Carrying The Team: Balancing Academics, Athletics and Mental Health in the NCAA

College is hard for students, but for student-athletes, the additional stress of their sport can be detrimental.

Photo: Meagan Cranston, 2010

Anxiety disorders are common among both male and female athletes. Stephanie Camacho was a Division III student-athlete at Brooklyn College on the women’s basketball team when she struggled with crippling anxiety.

Camacho’s anxiety would cause her to have panic attacks and get sick before practice and games. Her coach was of no assistance; he thought she was lazy. Camacho knew that she couldn’t confide in her coach, so she turned to the athletic trainer that worked very closely with her team.

“Talking with my [athletic] trainer really helped. But, the anxiety turned into depression and I went out on “injury” my second year” said Camacho. She injured her knee during the season, but her anxiety exacerbated the injury. Both her athletic trainer and orthopedist agreed that she should sit out the next season.

Camacho transferred after her sophomore year and to this day, she wishes that there was a counselor working with Brooklyn College Athletics that could have helped her through it.

As it is up to the Athletic Trainer’s discretion, they can submit approval for a redshirt for illness or injury, but they have to make it sound good. As of right now, student-athletes cannot redshirt specifically for struggling with mental health. Andrew Cornicello is the Head Athletic Trainer (ATC) for the 19 Division I athletic sports and the rehabilitation of injuries at St. Francis College in Brooklyn, NY. According to Cornicello, if an athlete is struggling from a severe mental illness and redshirts, the school can make the decision to revoke the student’s athletic eligibility.

“I don’t see the benefit in doing that. If you say that they can’t return, will the athlete think you don’t care about them and will it send them into a downward spiral? Will it benefit the athlete? Or do you say, ‘Come back here, we’ll take care of you, but you need to do X,Y,Z before you can go back to your sport.’” Once the athletes meet the criteria, they can return to the sport they love. “Hopefully, they’ll be happy and healthy once they do what we require.” said Cornicello.

A number of athletes recognize their sport as the way to destress. They have the privilege of stepping on the court, field, or mat where they can let go of the test they took that morning, their personal issues, or anything else on their mind. Their body has muscle memory that allows them to go through the motions of practice and leave their stressors at the door. For some athletes, their sport can be the source of their stress. If they are concerned about their performance, their rocky relationship with the coach, are bullied by their coach or other teammates, the sport that used to be their salvation may become their own personal hell.

The Stigma Attached

A recent study found that there were 477 student-athlete deaths from 2003 to 2012–35 cases of those deaths were ruled a suicide.

NCAA student-athletes have access to strength and conditioning coaches that handle their workouts, certified athletic trainers that assess injuries, team physicians that conduct annual physicals, and private academic advisors that help with their academics, just to name a few. The reason mental health counselors aren’t a priority: “Funding” said Cornicello.

Overseeing all 19 sports and the assistant athletic trainers, he works very closely with all of the athletes. “With the NCAA, there’s nothing really that we are required to implement. We have been asked to ask key questions in our entrance physicals, which most schools do.”

A majority of the questions the NCAA urges ATC’s to ask are basic. “Do you feel depressed? Do you feel anxious while partaking in your sport?” This can raise some concerns. The questionnaire requires student-athletes to be open with their trainers. Problems arise when they aren’t. Cornicello has had cases where an athlete will rate their depression a zero on a scale of one to ten, but later he will find out that they are having a really tough time and are embarrassed to admit that they’re struggling.

Cornicello says that anything higher than a three on that scale raises concern. “We usually will pull them aside in the days following a physical and gauge where they’re at.” After that, there’s not much more he and his team can do since they aren’t trained in mental health counselling.

Mind Over Matter

The NCAA’s mental health questionnaire is usually only completed at the athlete’s initial physical, depending on the school. When athletes go out on injury, according to Cornicello, they are not required to resubmit a new questionnaire.

“Depending on what the injury is, you can see how they are going through depression. If it’s an ACL injury and their season is over, you can see it. It’s very blatant.” If an athlete has a season-ending injury, Cornicello and his training staff are aware that this can lead to a change in mood. Although he and his team don’t specifically check on the athletes’ well-being, when they are rehabbing an athlete’s injury, they can gauge how the athlete is feeling in their day-to-day conversations.

In some cases, depression and anxiety occur when an athlete gets injured and has to sit out a season. A former Division I Track and Field runner, who asked to remain anonymous, said that being red-shirted and going out on injury in 2013 made him feel isolated from his team.

“I always thought that the same way the coaches care about practice and study hall, they should care about me,” he says.

“I’ve always been lucky enough to get along with everyone, so I was able to talk to people, but the people I felt were family didn’t feel like that anymore. I was missing out on the inside jokes and they were progressing athletically while I was regressing, so it was tough” he said.

For athletes similar to him, it becomes a power struggle. If you care too much about your performance and making practices, your schoolwork and personal relationships suffer. Athletes are all too familiar with mental toughness, but when you start worrying about letting others down, the sport becomes detrimental to their mental health.

The Mind Of An Athlete

January 2014, Madison Holleran, UPenn Track and Field runner.

November 2014, Kosta Karageorge, Ohio State Wrestler and Gridiron Football player.

January 2017, Jordan Hankins, Northwestern Women’s Basketball player.

These are just a few of the student-athlete suicides that received media coverage in the last few years.

For years, concussions have stolen the show as the most serious injury in the NCAA. When researchers looked at the NCAA Injury Surveillance Program, they discovered that Men’s Wrestling leads in sports-related concussions (SRC’s). Although wrestling leads, Men’s Football has the highest number of in-play SRC’s. Women’s sports, compared to their male counterparts, reported more SRC’s.

In 2016 at a National Collegiate Athletic Association meeting, NCAA Chief Medical Officer, Brian Hainline, announced that the mental health of athletes was just as important as concussions. “Concussions may be the elephant in the room, but mental health is really, I think, going to be a game changer for the NCAA.”

The effects of concussions span past the regulated 24–72 hours. In some cases, athletes can experience depression and anxiety years after suffering from a concussion. A study by the European Archives of Psychiatry and Clinical Neuroscience surveyed over 2,000 football players and found that those athletes who suffered a concussion at least three times revealed a significantly higher risk of depression. Recently, The Radiological Society of North America has discovered that in athletes who suffer from depression and anxiety post-concussion, the cause can be a result of damaged white matter in their brains.

White matter, or Axons, are responsible for transmitting signals to from one cell to the next. In patients who have suffered concussions and were diagnosed with depression, it was found that their were injuries in the reward circuit of the brain.

Kosta Karageorge, who died of a self-inflicted gunshot in November of 2014, had a history of concussions with the first documented concussion dating back to his high school wrestling career, according to this New York Times article. Throughout his collegiate career, Karageorge learned how to hide the symptoms of his concussions so that he wouldn’t lose playing time or appear weak — a stigma associated with both concussions and mental illness. In the article, it’s stated that Karageorge’s parents told researchers that their son sustained 15 concussions, but they were unsure.

In the report of the brain exam performed after Karageorge’s death, neuropathologist Ann McKee stated that there were “traces of past micro-hemorrhaging in Karageorge’s prefrontal cortex.” It is known that damage to that area of the brain can lead to cognitive issues that could potentially lead to depression and suicidal ideation.

Northwestern University’s Counseling and Psychological Services Center has one psychologist who works directly with student-athletes. According to their website, Northwestern also has an emergency service that will connect students in crisis with a counselor 24/7. When contacted, the Sports Communication department at the University of Pennsylvania did not know if they had a staff psychologist or therapist working directly with student-athletes. Ohio State University’s Athletics department was also unable to answer that question. This shows the lack of awareness among the colleges.

That is not to say that the majority of schools don’t have mental health counseling because some like St. John’s University, University of Wisconsin and Wellesley College do have departments that handle sport psychology. The athletes who do have access to these sport psychologists and counselors, like Michelle Duffy, a St. John’s alum, say that this makes a difference.

At St. Francis College, Cornicello says that the athletes and the mental health counselor have a good rapport. Although she doesn’t work specifically with athletes, Cornicello and his team will refer struggling athletes to her…sometimes, he will personally take them to meet with her. “The ones that really want help will say ‘Well, I’m not sure where it is, can you show me?’” said Cornicello. The issue with not having a mental health counselor who specifically works with student-athletes is lack of privacy on the school’s part. Although all meetings are confidential, the stigma attached to mental illness will cause most athletes to refuse to meet with a counselor if a student they know is working in the office.

It’s Not Only Mental

Although depression is the most common mental illness in the field of collegiate sport, many athletes suffer from anxiety and eating disorders as well. Most of the more serious cases that Cornicello has seen in his professional career revolve around eating disorders. The NCAA reported that an estimated 25% of female and 20% of male athletes suffer from symptoms relating to eating disorders.

“We’ve had athletes that recognized they gained more weight than they wanted to and they realize that they’ve been overeating all day. Others realize when they put a bathing suit on and say ‘I look like a toothpick, what am I doing to myself?’”

Even though some athletes recognize this through self-realization, there are times when Cornicello and his team have has had to sit them down and talk to them. It’s not always overeating or restricted dieting either, over exercise is a prominent eating disorder seen in collegiate athletes.

For most athletes, it’s normal to witness them do their lifts with the strength coach, rehab, do cardio and then go to practice. As Cornicello states, when it’s an athlete that doesn’t ever do cardio, but is spending an hour on the treadmill, it raises a red flag. Since this act is out of character for the athlete, Cornicello and his team can tell something is off. On the other end, if an athlete is hurt and has put on weight due to lack of exercise and poor nutritional habits, Cornicello and his team may instruct them to incorporate more cardio into their workouts.

A student-athlete is an athlete year round. When their season is over, they’re in the weight room, playing scrimmages, and sitting in study hall. As collegiate athletes, the sport monopolizes a majority of the free time they possess. The stress of playing a collegiate sport doesn’t end when the season ends — that’s where the importance of mental health assessments gain traction.

Are you a current or former athlete who is suffering from mental illness and want to tell your story? Reach out!