Early Guidance, Preventive Therapy Urged for Young Athletes

Deborah Brauser

May 16, 2012

May 16, 2012 (Philadelphia, Pennsylvania) — The recent death of former professional football player Junior Seau from apparent suicide once again highlights the need for elite athletes of all ages to receive early counselling and perhaps even mandatory prophylactic talk therapy to prevent psychiatric illness later in life in this high-risk population.

These were just some of the suggestions that emerged from a roundtable discussion between mental health professionals and several former and current athletes held here at the American Psychiatric Association's (APA's) 2012 Annual Meeting and hosted by the International Society for Sports Psychiatry (ISSP).

Junior Seau's death closely follows 2 other recent suicides by former National Football League (NFL) players Ray Easterling and Dave Duerson. All 3 players suffered multiple concussions during their careers, and Easterling, who was the eldest of the 3, had been diagnosed with dementia.

Retired NFL player Duerson, who reportedly believed he was suffering from the effects of chronic traumatic encephalopathy (CTE), shot himself in the chest and requested that his brain be donated to science. A degenerative condition, CTE can lead to depression, uncontrolled impulses, and dementia.

In Seau's case, the former San Diego Chargers linebacker reportedly experienced serious problems after retiring in 2009. He was jailed after a domestic violence arrest and drove his vehicle off a cliff in California soon after. Although Seau said at the time that he fell asleep at the wheel, the incident was widely suspected to be a suicide attempt. Seau's family is still considering whether to donate his brain for research purposes.

In the roundtable discussion between clinician attendees and several former and current professional athletes, former San Diego Charger Carlos Bradley noted that he had been with Seau last December.

Former NFL player Carlos Bradley at the ISSP roundtable discussion.

"You couldn't physically look at him and tell anything was going on, other than that he looked a little heavier than he had been. But then I hit myself a bit because if you really looked in his eyes, something seemed a little unsteady," said Bradley.

"The psychological makeup of being an athlete is very interesting because it starts when you're very young. Once talent is recognized, it's cultivated. But I think what is needed is more personal development," he added.

An Ounce of Prevention

Parents and coaches, said Bradley, need to "look at developing the whole person. If you don't have balance, then further down the line, there are going to be problems and other issues."

Ronald L. Kamm, MD, a psychiatrist in private practice in New Jersey who specializes in sports psychiatry, explained that as individuals reach their athletic potential, they are also "reaching maximum vulnerability" for developing a number of psychiatric illnesses, including depression, schizophrenia, and bipolar disorder.

Ira D. Glick, MD, professor of psychiatry and behavioral sciences at Stanford University Medical Center in California and a board member of the ISSP, reported that he has seen early symptoms of bipolar disorder in a number of young athletes.

Dr. Ira Glick (second from left) speaking at the ISSP roundtable discussion.

"But because of their athletic skills, they're pushed along, and it never gets properly treated. And there are some barriers to early treatment. Number 1 is stigma and number 2 is that teenagers don't want to hear about this," said Dr. Glick.

Bradley said he believes that any child who shows strong athletic prowess should see some type of counselor, whether they have psychiatric symptoms or not. He noted that just talking with young athletes about what is happening not only on the field but also in their home life would help.

"We as professionals have tried to make inroads in that way. And I think it would be great if we could turn this into a positive, that this would be extremely helpful for someone with talent. But that's a tough sell," said ISSP vice-president Antonia Baum, MD.

"I think what needs to happen is that in the schools, they need to have not just an orthopaedist but also a psychiatric sports physician on board early on," added Dr. Glick.

Bradley noted that sports psychologists are often available to new NFL players, but that may be too late because "it's hard to get their attention if they're thinking: 'I'm the man. I'll be okay because I'm going to be rich and famous.' "

"So help needs to start at the high school level. Many kids don't go on to professional careers. There are only around 59 positions [on an NFL team roster], but each year there are thousands upon thousands of people trying to get the same job you are," said Bradley.

Pushy Parents

"Parents also can be a problem if they keep pushing. But good ones talk to their children and show that they care about them as human beings and not just for their athleticism. Tell kids that if they fall short, it's still okay," he said.

Athletes cited other pressures, including the common burden of being the main breadwinner in a family and playing while injured.

They also noted the struggle to make peace once they are no longer able to play professionally and the frustration and confusion that often occurs when they retire at a relatively young age.

Bradley, who is now a personal trainer, played 6 years in the NFL, which he said is double the average NFL career.

"Your career is short. You're exalted up and up and up all the time, and then you're just let go with no support and told to deal with life. But often you haven't been given those tools," he said.

He noted that at the time he retired, there was even greater stigma associated with consulting a mental health professional.

"I think athletes are now becoming more open to that. With the news of today and talk of concussions and head injury, athletes are becoming more open and realizing that we need help," said Bradley.

Mandatory Therapy?

Nyere Aumaitre, a star football player in high school and an All-American at the University of Iowa, said he was shocked when he was not drafted by a professional team.

Nyere Aumaitre, lineman for the Cleveland Gladiators.

"Not getting drafted led to such depression. And to this day I still dread being seen as 'regular' because I got used to being treated so well. I wanted to be seen as successful. And when that stopped, I didn't know what to do. I didn't feel complete anymore," he said.

Aumaitre went on to become a lineman for the Philadelphia Soul, a team in the Arena Football League, and he now plays for the Cleveland Gladiators.

Several of the athletes stated that seeing a psychiatrist to deal with any stressors should become a mandatory part of every professional athlete's job.

When one of the psychiatrists at the session asked whether individuals would fight back against being forced into this, former semiprofessional football player Aaron Underwood said that a mandatory designation would remove the stigma often associated with seeking mental health care.

"If it was known starting out that this is required, than it would just have to be accepted," added Underwood, whose brother Dimitrius is a former NFL player who has been diagnosed with bipolar disorder.

Dr. Glick noted that an athlete in the National Basketball Association with bipolar disorder has it written in his contract that he must see a psychiatrist and take his medications if he wants to practice and to play.

"So perhaps a contract for everyone in all sports should note that a psychiatrist needs to be seen just for the everyday stresses of the sport," said Dr. Glick.

Trust Is Key

"Frankly, it's about developing a relationship where the players trust you," said David Baron, DO, executive vice-chair and psychiatrist-in-chief at the Keck School of Medicine at the University of Southern California, Los Angeles.

Dr. David Baron and Dr. Ronald Kamm.

"It's making sure they know: 'That person is here for me.' And it's letting them know that we're going to interact as two human beings," said Dr. Baron.

Overall, the participants agreed that it is important to talk with athletes of all ages as early as possible about balancing life, work, and play. However, there are still questions about the best ways to go about that.

"How do we get across that bruising your brain isn't the same as bruising your thigh? People get their bell rung and go right back in," said Dr. Baron.

"Our research has demonstrated that it's more problematic getting a slight ding in practice every day. And that builds up over time. Then we're seeing not only the dizziness, the headaches, the 'can't sleep,' but now we're also seeing effects on mood. How do we begin to change that culture with players and with coaches?" he asked.

"Football is a gladiator sport, and the day-to-day pounding is the nature of the game. Changing that is going to have to come from higher up. But I always say the only way to stop serious head collisions is to take away the helmet," said Bradley.

Dr. Glick said he is hopeful that "we're on the cusp of change" for leagues, high schools, and colleges.

"We just need to figure out how to change the culture so that the needs of people in the long run can be met — and we don't have more situations like the one with Junior Seau."

The American Psychiatric Association's 2012 Annual Meeting. Presented May 5, 2012.

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