Studies show that not being able to play sports because of the pandemic led to an increase in depression and anxiety. Photo by iStock.
This story discusses suicide. If you or someone you know is at risk of suicide, please contact University Counseling Services at BC to meet with the psychological emergency clinician, call the U.S. National Suicide Prevention Lifeline at 800-273-8255, text HELLO to 741741 for free crisis support, or go to https://www.speakingofsuicide.com/resources for additional resources.
As COVID-19 was forcing the cancellation of sporting events in the early days of the pandemic, Kimberly O’Brien was working to open a private practice dedicated to improving the mental health of athletes.
The practice, as she saw it, would be run by therapists who had played sports at a competitive level and could identify with the unique challenges of elite athletics.
Many high-level athletes overtrain, experience performance-related stress, and suffer from eating disorders far more frequently than most people realize, according to O’Brien, who captained Harvard to a national championship in ice hockey in 1999. But studies show that not being able to play sports because of the pandemic also led to an increase in depression and anxiety.
“There was such a need for athletes to be seen because they weren’t able to play their sports and they were so distressed,” says O’Brien, an alumna of the Boston College School of Social Work who launched Unlimited Resilience in October 2020. “They just needed someone to talk with about it.”
The stats bear this out: 68 percent of high school athletes polled by the University of Wisconsin in 2020 reported feelings of anxiety and depression at levels that typically require medical intervention, an increase of nearly 40 percent from past studies. And although the rate of suicide among college athletes is lower than that of the general population, the National Collegiate Athletic Association has found that suicide is still the third leading cause of death of student-athletes.
Unlimited Resilience now employs 20 clinicians who treat dozens of athletes, from peewee to pro. O’Brien, MSW’05, PhD’11, says that many of her clients struggle with anxiety, eating disorders, and perfectionism, a trait often seen in elite athletes who strive for flawless performance. But others talk about their suicidal thoughts, a topic that she has focused on as a clinical social worker at Boston Children’s Hospital and as a researcher at Harvard Medical School.
“We speak with them openly, honestly, and empathically about it,” says O’Brien. “We want our athletes to know that we are ready to hear whatever they have to tell us.”
The death of collegiate soccer star Katie Meyer, who died by suicide on March 1, has reignited concerns over the mental health of athletes. In recent years, a number of pros among the roughly 35 percent of elite athletes who suffer from a mental health crisis have come forward to acknowledge their struggles with anxiety and depression. Following a panic attack during a game in 2017, five-time NBA all star Kevin Love discussed his mental health in an essay published in The Players’ Tribune. Michael Phelps, the most decorated Olympian of all time, has spoken openly about his suicidal thoughts and now works as a mental health advocate. And Simone Biles, the most decorated gymnast of all time, withdrew from several events at the Tokyo Games in 2021 to focus on her mental health.
“We’re not just athletes, we’re people at the end of the day, and sometimes you just have to step back,” Biles told reporters at the time. “I didn’t want to go out and do something stupid and get hurt. I feel like a lot of athletes speaking up has really helped.”
As COVID-19 was forcing the cancellation of sporting events in the early days of the pandemic, Kimberly O’Brien was working to open a private practice dedicated to improving the mental health of athletes. Courtesy photo.
The American Foundation for Suicide Prevention says that most people who take their own lives exhibit one or more warning signs, such as talking about killing themselves, withdrawing from activities, or giving away prized possessions. But suicide is often not proceeded by warnings. Meyer’s parents, for example, told the “Today” show that they saw “no red flags” that their daughter might end her life.
“We, as researchers and clinicians, always want to operate under the idea that every suicide is preventable,” says O’Brien. “But the fact of the matter is suicide still happens, and it’s never anybody’s fault for missing a warning sign.”
She cautions that there is no single factor that leads someone to suicide, but says that perfectionism can hurt the self-confidence of athletes and increase the risk. “Perfectionism got them where they are and is not a bad thing if it’s harnessed in the right way,” she says. “What we work with our athletes on is helping them understand the point at which perfectionism turns unhelpful.”
As a clinical social worker in the Sports Medicine Division and Female Athlete Program at Children’s Hospital, O’Brien is currently working to survey over 500 female athletes from colleges across the country to identify the factors that make sportspeople resilient.
While she was leading the Crimson to a national title in ice hockey, she found that her mental health improved when she focused on the love of the sport rather than the outcome. But when she zeroed in on the number of goals she scored or the amount of playing time she received, her mental health suffered. “It’s important to note here that it’s not the sport itself that affected my mental health negatively,” says O’Brien, who still plays competitive ice hockey and platform tennis, an outdoor racquet sport. “It’s the way I was interpreting it.”
As a kid, O’Brien constantly thought of ending her life. But suicide was a taboo subject when she was growing up in the 90s, she says, and she didn’t talk about her suicidal thoughts until her late teens. She found that the MSW program in the Boston College School of Social Work “improved her self-awareness” and helped her “put a name to things that I never was given the ability to do when I was younger.” But it wasn’t until she was working in the Emergency Department at Children’s Hospital, analyzing the charts of kids who had been admitted for attempting suicide as part of her doctoral dissertation in 2011, that she began to connect her own experience with her desire to help other people who are suicidal.
“When I was doing that work, I found that I understood those kids. I understood this problem,” she recalls. “Now I really feel like I can help and make a difference, especially with kids who are struggling with suicidal thoughts and feeling like there’s no way out of their situation.”
O'Brien's book aims to arm teachers, coaches, and parents with the skills to help save the lives of youth, for whom suicide is the second-leading cause of death.
Over the past several years, O’Brien has developed and tested a variety of short interventions for suicidal adolescents. One ongoing intervention focuses on helping suicidal teens who use alcohol better understand the strong association between drinking and attempting suicide.
The intervention, for teens in the inpatient psychiatric unit at Children’s Hospital, is split into three parts. The first part, a 60-minute session, centers on creating plans to help the teens change their relationship with alcohol. The second part, a 30-minute session with the teens and their families, gives the patients the chance to share their course action with their loved ones. The third part, which takes place after the teens have been discharged, arms them with an app to remind them of their plan and connect them with peers in a chat room that’s moderated by a clinician.
“Teens don’t want to stop drinking, but they also don’t want to feel suicidal,” says O’Brien, whose program was funded by grants from the National Institutes of Health and the American Foundation for Suicide Prevention. “So if we can help them understand the link between their alcohol use and continued suicidal thoughts and attempts, then we might be able to prevent any future alcohol-related suicidal thoughts and attempts.”
She recently co-authored a book that aims to give teachers, coaches, and parents the skills to help save the lives of youth, for whom suicide is the second-leading cause of death. Emotionally Naked: A Teacher’s Guide to Preventing Suicide and Recognizing Students at Risk, published in August 2021, explains what an educator should do and say when a student tells them they are thinking of taking their own life and spotlights the stories of several teens who have learned to cope with suicidal thoughts.
“Conversations about suicide need to happen in our families and in our schools. We can’t talk about this in secrecy,” says O’Brien. “The more people have conversations about suicide with their kids or with students, the better kids will be able to see that they may be at risk and that there might be help out there for them.”
The primary goal of stripping the stigma around suicide is twofold: to help children understand that suicidal thoughts are pretty comon and to teach them that it’s possible to manage them. “You may not know how you can help, but it’s about trying to have a conversation, staying calm, being loving, being empathic, and validating how they feel.”