Depression and suicidal ideation in high‐performance athletes suffering from low back pain: The role of stress and pain‐related thought suppression

Abstract

Background Depression and suicidal ideation are important health problems in athletes suffering from pain. Dysfunctional pain cognitions, that is, pain‐related thought suppression (PTS), may play an important role in their aetiology. Thought suppression was shown to increase depressive mood, particularly in highly stressed individuals. This cross‐sectional study examines the relationship between PTS and stress on depression and suicidal ideation in athletes with pain. Methods A total of 159 athletes with non‐specific low back pain completed a set of questionnaires to measure PTS, depression and stress. Participants were split into groups with high and low stress, and high and low PTS. Two‐way ANOVA calculated main effects for PTS, stress and a PTS*stress interaction, with depressive symptoms as dependent. Subsequently, distribution tests were calculated, investigating if the presence of clinically relevant depression and suicidal ideation is dependent of conditions of high/low PTS and stress. Results A main effect of stress demonstrated higher depression scores in highly stressed athletes. Further, a significant PTS*stress interaction showed elevated depression scores in athletes with high PTS and high stress. Distribution analysis revealed positive associations between PTS, stress and depression, with depression being most frequent among athletes with high PTS and high stress. Suicidal ideation was not significantly associated with PTS and only weakly correlated with stress. Conclusions Our findings show that PTS is the most common pain response in athletes with pain. The results indicate a higher prevalence of depression and elevated depressive symptoms in athletes experiencing high stress, seemingly more pronounced when highly engaging in PTS. Significance This study contributes to the understanding of depression in athletes with pain, suggesting stress and pain‐related thought suppression to increase symptoms and prevalence of depression. As athletes often experience acute or chronic pain, understanding the impact of pain cognitions on health outcomes is an important step in the optimization of treatments.

Endogenous Modulation of Pain

“…Thought suppression can easily trigger affective distress, as thought suppression is highly failure prone [137] and failures can lead to greater distress [135]. Moreover, recent studies indicated that habitual thought suppression was, when co-occurring with high stress, related to increased depression in women with sub-acute back pain [160] and also in physically highly active individuals, such as athletes with back pain [186]. Notably, physical exercise per se may counterintuitively increase pain in the short-term, especially in patients with chronic pain.…”

Athletes are not at greater risk for death by suicide: A review

“…52 Severity of depression can be exaggerated by elevated levels of pain, stress, and the so-called "pain-related thought suppression" (characterized as inhibition of thinking about pain). 68 Sports injuries are shown to have a timely association with depression and anxiety incidences in athletes. 37,69 It is important to note that a psychological strain, frequently experienced by sports professionals, facilitates suicidal ideation.…”

“…Chronic pain, known to increase the risk of depression with a 5%–15% lifetime prevalence of suicide attempts, 67 is seen in as many as half of retired American football players 52 . Severity of depression can be exaggerated by elevated levels of pain, stress, and the so‐called “pain‐related thought suppression” (characterized as inhibition of thinking about pain) 68 . Sports injuries are shown to have a timely association with depression and anxiety incidences in athletes 37,69 .…”

Body Image in Athletes and Nonathletes With Low Back Pain: Avoidance–Endurance-Related Subgroups and Sports Status Play a Role

“…There is ample evidence that thought suppression is often ineffective in reducing pain, with increased emotional distress and depressive mood as emotional consequences. 5,10 Patients may further respond with an eustressendurance response (EER) pattern, characterized by cognitions of focused distraction from pain (eg, concentrating on valuable effects of an activity) 5 and the ability to maintain a positive mood despite pain. Both endurance patterns are characterized by physical overactivity behavior and, therefore, overload of physical structures, such as muscles, discs, or fascia.…”