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Leeann Passaro wasn’t opposed to coaches pushing her hard. As a lifelong soccer player growing up in New Jersey, she was a member of some of the most decorated youth clubs in the country. When she decided to compete at the collegiate level, she was prepared.
“I was not soft,” she says.
Still, Passaro was deliberate about the role she wanted soccer to play in her college life. At one time she had legitimate dreams to play in the Ivy League. But she recalibrated her goals after a former high school soccer teammate, Madison Holleran, died by suicide in 2014, at age 19. Passaro was shattered. Holleran, a track and field athlete at the University of Pennsylvania, was everything Passaro had wanted to be, but her death, and the subsequent book about her life, What Made Maddy Run, cracked open a new conversation about the declining mental health of young female athletes.
“I saw a lot of the same things in myself that I saw in Madison, with the perfectionism and always needing to be the best at school and sports and all of that,” Passaro says.
Not long afterward, Passaro suffered a concussion while playing at a training camp during her junior year at boarding school, which led to a cascade of her own struggles, including anxiety and depression. “For the first time, I was having trouble in school, having trouble on the soccer field, having trouble socially,” Passaro says. “I suffered in silence for a little bit, but began to figure it out with the help of therapy and medication and talking to my parents.”
So when she decided to forgo more rigorous NCAA programs to play soccer at a D-III college, it was Passaro’s way of taking her mental health into account. Even so, when she was cut from the team before her senior season, the departure left her grappling with her identity, wondering who she really was if not the high-performing soccer player she’d always been. But she was also fortunate. Unlike so many student-athletes who experience similar circumstances, Passaro was already comfortable seeking help and had a therapist she could call immediately.
“We discussed what I could do my senior year without soccer that fills my cup and brings me joy and prepares me for whatever my next step might be. I see it now as a blessing, but it was extremely hard in that moment, as a 21-year-old who had played soccer their whole life, to understand that perspective is everything,” she says.
Young female athletes are increasingly finding that the environment surrounding the sport they love is hurting them.
After graduating in 2020, Passaro became a high school English teacher and lacrosse coach in Annapolis, Maryland. Her experiences as an athlete also led her to the role of chief operating officer at The Hidden Opponent, a national nonprofit organization that advocates for student-athlete mental health and raises awareness about the stigma of seeking treatment within sports culture. The group, which was founded by former University of Southern California volleyball player Victoria Garrick, names student-athlete captains on hundreds of high school and college campuses who promote mental health conversations and educational programs at their schools.
As involved in advocacy as Passaro is, she—like so many in the NCAA community—was still taken aback in the spring when she heard about the deaths of five young women who were, by many accounts, stars at their schools and in their communities.
Katie Meyer, 22, a goalkeeper and soccer team captain at Stanford University, was heralded for her part in the 2019 College Cup national championship. On March 1, she died in her dorm room, her parents guessing that a pending campus disciplinary measure may have contributed to their daughter’s anxiety. Jayden Hill, 19, who competed for Northern Michigan University track and field, also died in her dorm room on April 3, her family stating on a GoFundMe page that she “tragically and unexpectedly lost her battle with mental health.”
Then Sarah Shulze, 21, a University of Wisconsin cross-country runner who championed women’s rights and volunteered as a poll worker, died on April 13. “Balancing athletics, academics, and the demands of everyday life overwhelmed her in a single, desperate moment,” her family wrote in a memorial statement.
Softball player Lauren Bernett, 20, helped James Madison University make it to the Women’s College World Series for the first time. She died by suicide on April 25 and her team canceled the rest of the season to focus on healing. Arlana Miller, a 19-year-old cheerleader at Southern University, posted a note before she died near campus on May 4, describing how isolated she felt during COVID and after tearing her ACL.
The deaths of these five female student-athletes have left communities shocked, grieving, and searching for a way forward.
“Is it an epidemic? It’s hard to say,” says Arman Taghizadeh, MD, a child, adolescent, and adult psychiatrist and founder of the Mindset Training Institute near Baltimore, where he’s also a practicing sports psychiatrist. “I think we understand that people are struggling but we don’t know what to do about it. There’s more awareness, but we’re lagging on a plan of action and resources.”
Seventy percent of student-athletes said they’re experiencing mental health issues, according to a July survey of 1,200 college students by TimelyMD, a digital platform that offers virtual health care for students. The problem is dire: In October 2021, the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry and Children’s Hospital Association declared a national emergency as rates of mental health concerns and suicide rose for people between the ages of 10 and 24, with female adolescents particularly at risk—from February to March of 2021, emergency department visits for suspected suicide attempts increased 51 percent for girls ages 12 to 17 compared with the same time period in 2019.
The NCAA’s own survey of 9,800 athletes in 2021 showed 38 percent of women reported feeling mentally exhausted constantly compared with 22 percent of men. Less than half of the female athletes agreed or strongly agreed that mental health was a priority of their athletic department and less than half said they felt comfortable seeking support from a mental health provider on campus.
“When people say they feel hopeless, that’s sort of a striking thing to say, and 6 percent of males and 10 percent of females said they felt hopeless,” says Brian Hainline, MD, NCAA chief medical officer. “The takeaway from that is just one of overwhelming sadness. One suicide is already too many.”
Female athletes may be at a greater risk for mental health problems related to their sport.
Any combination of influences can prod and exacerbate conditions like depression and anxiety among athletes, and unfortunately, there isn’t one satisfying answer to the question of why. But female athletes face unique circumstances that lead them to higher rates of mental health disorders, experts say. Since Title IX became law 50 years ago, women have played sports mostly within systems and under coaching philosophies created for and by men. Only now are researchers beginning to give more attention to how female athlete psychology differs and how that affects performance, coaching relationships, and optimal training conditions.
One example? Girls and women struggle with body image and eating disorders at a higher rate than their male counterparts (up to 45 percent of female athletes have experienced an eating disorder, according to some studies), as well as anxiety caused by perfectionism, which can lead to substance use, self-harm, and suicidal ideation, points out Leah Howard, an Atlanta-based counselor and CEO of the Counseling for Athletes Directory.
College athletes are also 2.5 times more likely to encounter sexual abuse than their peers who don’t play sports, according to a 2021 survey of 1,500 college-educated Americans by Lauren’s Kids, a nonprofit organization that educates adults and children about sexual violence. The survey revealed that male coaches and professors were commonly identified as abusers and 37 percent of survivors didn’t report the abuse because they were afraid of losing their scholarship. Of these athletes, 50 percent reported post-traumatic stress disorder, anxiety, substance use, and other mental health issues as a result.
Another sobering statistic: Approximately 65 percent of athletes have experienced at least one of 18 indicators of psychological harm or neglect, usually by their coaches, per a 2021 survey of nearly 4,000 athletes across more than 50 sports by the U.S. Center for SafeSport, the nonprofit organization authorized by Congress to investigate and sanction sexual, physical, and emotional abuse at all levels of Olympic sports (from youth to elite level). These indicators of psychological harm can include behavior such as body shaming, bullying, neglect, scapegoating, or belittlement.
Mental health professionals also emphasize how COVID-19 has taken a toll. While everybody has suffered in a multitude of ways, college-age athletes who depend on their teammates and their sport for community and a sense of identity felt it in a unique way, during a particularly important time in their development.
At the same time most student-athletes were still negotiating their eligibility amidst the pandemic, new rules regarding name, image, and likeness (NIL) emerged. In June 2021, the Supreme Court unanimously ruled against the NCAA that it could not limit education-related payments to student-athletes. As a result, college athletes can now earn money and build their individual brands while competing in college, signing endorsement deals with local businesses or even corporate partnerships. While the extra cash is a boon to some, many opportunities require athletes to become social media influencers, maintaining an image and presence that can become difficult to sustain—and multiple studies show that increased social media use among girls can lead to depression, reduced sleep, lower self-esteem, and body-image issues.
“It’s crazy to think about the things that these 18-year-olds are navigating as adolescents—it’s way bigger than I think any of us fully understand,” Passaro says.
Organizations like the American Medical Society for Sports Medicine and the National Athletic Trainers’ Association are studying the effects of NIL to help the NCAA understand how it’s impacting student-athlete health. One fear is that athletes will feel compelled to hide injuries or illnesses in order to fulfill their obligations to sponsors. If nothing else, it’s an additional pressure to perform and another source of stress. “Are you going to be forthright about reporting any physical or mental health ailments if you perceive that you must be playing at all costs?” Dr. Hainline asks.
That pressure speaks to a larger issue in sports culture: whether one can ever be honest about their struggles without facing some sort of serious repercussion. Even when mental health services are available to athletes and they know how to access them, it can still be incredibly difficult for them to take the first step in seeking care. “Stigma often prevents student athletes from using [these services],” says Passaro. Many students feel shame in asking for help. That sense is often even greater for teens who play sports, and have repeatedly been praised for stoicism and an ability to endure both physical and emotional pain, and punished for sharing their setbacks and needs. Women in particular are more often seen as unable to handle the rigors (or unfair mind games) of sport, and may overcompensate by denying their struggles.
“I cringe when I hear old-school coaches talk about ‘mental toughness,’” says Dr. Taghizadeh. “To say that you’re struggling? There’s nothing more mentally tough than wanting to do something about it. If you had a physical injury, the coach would seek out the resources to treat it. When it’s a torn ACL you can understand what it means even if you’ve never torn your ACL. You shouldn’t have to have had depression to understand depression.”
Percentage of athletes who have experienced at least one of 18 indicators of psychological harm or neglect, usually by their coaches.
The stigma surrounding care is why so many advocates and mental health professionals are trying to help student-athletes feel more comfortable and equipped to discuss mental health and recognize and report changes in their typical disposition or functioning as comfortably as they talk about physical injuries. Their coaches need to be equipped to receive that information as well. “If you go to somebody and feel like they’ll judge you for what you say and it will affect your playing time, the message is, ‘It’s okay not to be okay but keep your mouth shut.’ We often isolate athletes more if they do speak up,” says Dr. Taghizadeh. For many athletes, it can feel impossible to admit they’re struggling without facing some kind of retaliation.
“I think the pressure surrounding female student-athletes is so great that being vulnerable is a major challenge for them,” Howard says. If that culture can be changed, and athletes feel they can ask for help or verbalize their struggles to their peers, coaches, or trainers, the worst-case scenario becomes preventable. Another key? Training teams in recognizing when an athlete is more at risk for mental health issues (like after an injury or if they have a strained relationship with a coach) and how to reach out to check in.
Framing counseling as a way to improve sport performance, build confidence, promote enjoyment and resilience, and achieve future goals, as opposed to a service only for those with mental health concerns, is one way to make athletes more open to talking to a professional, too, notes Dr. Taghizadeh. They may not realize they are struggling but identify with a desire for performance optimization. This can create opportunities for evaluation and education, resulting in mental health benefits throughout the process.
Normalizing mental health conversations is only part of the path forward: Athletes need more support from the NCAA, their colleges, and their communities.
The spring was a tragic reminder for Aberle Rodgers about how much work lies ahead when it comes to improving student-athletes’ mental health. Her twin sister, Morgan Rodgers, a standout lacrosse player at Duke University, died by suicide in July 2019 at age 22. In January 2017, Morgan sustained a difficult knee injury and spent a year intensely rehabbing after surgery to return to play as soon as she could. But isolated from her team and feeling disconnected from her support system, Morgan struggled with depression. She suffered mostly in silence, putting on a happy face in front of friends and family.
Not long after her sister’s death, Aberle Rodgers, her mom, and five of her sister’s close friends founded the nonprofit Morgan’s Message, a platform that shares athletes’ mental health stories through a blog and podcast and offers an ambassador program on school campuses to provide peer-to-peer education and support—a service now reaching about 11,000 athletes. If a service like this had been available when Morgan was struggling, they believe it could have saved her life.
“What we found after she died were a bunch of notes and self-recorded videos of her speaking her true self,” Rodgers says. “I feel like if she had a group to go to who were her age, who didn’t have the ability to rip her out of the team, I think it would’ve been exactly what she needed—just to hear that she wasn’t alone.”
Organizations like Morgan’s Message and The Hidden Opponent are filling a need where colleges are falling short on resources. In 2019, 90 percent of counseling center directors reported an increase in students seeking services, according to the Association for University and College Counseling Center Directors. Even before the pandemic, most had up to three-week waitlists for students seeking care, the Association of Psychology Postdoctoral and Internship Centers reports. It’s a reflection of a larger problem: In the general U.S. population, more than one-third of Americans live in regions experiencing shortages of mental health professionals. Sadly, campuses are no different.
While the NCAA requires athletic departments to make mental health resources available, often one or two counselors are asked to serve the needs of 30 teams. The NCAA also provides “best practices” for athletic departments, which include advice for promoting mental health, suggestions for rehearsing a mental health emergency action plan, and screening tools for signs and symptoms of mental illness, which were most recently updated in 2020. For many experts, it’s not enough. “A lot of programs are just checking a box and it’s one person who can’t take care of that many people. There are limited resources and athletes often find providers lack a true understanding of their challenges if the provider was not a competitive collegiate athlete themselves,” Dr. Taghizadeh says. “The NCAA’s guidelines are missing the mark in that they’re reactive. They’ll update them after they’ve lost a student athlete. Now you’re hearing more publicly: It shouldn’t take even one person for there to be change. This issue is something everybody should identify with.”
Since last spring, many have pressed the NCAA to do more to ensure the wellbeing of athletes, like taking a look at how coaches are incentivized almost entirely for winning, and how that can result in all kinds of mental health repercussions for athletes. Critics also point out that the NCAA could provide specific mental health mandates instead of guidelines, as well as financial backing for institutions that are struggling to hire enough mental health care providers for the needs of teams.
Lindsey Kilpatrick, who played field hockey at the University of Massachusetts at Lowell, wrote a petition to the NCAA, signed by almost 37,000 people, calling for mental health practitioner salaries to be subsidized to lessen the cost for universities. She also asked that the NCAA provide increased education and training on mental health for coaches and trainers.
“Student-athletes are begging for your help, and investment in our well-being, as we dedicate ourselves to our university and sport every single day,” Kilpatrick wrote.
Such financial support and mandates so far haven’t come to fruition, although an NCAA-commissioned Mental Health Advisory Group met for the first time in October to advise the NCAA “on emerging developments in mental health science and policy” that could lead to updates to their advised best practices. Passaro says she’d like to see the NCAA “step up” in lobbying for legislative changes that could benefit student-athlete mental health, like fighting for 24-hour phone counseling to be a mandated service at all colleges. When pressed by Women’s Health, Dr. Hainline maintains that it’s up to the leadership on every campus to come up with their own solutions, and to make sure they’re actually carrying out the best practices. “It’s the campus’s responsibility to take care of each student-athlete and each student in general. It should not be the NCAA’s role to be directly overseeing medical care at a campus, and that would be an impossibility anyway. There’s no way the NCAA could oversee medical care at 1,100 member schools, but also it would be inappropriate,” Dr. Hainline says. “Just like in my practice, I didn’t want a governmental agency overseeing what I did day to day and it was my job to make certain that I was providing the best medical care according to community standards.” For schools struggling to hire more mental health care staff, he suggests they partner with therapists in their communities to help athletes (though the nationwide shortage in care could make this option difficult in many places).
Coaches, too, should play a big role in the mental health of athletes, or at the very least, do no harm—and universities can incentivize their involvement, rewarding a healthy team culture alongside winning records. The University of Oregon, for example, recently hired Jerry Schumacher as its new head coach for track and field, after the previous head coach had his athletes receive DEXA scans (which provide precise body fat measurements), leaving women on the team feeling body-shamed and triggering disordered eating and other unhealthy behaviors. (The previous coach told The Oregonian that technology like DEXA “allows us to be cutting edge and innovative in our approach to performance.” The university directed Women’s Health to a June 2022 statement that does not state why the prior coach’s contract was not renewed.) Part of the new coach Schumacher’s contract seems to address the past complaints, with a benchmark for extension if he “consistently supported student-athlete health, safety, and wellness and had developed a culture within the cross country/track and field program which places the highest priority on student-athlete experience.” Passaro says a better reporting system for team leadership who are seen contributing to a decline in student-athletes’ mental health could help curb issues like this.
Of course, a lot of the reform that’s needed will have to come from the culture that surrounds sport—one with rigid definitions of success, of mental toughness leaving little space for vulnerability, and a win-at-all-costs attitude. Passaro is part of a new generation of up-and-coming coaches who she believes will approach their jobs differently, based on what they experienced as athletes. She wants to make sports a place where women and girls can flourish holistically, developing healthy people, not just winning athletes. So far, it’s been a successful strategy in the traditional sense as well—her high school lacrosse team has won two championships in two years.
“If you build a culture from the bottom up and make everyone feel valued, nurtured, loved, safe, and like they’re part of something special, the winning comes with that,” she says. “We definitely have seen an increase of athletic departments and adults on campuses wanting to partake in this conversation. I think we’re beginning to see that bigger picture more and more these days.” Not losing sight of that bigger picture, it seems, should be the ultimate goal for anyone working with young athletes, and really, anyone who calls themselves a sports fan.
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