When College Athletes Face Depression

“It was very hard, as a man playing D1 football, to go to somebody and say ‘I’m having a hard time’.”

Former Syracuse offensive tackle Jonathan Meldrum remembers the scrimmage drill that had him considering suicide. He was a college sophomore, almost six and a half feet tall and over 300 pounds, and one of the school’s standout players. During the drill, he’d hit someone, and shortly thereafter the fellow returned the favor. “He hit me back so hard,” Meldrum, now 27, told me. “And I just started tearing up. If I’d had a gun, I’d have probably put a bullet in my head.”

Meldrum was battling depression, and not for the first time in his life. The trouble started in junior high school, right about when he began playing football. His parents had depression, and his mother was a drug addict. Meldrum’s grandparents had stepped in to care for him, and got him the help he needed—a combination of medication and counselling—to manage his low mood. When he arrived at Syracuse in the spring of 2007, after a short stint at the Hargrave Military Academy in Virginia to shore up his academic eligibility, he felt emotionally solid.

It didn’t last. “During my sophomore year, I got so I wasn’t able to control my ups and downs,” Meldrum said. His football career stalled, he clashed with his coach, and he had girl trouble. “I dreaded waking up. My body would ache. I felt physically sick,” he said. “It was very hard, as a man playing D1 football, to go to somebody and say ‘I’m having a hard time’,” Meldrum said. He marvels at his ability to have made it to practice every day while feeling so desperate. “Here I am, I’m feeling sick, I wished I would die, and I have to go out there and hit people.”

Meldrum is hardly the only college athlete to experience such debilitating depression. Data from the NCAA and American College Health Association, interviews with athletic trainers and clinical psychologists, and conversations with former college athletes reveal that a growing number of student athletes are struggling with mental health issues that often go untreated.

To be sure, college students as a whole are facing an epidemic of depression; the American College Health Association reported in 2013 that 31.3 percent of undergraduates surveyed felt “so depressed it was difficult to function,” and 7.4 percent admitted to seriously considering suicide. Meanwhile, a 2013 National Survey of Counseling Center Directors found that the ratio of college counsellors to students was 1 to 1,604; and a 2009 Healthy Minds Study revealed that just 22 percent of depressed college students received “minimally adequate treatment.”

While statistics for student athletes are not broken out, these young adults face distinctive pressures that can trigger or exacerbate a mental illness, and may require more specialized attention and treatment. Unlike the rest of the student body, college athletes—particularly those participating in the most competitive Division I category—must manage a full-time sports career while being full-time students. A 2010 NCAA survey on the “student-athlete experience” shows that undergraduates playing DI sports devote upwards of 32 hours per week to the game. Along with the extended hours come special deprivations that can wreak psychological havoc: weekends, vacations, family milestones, and summers are given over to the sport. First-time college athletes also experience a special kind of shock that comes from starting at the bottom; they quickly discover that every teammate was once a player-of-the week in high school, and that no competition is ever just for fun. Further, their athletic futures depend on the whims of the head coach, who may or may not be sensitive or fair-minded. When their college athletic careers end—and in sports other than baseball, less than two percent of the roughly 450,000 NCAA-student athletes go on to play professionally—the now-retired jocks have to adjust to an alien way of life, one that doesn’t revolve around workouts and competition.

Sports injuries are especially difficult for college athletes. Katie McCafferty, who ran cross country and track for Georgetown, remembers the homesickness and exhaustion she felt in transitioning from high school to Division I athletics. But hardest for her was the psychological fallout from a stress fracture she suffered after competing at the Big East Cross Country Championship in October of her sophomore year. “It was the first time I had ever experienced a true injury such as a stress fracture that really kept me out of the sport for such a long time,” she wrote in an email. The pain of losing her identity as a runner, even temporarily, on top of the isolation from her teammates, who continued to go out for runs while she pedaled on gym equipment, undermined her confidence and well-being. “The psychological impact of injuries is greatly underappreciated,” Timothy Neal, Assistant Athletic Director for Sports Medicine at Syracuse, told me. “It’s a lot deeper and more concerning than people realize.”

A more pervasive source of stress for young athletes is the Darwinian culture of youth sports, which starts well before university and persists throughout it. The gifted few who make it to the collegiate level must adapt to what John Sullivan, a clinical sports psychologist and applied sport scientist, calls America’s “attrition model” of training, wherein college athletes are expected to endure more and tougher workouts, and are then discarded and replaced with new blood once they have been injured or gone stale. “When you over-train athletes, neurologically speaking the symptoms are quite predictable: sleep problems, anxiety, depression,” Sullivan said. “We’ve created a professional environment where, unfortunately, there’s a desire to find a way to do more,” he added.

College athletes are at greater risk of developing particular mental health maladies than the rest of the student body. In sports that reward leanness, like running and gymnastics, eating disorders are common, particularly among women. Those playing contact sports like football are more apt to abuse alcohol than those who don’t, said Chris Carr, a counseling sports psychologist and coordinator of Sport and Performance Psychology Services at St. Vincent Sports Performance in Indiana. Depression cuts across all teams, genders, and divisions. Yet many athletes hesitate to use the college counselling services because they consider their problems sports-related, and thus unfamiliar to ordinary counselors. Some, like Jonathan Meldrum, are reluctant to admit their woes, in part to preserve their reputations as fearless competitors. “When I was at my lowest, it was so embarrassing,” Meldrum said. “I’m a DI football player who wants to play in the NFL and I can’t stop crying.”

The natural place to address the problem is in university athletic departments, but few are equipped to recognize a problem and then refer a student for treatment. Only 22 Division I athletic departments are staffed with a full-time, licensed mental health professional, according to Nicole Noren at ESPN. Other athletic departments hire these licensed professionals as part-time consultants. But some universities bring in non-licensed “sports psychologists” to work with their teams, usually to focus on performance rather than psychological care and performance. “When I started, sports psychologists were mostly either a.) not psychologists, or b.) psychologists who read Sports Illustrated and who wanted to hang out with athletes,” Carr said. The problem persists today: in the United States, there are only about 50 licensed clinical sports psychologists working in athletics. Although that amount is growing, says Sullivan, “the number of students not being served is alarming.”

For their part, coaches are under pressure to win championships, and are generally not educated about players’ emotional health. “Our understanding and care of mental health issues today is where we were with concussions 10-15 years ago,” Neal said. He became interested in athletes’ mental health when he noticed that more and more of those who came to him with injuries were struggling emotionally.

Last year, Neal served as chairman of a National Athletic Trainers Association task force on mental health, which came up with guidelines for colleges and universities on how to address the problem. Athletic trainers often have the most day-to-day contact with the student athletes, and are thus well situated to observe early signs of distress. The NATA guidelines call on university athletic departments to develop plans for handling their players’ emotional problems and to establish teams of concerned parties—a trainer, team doctor, college counsellor, and mental-health provider from the community—who can assist the student in need. They also recommend that pre-season exams include questions about mental health, so that when an athlete is injured or under stress the athletic department will be more alert to the psychological impact.

The NCAA is also making a move to confront the problem. In January of 2013, the organization hired Brian Hainline, a neurologist, to serve as its first Chief Medical Officer, and established the Sports Science Institute to look more closely at health and safety issues among college athletes. Last November, following the release of the trainers association’s guidelines, the institute convened its first Student-Athlete Mental Health Task Force; it is expected to publish comprehensive guidance for college administrators that reinforces the association’s work. “The intent will be to provide best practices guidance,” Mary Wilfert, an Associate Director at the Sports Science Institute, told me. But it will not call for mandatory changes in the way athletic departments address their players’ mental health.

Other professionals who work closely with young athletes have more ideas on how to step up the pace of care. Paul Stricker, a staff physician at Scripps Clinic Carmel Valley and youth sports medicine specialist, wants colleges to do baseline personality and profile testing for mental health issues among their athletes. The NCAA, too, should start collecting data on athletes’ mental health, much like it does with injuries to the rest of the body, he told me. Carr, a counselling sports psychologist and member of the NCAA task force, believes that colleges and universities need to break free of their “reactive model of care” and build staffs of two or three mental health providers who can monitor the athletes’ mental health. “A Division I athletic department might have 500 to 900 student athletes under its care. We don’t send those kids to the student health center to have their ankle wrapped,” he said. Dr. Sullivan would like the NCAA to respond to evidence of the mental health crisis the way it did to data showing substance abuse among athletes: mandate action, in this case by requiring all sports medicine departments to include a licensed, clinical sports psychologist. He also wants to replace the “performance draining” model most coaches depend on with one that emphasizes resilience. “We need to educate everyone involved that we’ll get better results if we train smarter,” he said.

Jonathan Meldrum finally got the help he needed when his football coach at Syracuse noticed Meldrum’s emotional withdrawal. “My coach saw me and said, ‘Are you okay? You don’t look okay.’ At that point I started bawling,” Meldrum said. The coach set him up at Syracuse with the head athletic trainer who in turn referred Meldrum to mental health professionals. “After feeling bad for so many months—it was a huge weight off my shoulders,” Meldrum said. Katie McCafferty, on the other hand, says she made it through Georgetown without assistance from the athletic department. “Despite the fact that the coaches and other staff claimed to be supporting us, I always felt like it was only so far as we were giving back to them,” she said. “On the emotional side, there was little in the way of support.” With any luck, the next generation of college athletes will get the emotional care it deserves.