Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

Costanza, Alessandra; Radomska, M; Zenga, Francesco; Amerio, Andrea; Aguglia, Andrea; Serafini, Gianluca; Amore, Mario; Berardelli, Isabella; Ojio, Yasutaka; Nguyen, Khoa D.

doi:10.3390/ijerph18030876

Cited by 15 publications

(10 citation statements)

References 109 publications

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“…At the biomolecular level, we postulate that the etiopathogenic mechanism of SA in this population is associated with chronic, exacerbated neuroinflammatory process associated with both chronic headache/migraine, TBI, and SA. 9 …”

Section: Discussionmentioning

confidence: 99%

“…Having a history of TBI increases risk for suicidal ideation, 5 suicide attempts (SA) 6,7 and death by suicide. [8][9][10] Specifically, an increased risk of suicide has been reported in veterans with TBI and retired athletes with chronic traumatic encephalopathy. 9,10 Headaches, arthritis, and back pain have lifetime rates of SA that range from 5% to 14% in the civilian population and commonly result in chronic pain.…”

Section: Introductionmentioning

confidence: 99%

“…[8][9][10] Specifically, an increased risk of suicide has been reported in veterans with TBI and retired athletes with chronic traumatic encephalopathy. 9,10 Headaches, arthritis, and back pain have lifetime rates of SA that range from 5% to 14% in the civilian population and commonly result in chronic pain. 11 Several studies have shown that experiencing chronic headaches or having chronic pain in general increases the risk for SA as compared to healthy controls.…”

Section: Introductionmentioning

confidence: 99%

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Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

Guo¹,

Zhang²,

Sico³

et al. 2021

JPR

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Objectives A large-scale retrospective analysis of veterans with chronic pain was conducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain. Methods This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA in veterans with chronic headache and chronic headache concurrent with TBI as stratified by sex. Results Veterans with chronic headaches had the highest annual incidence of SA (329 to 491 per 100,000) each year among all identified types of chronic pain conditions. Compared to other non-headache chronic pain, chronic headache is associated with increased risk of SA [men RR (1.48), CI (1.37,1.59); women RR (1.64), CI (1.28,2.09)], after adjusting for demographic factors, TBI, and psychiatric comorbidities. The risk increased further when chronic headache is comorbid with TBI [men RR (2.82), CI (2.60, 3.05); women RR (2.16, CI (1.67–2.78)]. Conclusion Veterans with chronic headache have a higher risk of SA than those with other chronic pain and women with chronic headache are at a higher risk than men with chronic headache. Chronic headache concurrent with TBI further heightened this risk, especially in men. Our data underscore the importance of identifying specific types of chronic pain in veterans with comorbid TBI and sex disparity associated with SA when targeting suicide prevention measures.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

Guo¹,

Zhang²,

Sico³

et al. 2021

JPR

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“…114 In some individual case studies and series, suicide was observed in persons with CTE, including but not limited to athletes. [115][116][117][118][119][120] An analysis of 85 brain specimens from former athletes, military veterans, or civilians with histories of repetitive mild TBI found CTE in 80% of the cases with 26% experiencing suicidal ideation and 14% of deaths occurring due to suicide and 12% due to substance abuse. 121 Mez et al 122 reported that 87% of 202 deceased American Football Players were diagnosed with CTE, 96% of them featured psychiatric conditions during their lifetime, including depression (67%), anxiety (52%), impulsivity (89%), substance abuse (67%), and suicidality (56%).…”

Section: Chronic Traumatic Encephalopathymentioning

confidence: 99%

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

Eva-Maria

Simon

Ajdacic-Gross

et al. 2023

Scandinavian Med Sci Sports

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IntroductionSuicide represents a major mental and public health issue. Elite athletes share certain individual and environmental characteristics that may increase their risk for mental illnesses, ultimately leading to suicide. This notion conflicts with the general perception of athletes, being the healthiest representatives of society.MethodsA comprehensive literature search was carried out through PubMed and Embase databases for relevant publications.ResultsRecent calls for investigating suicidality among athletes resulted in a considerable amount of literature providing some evidence regarding lower rates of suicide among professional and high‐performance athletes as well as similar incidence and prevalence of mental conditions, which are known as risk factors for suicide. Nevertheless, special attention is required in this population as predisposing and precipitating factors might differ from classical features of suicidality in the general population. Sports physicians, sports psychiatrists, and other mental health professionals in elite sports should be aware of early signs of affective disorders, risk of recreational drug abuse, misuse of performance‐enhancing medications, sport‐specific environmental stressors, serious physical injuries, and presence of physical or mental illness, all of which may increase suicidality. Traumatic brain injury (TBI) is with suicide with higher severity correlated with increased risk. Compared to active athletes, former athletes may have higher rates of suicide due to common life stressors occurring after sports retirement.ConclusionsThe findings suggest a multidisciplinary approach to suicidality in elite athletes, the main goal of which should be the reduction of suicide‐related morbidity and mortality. Further research is required to clarify the existing gaps in the current knowledge of the issue. While having lower rates of suicide, athletes share some similar (affective disorders, drug abuse, mental and physical illness) and unique factors (misuse of performance‐enhancing substances, sports‐related stressors, sports injuries, TBI) putting them at risk of suicide during active career and retirement.

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“…[ 3 ] The multiple factors of the mental health problems include general factors (e.g., stressful life events and inadequate social support) and athlete-specific factors (e.g., physical injury, poor performance, competition for selection, career transition). In addition, contact sports athletes may exhibit mental health symptoms and associated suicidal behavior due to biological causes such as chronic traumatic encephalopathy [ 4 ]. The usual definition of an elite athlete is an athlete who competes at a national or international level, including athletes in the domestic league [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

Anxiety and Depressive Symptoms in the New Life With COVID-19: A Comparative Cross-Sectional Study in Japan Rugby Top League Players

Ojio

Matsunaga

Kawamura³

et al. 2022

Int J Public Health

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Objectives: The primary objective is to compare the prevalence of mental health problems, including psychological distress, anxiety and depressive symptoms in Japan Rugby Top League players in the new life with COVID-19 with those evaluated before COVID-19.Methods: An observational comparative web-based cross-sectional study was employed for Japan Rugby Top League players. We compared the data from 220 Japanese and 7 foreign players during the new life with COVID-19 with the data from before COVID-19, which was obtained from 233 Japanese and 18 foreign players. We measured anxiety and depression symptoms with the validated Kessler-6, which has been widely used in clinical and research settings among different populations. To investigate the distribution of K6 score and whether there are discrete clusters or not, we conducted the two-step cluster analysis.Results: In the new life with COVID-19, 15.0% of players reported mild symptoms, which was significantly lower than the 32.3% of players before COVID-19. The prevalence of moderate and severe symptoms was 6.7 and 3.5%, respectively, in the group during the new life with the COVID-19, and 4.8 and 5.2% in the pre-COVID-19 group, with no significant difference. A two-step cluster analysis supported the existence of these two qualitatively different clusters in both groups.Conclusions: With the spread of new lifestyles related to COVID-19, some rugby players may have improved mental health status due to changes in their daily living environment. Such environmental adjustments alone may not have been sufficient to change the mental health status of others. Rugby players or their teams may require mental health professionals and systems that ensure rest, adjust the environment, and sustainably provide more professional care.

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Severe Suicidality in Athletes with Chronic Traumatic Encephalopathy: A Case Series and Overview on Putative Ethiopathogenetic Mechanisms

Cited by 15 publications

References 109 publications

Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

Suicide Attempts in US Veterans with Chronic Headache Disorders: A 10-Year Retrospective Cohort Study

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

Anxiety and Depressive Symptoms in the New Life With COVID-19: A Comparative Cross-Sectional Study in Japan Rugby Top League Players

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