Increased Risk for Teen Athletes, Boys and Girls with Body Dysmorphic Disorder

Over the past several years, national news media published countless reports on increases in mental health disorders among adolescents (age 12-17) and young adults (age 15-29). Before the coronavirus pandemic began, mental health professionals called it a mental health crisis in our teens and young adults.

One major factor leading this wave of reporting was the fact that in 2015, research published by the National Institutes of Health (NIH) and the Centers for Disease Control (CDC) indicated that suicide became the second leading cause of death for adolescents and young adults. Alongside this disturbing trend was the fact that among both groups – adolescents and young adults – rates of anxiety, depression, and alcohol/substance use disorders showed a steady increase over the past twenty years, with the most dramatic increases occurring between 2012 and 2018.

Data from a massive, worldwide research effort on youth behavioral health, called Worldwide Increases in Adolescent Loneliness showed that between 2000 and 2018:

• Self-reported loneliness and sadness in school increased in 36 out of 37 countries analyzed.
• Worldwide loneliness and sadness scores where higher for twice as many adolescents in 2018 as compared to 2000
• Most of this increase occurred between 2012 and 2018

Two things about this survey caught our attention. First, they considered data from over a million 15-16 year-olds from 37 countries. Second, they administered surveys to teens at five points in time: 2002, 2003, 2008, 2012, and 2018. The scope and duration of the study lends it credibility. It underscores the validity of previous data on increasing rates of mental health disorders in teens and confirms our national-level worry about our teens.

In addition, new information on the relationship between body image disorders, concussions among teen athletes, and suicide mean that our teens are at greater risk of suicide than ever before.

Teens and Suicide Risk: The Big Picture

We should contextualize the suicide numbers for you.

It’s important to understand that what concerns most mental health practitioners is the rate of increase of suicide and suicidal ideation among adolescents and young adults. It’s a legitimate concern. Coupled with the increase in reported mental health disorders among adolescents – and compounded by the increase in stress and degradation of teen mental health as a result of the coronavirus pandemic – anyone involved in the life of a teen should be aware of and concerned by this phenomenon.

With that said, here are the suicide numbers in context, with regards to age group:

• 60 men per 100,000 age 80+ commit suicide every year.
  • 42 per 100k for age 70-79
  • 28 per 100k for age 60-69
• 28 women per 100,000 age 80+ commit suicide every year.
  • 19 per 100k for age 70-79
  • 12 per 100k for age 60-69
• 15 males per 100,000 age 15-29 commit suicide every year
• 11 females per 100,000 age 15-29 commit suicide every year

The fact that the trend lines for young adult females and women age 60-69 almost overlap is alarming. Although there is still a significant gap between older adults and younger adults for males and females, the convergence is indeed enough to make everyone pay attention.

That’s why we’re writing this article. We need to inform parents and adults they need to be aware of what’s happening with our teens, and to identify two new contributing factors to the suicide rate and risk of suicide among young adults: the presence of body dysmorphic disorder (BDD) and a history of concussion.

New Data: Body Image, Concussion, and Suicide Among Teens

The fact that both these new factors are associated with teen athletes is something we should understand, as well. We’ll discuss that in a later article. For now, we’ll offer the new data on the relationship between body image disorders and suicide, followed by the data on the relationship between concussion and suicide.

Body Dysmorphic Disorder (BDD): Overall Rates and Association with Suicide

• Diagnosis of BDD typically occurs during adolescence, with prevalence rates of:
  • 1% for females
  • 6% for males
• Compared to people without BDD, people with BDD are:
  • Four times more likely to engage in suicidal ideation
  • 6% more likely to attempt suicide
• BDD and anorexia nervosa:
  • 25%-39% of people with anorexia also have BDD
  • Compared to people with one or the other, people with both BDD and anorexia:
    • Are hospitalized at greater rates
    • Attempt suicide three times more often
  • Males with muscle dysmorphia (belief their muscles are not big enough) have:
    • Lower overall quality of life
    • Increased risk of substance use disorder
    • Increased suicide risk
  • Among adolescents with BDD:
    • 6% report distress and severe disruption:
      • Social
      • Academic
      • Psychological
    • 4% reported suicide attempts
  • Among people with BDD, risk factors for suicide attempts and suicidal ideation include a diagnosis of:
    • Bipolar disorder (BD)
    • Borderline personality disorder (BPD)
    • Substance use disorder (SUD)
    • Post-traumatic stress disorder (PTSD)

Those statistics start out not-so-alarming, and end very alarming. Consider the fact that over ninety-five percent of adolescents with BDD report severe psychological distress and that psychological distress is a significant risk factor for suicide, and it’s hard not to conclude that BDD is a dangerous condition for an adolescent, with consequences up to and including increased risk of suicide.

Now let’s look at the new data on the relationship between concussion and suicide among adolescent athletes.

Concussion, High School Athletes, and Suicide

• In a study of over 700,000 individuals with concussions, risk for suicide – even among those with mild concussion – increased.
• Adolescents who reported concussions in the last year were at increased risk of:
  • Depression
  • Suicidal ideation
  • Planning suicide
  • Attempting suicide
• Among adolescents who reported concussions in the last year:
  • 36% reported feeling sad and hopeless
    • 31% for all teens
  • 21% reported suicidal ideation
    • 17% for all teens
  • Adolescent females with concussions were more likely to report:
    • Feeling sad and hopeless
    • Engaging in suicidal ideation
    • Planning a suicide attempt
    • Attempting suicide
  • Among gender-comparable sports:
    • Females had a higher concussion rate
    • Females had a higher recurring concussion rate (more than one concussion)

Those statistics start out alarming and end alarming. Reports about concussion and later cognitive problems among professional athletes have been in the headlines for around a decade. Most of the attention in those reports was reserved for aging football players and related to the financial and/or emotional hardships they experienced decades after their professional sports careers. These recent studies are among the first to connect concussion (known as traumatic brain injury), mental health disorders, and suicide among adolescents and young adults.

Now let’s transition to something that’s also important to understand: appropriate treatment and support can prevent teen suicide.

How to Prevent Teen Suicide: Awareness First

We’ll start with awareness.

Based on data presented in the journal article Suicide and Youth: Risk Factors, these are the risk factors for teen suicide.

Teens and Suicide: What Increases Vulnerability?

• Mental health disorders
  • About 90% of adolescents who commit suicide have a mental health disorder
  • Depression is the most common disorder associated with suicide
  • About 35% of adolescents who commit suicide have a mental health disorder
  • Alcohol misuse is associated with suicide attempts
• Previous suicide attempts
  • Around 27% of adolescents who commit suicide have a history of suicide attempts
• Personality characteristics
  • Although suicide may be planned over months or years, impulsivity is associated with increased suicide attempts
• Family factors
  • The presence of a mental health disorder in a family member – particularly depression and alcohol or substance use – increases risk of suicide
  • Family conflict increases suicide risk
  • Poor family communication increases suicide risk
  • Presence of, experience of, and/or witnessing domestic violence increases suicide risk
• Life events
  • 20% of adolescents who attempt suicide report romantic breakups, death in family, death of friends, and rejection by peers
  • Concussion (see above)
  • 14% of suicide cases involve academic stress/school problems
  • 40% of suicides are preceded by intense conflict with parents or parental figures.
• The Contagion Effect
  • Peer suicide impacts rates of suicide on a micro- and macro-level:
    • Media reports and TV shows sensationalizing suicide increase suicide risk
    • Suicide in a peer group increases suicide risk for members of that peer group
  • The volume and tone of media reports increase suicide risk in a dose-effect relationship:
    • More stories, more headlines, and the repetition of the same stories and headlines increases suicide risk
  • Availability of means
    • Research indicates that limiting access to lethal means, such as firearms, can reduce suicide risk in vulnerable teens

Parents, teachers, school administrators, and policy makers who are aware of these risk factors can watch for them and take the next step in preventing teen suicide: advocating for increased mental health support for teens.

Preventing Teen Suicide: Treatment and Support

Since it’s impossible to eliminate all risk factors for teen suicide, one of the most effective ways to prevent teen suicide is by making professional support available to all teens who have a mental health, behavioral, or alcohol/substance use disorder. The data above make the connection clear: teens with mental health disorders are more vulnerable than any other group of teens. Therefore, it’s crucial we listen to the experts when they talk about the mental health crisis among teens. Now, after the stress of the pandemic – which has lasted over a year and continues – we need to listen to those voice more than ever before.

The therapists, psychiatrists, and counselors aren’t making all this up. The data shows teens with mental health disorders are at increased risk. The data also show that the pandemic had a negative impact on teen mental health. When we add the new data connecting body image issues and concussion to suicide risk, we know they’re not overreacting.

The evidence says the teen mental health crisis is real.

Evidence also says that the mental health disorders most commonly associated with suicide – depression, for instance – respond positively to tailored, specialized support in treatment centers for teens.

Therefore, if your teen – or any teen you know – needs professional treatment, please do everything you can to help get them the treatment they need.

When we talk about mental health/behavior/addiction disorders associated with suicide, we’re not exaggerating when we say that the right treatment, right now, can save lives.

Finding Help: Resources

If you’re seeking treatment for your teen, please navigate to our page How to Find the Best Treatment Programs for Teens and download our helpful handbook, A Parent’s Guide to Mental Health Treatment for Teens.

In addition, the American Academy of Child and Adolescent Psychiatry (AACAP) is an excellent resource for locating licensed and qualified psychiatrists, therapists, and counselors in your area. Both the National Institute of Mental Health (NIMH) and the National Alliance on Mental Illness also provide and high-quality online resources, ready and waiting for you right now.