they want to emulate these superficial images. A survey of American teenage students found out that 3%-11% of male high school students had used AAS some point in their teenage years (Kanayama, Hudson, & Pope, 2010). These drugs due to the high testosterone levels induce aggressive behaviour that some athletes wrongly perceive as performance enhancement. The heightened aggression is a major cause of suicidal thoughts especially during withdrawal. When a sister to a 17-year-old body builder who shot himself was interviewed, she answered that the steroids pulled the trigger (Baum, 2005). Despite most governments banning and educational attempts on the adverse effects of these drugs, they are still available especially from the internet. Injuries In the U.S. alone, there are over 7 million teenage students participating in sports. In this number, 39 per 100 male participants get injuries. Wrestling and football cause the majority of sports related injuries with football alone resulting to over 600,000 injuries per year. The nature of the sport techniques used in football also cause majority of head injuries. Head injuries may result in postconcussive syndrome that is a potential etiologic factor in suicide attempts. A player with a concussion is at an increased four times risk of sustaining another concussion. Because these teenagers want to look macho in front of their peers, they often brush off these injuries. They later retreat into their cocoons after multiple concussions that predispose them to suicide. The participants are also reluctant to take enough rest yet the adolescent bodies are not well formed to withstand massive strain (Sharon et al., 1983). An injury to an athlete’s body means his career may be in jeopardy. Other suicidal risks due to injury are rehabilitation difficulties that may restrict active participation in sports between 6 weeks to one year, injuries requiring surgery, failure to regain the same fitness as before injury, replacement in the first team position, and sustained success before the abrupt stop by the injury. The traumatic stress that results predisposes this group to suicide (Baum, 2005). Substance abuse The 13-19 age groups is usually in high school and the increased pressure to perform in education and excel in sports at the same time leads many male teenagers to abuse drugs such as alcohol, cigarettes, inhalants, and other hard drugs. These drugs are considered getaway drugs to escape from the performance pressures. Pharmaceutical companies using sport personalities that male teenagers idolise in advertisements enhance this problem. Male athletes also tend to be among the “cool” students in high school. They are therefore prone to peer-pressure to maintain this image. They indulge in substance use and before they realise it they are abusing the drugs. This more often results in expulsion from the team due to indiscipline usually un-tolerated in elite sports. Consequently, they end up attempting suicide (Greydanus & Patel, 2003). Eating disorders There is an increased prevalence of teenage athlete males with eating disorders either bulimia nervosa or anorexia nervosa. About 10%-15% of the teenage males suffer from an eating disorder with a peak period between ages 14-19. The males participating in sports that consider weight regulation such as gymnastics, wrestling, swimming, rowing, and track are more susceptible. The athletes believe that the less body fat they have the better the performance and consequently end up eating very little. The misconception that anorexia is a female disorder makes the teenage male athlete hide behind this disorder. Bulimia nervosa is difficult to detect since most patients have an ideal body weight and can hide this disorder. Contrary to their belief that they will perform better, the disorders weaken their bodies and reduce performance levels. The failure to perform as expected and denial of an underlying eating disorder makes the athlete prone to suicide (Ray, 2004). Sexual orientation According to Evans, Hawton, & Rodham (2004) there is a correlation between teenage male homosexual athletes and suicidal thoughts and attempts. A study in Massachusetts high school showed that 46% of the gay population in the school had attempted suicide at least three times in their high school life. Such cases are prevalent in male athletes because male dominated sports such as football that is popular in U.S. high schools are considered macho. Most homosexuals therefore suffer inwardly rather than expose themselves to ridicule or unnecessary scrutiny from their peers. Greg Louganis the famous Olympic champion says that he attempted suicide three times before 18 years due to ridicule from his peers for his preference for theatre, dance, and acrobatics considered female sports. Greg Congdon a gay athlete activist in the U.S. survived two suicide attempts during his high school years as he struggled to maintain his jock status and being gay (Baum, 2005). Negative outcomes of health risks Anabolic-androgenic steroid abuse has direct toxic effects on the heart tissues resulting to cardiomyopathy characterised by impaired diastolic and systolic function. This has been a cause of cardiac-related deaths among teenage male athletes. AAS abuse is also attributable to reduced high-density lipoprotein cholesterol and increased low-density lipoprotein cholesterol major cholesterol anomalies that pose a high risk of coronary heart diseases. The immediate withdrawal of AAS use after a number of abuse years among males results in hypogonadism and may lead to infertility or impaired sexual function. These withdrawal symptoms may lead to depression especially among male teenagers who tend to be very conscious of their sexuality. Depression may then lead to suicide. AAS abuse may also cause hypertrophy and hepatotoxicity including hepatic neoplasms (Kanayama, Hudson, & Pope, 2010). Anorexia and bulimia nervosa eating disorders result in somatic consequences such as dyspeptic symptoms, headaches, irregular heartbeat, chronic constipation, abdominal pain, regurgitation, fatigue, nausea, and hypotension. The disorders may also result in adverse psychological health such as anxiety disorders, depression, and dysthymia (Chamay-Weber, Narring, & Michaud, 2005). Substance abuse may result to negative outcomes of the health risks. Inhalants such as toluene may cause hearing loss, limb spasms, bone marrow damage, central nervous system damage, kidney and liver damage, and Kaposi’s sarcoma. Cigarette smoking in adolescence may lead to addiction that predisposes lung, oral, and throat cancer later in life. Teenage alcohol drinkers may develop elevation in serum y-glutamyl transpeptidase, macrocytosis, anemia, increased levels of uric acid, alkaline phospahatase, and bilirubin. Marijuana may cause bronchitis. Hard drug abuse such as cocaine may lead to permanent brain damage (Greydanus & Patel, 2003). Key specific symptoms/features Aggression and violence A study by Kanayama et al. (2010) show that male teenage athletes using anabolic-androgenic steroids have an increased level of aggressive behaviour compared to non-users. The respondents reported increased aggressive or violent behaviour especially with their women friends or girlfriends. The respondents reported highly irritability levels and minimal provocation was met with a high intensity and longer duration of vengeful behaviour. After the effect subsidised the teenagers often regretted their behaviour and due to shame, some contemplated suicide. This behaviour was directly linked to the AAS abuse because the symptoms ended after a two months withdrawal period. Mood disorders Some of the adolescent male athlete AAS users have reported manic and hpomanic symptoms. Some report paranoid delusions and grandiose symptoms. Some more reported major depression symptoms and suicidal thoughts during withdrawal (Hoff, 2012). These mood swings may confuse the male adolescent and if not handled by a psychiatrist who can explain the withdrawal symptoms, they may end up committing suicide. Increased substance abuse According to Zullig & Divin (2012) suicide victims tend to have an increased abuse of substances over a short period of time preceding the suicide attempt. The substances mostly abused are antidepressants, sedatives, stimulants, and painkillers. These athletes mostly use Opioid painkillers, sedatives, and antidepressants because they have a calming effect that reduces anxiety associated with sports performance. However, before a suicide attempt, the victim is prone to overdose on them. Stimulants are abused in an attempt to uplift moods. Increased self-harm Teenage male athletes on the verge of suicide may show an increase in self-harm behaviours such as slicing one’s hand. Shannon Wright, an Arkansas high school football player sliced his wrists for several years before he finally committed suicide using a gun (Baum, 2005). The reason given by such victims is that they want to punish themselves for under or non-performance in their respective fields. The pain helped them escape the realities of the situation and repeated slicing is common as they long to experience the same relief. Finally, when they cannot take it anymore, they commit suicide (Kidger et al., 2012). Restrictive emotionality Most of the teenage male athletes want to be the best at whatever cost. Perfectionism makes them prone to suicide because when they encounter problems they do not want to share lest they appear weak. In addition, the inability to express one’s feelings when in problems precedes suicide. Victims tend to withdraw suddenly and want very little association with peers (Jacobson et al., 2011). For example, the coach may replace the victim in the team due to under-performance and misjudgement of the move may result in emotional withdrawal. If left unchecked, it may lead to suicide. This is common in the athletes who are overly success conscious. Previous suicidal attempts Studies show that before the athletes finally execute suicide, they have attempted several suicides mostly from substance overdose or self-inflicted harms. Depressive symptoms are considered the major cause of the serious suicide ideation and the intensity increases with each attempt. According to Jacobson et al. (2011) the victims of previous attempts have an approximately three times higher risk of suicide actualisation than those with no previous attempt. Depressive symptoms Depressive symptoms may include withdrawal from the sport with no conclusive reason, increased feelings of fatigue and stress even when there has been no practice or game, disrupted sleeping patterns, poor eating habits in relation to the sport requirements and talk of suicide oftenly. Prevention Adolescents are a sensitive group generally and this becomes worse with the increased responsibility to perform as a student and male athlete. The best way to prevent suicide among this group is through education. They need to be educated on the combined pressures of athletics, school, and teenage. The education should also address the adverse effects of substance and AAS abuse. The education should incorporate all stakeholders in the athletes life such as the family, coach, and trainers. Schools and professional bodies should also provide both physician and psychologists before an athlete joins a sports team to gauge their propensity to commit suicide. This should be done in a manner that the athlete’s privacy is respected to encourage openness. The same services should be readily available during the athletes time span in the sport (Baum, 2005). Governments the world over should also unite in the ban against AAS use among teenage athletes and criminalise not only the use but the supply too. Barriers to behaviour change According to a study by Baum (2005) on suicide among teenage athletes, he found out that 80% of the athletes have access to a physician only once during the preparticipation sports physical. The emphasis at such times is the cardiovascular and musculoskeletal conditions and hardly on psychological conditions. This only increases the risk of the athlete to use AAS and suffer from eating disorders as he assumes what is important is the physical body only predisposing him to AAS abuse and eating disorders. In addition, any underlying psychological problem that could otherwise be treated is not exposed (Baum, 2005). The athlete may also feel uneasy to share the intimate details of his troubles especially when it involves banned substances such as AAS drugs. The athlete risks expulsion from the team if the use of such drugs is exposed and because no athlete would want that, they rather keep it inside than share. This therefore becomes a barrier to help the athlete in distress. In addition, naturally, teenage males are less likely to share their deepest feelings and emotions compared to teenage women and breaking this barrier to help them is problematic (Cavanaugh, Miller, & Henneberger, 1997). According to Baum (2005), culture is also a potential barrier to suicidal behaviour change. In Japan for example, they have great admiration for people who are able to withstand extreme pain and suffering. In the country, marathon is a highly regarded sport and the perfect marathon is viewed in terms of draining one’s body. This is a sort of ritual suicide. It therefore becomes very difficult to convince a teenage male athlete in such a culture not to commit suicide. The athlete may fail to take the initial assessment test for psychological disorders that may lead to suicide. In cases of positive diagnosis, the athlete may refuse to follow through with the treatment. He may also refuse treatment in cases where he feels that the psychologist is acting on behalf of the sport’s team and not for the victim’s need. Lack of institutional support presents a barrier too. According to a study by Bonci et al. (2008), 33% of high schools in the U.S. have provision for education programs targeting teenage sports and suicide. However, less than 9% of this number made it mandatory for the students to attend. Furthermore, only 15% had provision for coach education programs. The athlete has no incentive therefore to participate in the preventive programs. Handling When a male teenage athlete attempts suicide, one can take several precautions before medical attention is accessed. The patient of the suicide attempt should be handled with caution avoiding questions that he may perceive as judgemental. The handler should establish a good rapport with the patient, listen more than talk, and ensure that the patient is assured of confidentiality. Caution should however be taken not to be sworn into secrecy. One should look out for any feelings of hopelessness or worthlessness especially in the team. The information provided should be well documented to be given to the medical personnel at the hospital later. Professional help should then be sought out immediately (Working with the suicidal person, 2010). Conclusion Contrary to the disciplined demeanour of athletes, male teenagers are faced with psychological challenges that predispose them to suicide. The risk factors in their environment make this group susceptible to suicide. However, various symptoms may show suicidal thoughts and appropriate action taken to handle the patient or prevent actualisation. Barriers to suicidal behaviour may arise such as the male teenage athlete refusal to follow through with the treatment. CHECKLIST Fig. 1 Checklist for medical health practitioners Tick as appropriate Symptoms Mild Moderate High 1. What is the patient’s perceived risk of aggression/violence? 2. Does the patient show any signs of mood disorders? 3. Have there been cases of substance abuse? 4. Has the patient had any cases of self-harm? 5. Has the patient had any cases of previous suicide attempts? 6. Does the patient show any signs of emotional restrictiveness? 7. Have there been unexplained incidences of missed practice sessions? 8. Does the patient show signs of loneliness? 9. Any sleeping pattern change in the recent past? 10. Any incidences of suicidal talks/ideation? Barriers Yes No 1. Has the patient sought help prior to the suicide attempt? 2. How did the patient perceive the help offered(brief explanation) 3. In case of “No” why did the patient not seek help? (brief explanation) 4. Does the patient have access to professional help? 5. Are there cultural barriers that may hinder positive response? Note. From Working with the suicidal person: Clinical practice guidelines for emergency departments and mental health services by the department of health, Victorian State Government, 2010. References Baum, A.L. (2005). Suicide in athletes: A review and commentary. Clinic in Sports Medicine, 24 (4), 853–869. Bonci, C. M., Bonci, J.L., Granger, L.R., Johnson, C.L., Malina, R.M., Milne, L.W., Ryan, R.R., & Vanderbunt, E.M. (2008). National athletic trainers’ association position statement: preventing, detecting, and managing disordered eating in athletes. Journal of Athletic Training 43 (1), 80–108. Cavanaugh, R.M., Miller, M.L., & Hennerberger, P.K. (1997). The preparticipation athletic examination of adolescents: A missed opportunity? Current Problems in Paediatrics 27 (3), 109-120. Chamay-Weber, C., Narring, F., & Michaud, P. (2005). Partial eating disorders among adolescents: A review. Journal of Adolescent Health 37 (2), 417–427. Department of health. (2010, September). Working with the suicidal person: Clinical practice guidelines for emergency departments and mental health services. Victorian State Government. Retrieved July 11, 2013, from http://www.health.vic.gov.au/mentalhealth/suicide/suicidal-person-book2010.pdf. Evans, E., Hawton, K., & Rodham, K. (2004). Factors associated with suicidal phenomena in adolescents: A systematic review of population-based studies. Clinical Psychology Review 24, 957 – 979. Greydanus, D.E., & Patel, D.R. (2003). Substance abuse in adolescents: a complex conundrum for the clinician. Journal of Paediatric Clinics of North America, 50 (1) 1179 – 1223. Hoff, D. (2012). Doping, risk and abuse: An interview study of elite athletes with a history of steroid use. Performance Enhancement & Health, 1 (2), 61-65. Jacobson, C.M., Marrocco, F., Kleinman, M., & Gould, M.S. (2011). Restrictive emotionality, depressive symptoms, and suicidal thoughts and behaviors among high school students. J Youth Adolescence 40, 656–665. Kanayama, G., Hudson, J.I., & Pope, H.G. (2010). Illicit anabolic-androgenic steroid use. Hormones and Behavior, 58 (1), 111–121. Kidger, J., Heron, J., Lewis, G., Evans, J., & Gunnell, D. (2012). Adolescent self-harm and suicidal thoughts in the ALSPAC cohort: A self-report survey in England. BMC Psychiatry 12 (69), 1-12. Ray, S. L. (2004). Eating disorders in adolescent males. Professional School Counseling, 8(1), 98-101. Sharon, F.H., Joel, L.B., Kishor, A.H., Kathleen, D.B. (1983). Unintentional injuries among adolescents and adults: A review and analysis. Journal of Adolescent Health Care, 4, (4), 275-281. Zullig, K.J., & Divin, A.L. (2012). The association between non-medical prescription drug use, depressive symptoms, and suicidality among college students. Addictive Behaviors 37 (8), 890–899. Read More