Supporting StudentAthlete Mental WellBeing The following NCAA content

Supporting Student-Athlete Mental Well-Being The following NCAA content is for educational purposes only. You acknowledge that the NCAA owns all proprietary rights in and to the NCAA Content provided to you. You agree not remove, distort, or alter any element of NCAA Content. The NCAA reserves the right in its sole discretion to edit the Content or modify your permission to display the NCAA Content.

Why Focus on Mental Health? “When I began my tenure as NCAA Chief Medical Officer in January 2013, my first task was to connect with NCAA stakeholders and constituents to understand their concerns. I have since met with hundreds of student-athletes and dozens of studentathlete groups to ask them their primary challenges from a health and safety standpoint. Almost to a person, the No. 1 response is student-athlete mental health and wellness. ” -Brian Hainline, Chief Medical Officer, NCAA Sport Science Institute

NCAA Mental Health Task Force • Created to address emotional health in our student-athletes. • Comprised of clinicians, researchers, advocates, educators, athletics administrators, coaches and student-athletes. • To identify recommendations that support member institutions efforts; to identify research gaps.

Mind, Body and Sport • Personal narratives. • Expert recommendations. • Student-athlete experiences. • Roles and responsibilities of sports medicine staff. • Coaches’ needs and roles. • Models of service. • NCAA resources and policies. www. ncaa. org/mentalhealth

Mental Health Occurs on a Continuum Resilience and thriving Mental health disorders

NCAA Sport Science Institute Mission: To promote and develop safety, excellence and wellness in college student-athletes, and to foster life-long physical and mental development

SSI Strategic Priorities 1. 2. 3. 4. 5. 6. 7. 8. 9. Concussion Cardiac health Doping & substance abuse Mental health Nutrition, sleep, & performance Overuse injuries & periodization Sexual violence prevention Athletics health care administration Data-driven decisions ncaa. org/ssi

Data Sources • 2013 Clinical Journal of Sports Medicine • 2015 -2017 American College Health Association-National College Health Assessment • 2017 NCAA Substance Use Survey • 2019 NCAA GOALS Survey

NCAA Student-Athlete Fatalities 2004 -2009

American College Health Association Data

American College Health Association-National College Health Assessment • A semi-annual survey of college students. Current data span five administrations from fall 2015 through fall 2017. • Survey covers several mental and physical health topics. • Institutions have authority over sampling, survey method and time of administration. • We have data from 152, 829 full-time undergraduate students ages 18 -24 attending NCAA-member institutions. 9. 2% (N=14, 134) identified as a varsity athlete. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15). The opinions, findings, and conclusions reported in this presentation are those of the author(s), and are in no way meant to represent the corporate opinions, views, or policies of the American College Health Association (ACHA). ACHA does not warrant nor assume any liability or responsibility for the accuracy, completeness, or usefulness of any information presented in this presentation.

Depression-ACHA Data Have you ever felt so depressed that it was difficult to function? (Yes, in the last 30 days) STUDENTATHLETES NON-ATHLETES* ATHLETE NON-ATHLETE GAP Male 12% 18% +6% Female 18% 24% +6% White Male Non-White Male White Female Non-White Female 10% 16% 23% 17% 19% 23% 26% +7% +3% *Non-athletes are full-time undergraduate students between the ages of 18 -24 attending NCAA-member institutions who do not identify as varsity athletes. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

Anxiety-ACHA Data Have you ever felt overwhelming anxiety? (Yes, in the last 30 days) STUDENTATHLETES NON-ATHLETES* ATHLETE NON-ATHLETE GAP Male Female 22% 38% 29% 46% +7% +8% White Male Non-White Male White Female Non-White Female 21% 23% 38% 39% 30% 28% 44% +9% +5% +10% +5% *Non-athletes are full-time undergraduate students between the ages of 18 -24 attending NCAA-member institutions who do not identify as varsity athletes. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

Feeling Rested Upon Waking On how many of the past 7 days did you get enough sleep that you felt rested when you woke up in the morning? MALES FEMALES STUDENT-ATHLETES NON-ATHLETES* 0 -3 52% 56% 60% 64% 4 -5 34% 31% 27% 6 -7 14% 13% 9% 9% *Non-athletes are full-time undergraduate students between the ages of 18 -24 attending NCAA-member institutions who do not identify as varsity athletes. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

National Comparison Data on Sleep Behaviors • 24% of NCAA student-athletes and 31% of their non-athlete* peers reported that in the last year sleep difficulties had been difficult to handle. STUDENTATHLETES NON-ATHLETES* Awakened too early and couldn’t go back to sleep 16% 17% Felt tired, dragged out, or sleepy during the day 61% 64% Had an extremely hard time falling asleep 24% 28% 3+ days within the last week: *Non-athletes are full-time undergraduate students between the ages of 18 -24 attending NCAA-member institutions who do not identify as varsity athletes. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

NCAA GOALS Survey

Median Sum of Hours Spent Per Week on Academic and Athletic Activities In-Season Baseball Men’s Basketball Football FBS|FCS Men’s Other Women’s Basketball Women’s Other 64 73 72 67 66 71 65 71 71 Division I Acad+Ath 69 66 75 73 Division II Acad+Ath 69 65 72 Division III Acad+Ath 68 67 69

In the last month, how often have you felt difficulties were piling up so high that you could not overcome them? (% Responding “Very often” or “Fairly often”) Baseball Men’s Basketball Football FBS|FCS Men’s Other Women’s Basketball Women’s Other 29% 28% 27% 31% 25% 27% Division I 21% 24% 33% 31% 22% Division II 20% 26% 27% 25% Division III 26% 25% 22%

Other Findings • 27 percent of student-athletes self-report they have been intractably overwhelmed during the past month. • 1/3 report they struggle to find energy for other tasks because of the physical demands of their sport. • 22 percent report being exhausted from the mental demands of their sport. • 73 percent believe that their coach cares about their mental wellbeing. • Over 40 percent who sought help for a mental health issue report high levels of satisfaction with the care they received from team or college personnel.

NCAA Substance Use Survey

NCAA 2017 Substance Use Study Background • The NCAA has conducted a national substance use survey every four years. • One to three teams were invited to participate at each NCAA school, with an estimated 60 percent of schools participating. • Fall 2017 survey included approximately 23, 000 student-athletes, comprising a representative sample from all three divisions.

Comparative Data (Within the Last 12 Months) NCAA [2017] Core [2013] ACHA-NCHA [2015 -17] MTF [2017] Alcohol 61. 1% 68. 6% 62. 3% 62. 0% Cigarettes 3. 2% - 8. 7% 7. 9% Marijuana 9. 5% 18. 8% 20. 6% 21. 3% Amphetamines 0. 8% 2. 9% 2. 1% 3. 7% Anabolic Steroids 0. 2% 0. 4% 0. 2% 0. 3% Cocaine 0. 8% 1. 6% 1. 9% 1. 3% Ecstasy/Molly 0. 2% - 1. 0% 0. 5% LSD 0. 2% - - 0. 9% SIUC/Core Institute. (2013). Core alcohol and drug survey long form: Executive summary. Retrieved from: https: //core. siu. edu/_common/documents/2013. pdf American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15). Schulenberg, J. E. , Johnston, L. D. , O’Malley, P. M. , Bachman, J. G. , Miech. R. A. , Patrick, M. E. (2016). Monitoring the Future national survey results on drug use, 1975 -2016: Volume II, college students & adults 19 -55. Retrieved from: http: //www. monitoringthefuture. org//pubs/monographs/mtf-vol 2_2016. pdf

Alcohol Use by Division (Use within last 12 months) 86% 84% 82% 81% 75% 74% 80% 78% 76% 74% 72% 2005 2009 Division I 2013 Division III 2017

Heavy Alcohol Consumption When you drink alcohol, typically how many drinks do you have in one sitting? Men's Sports Division III 5+ drinks 39% 52% 10+ drinks 11% 12% 16% Women's Sports Division III 4+ drinks 39% 33% 41% 10+ drinks 1% 2% 2%

Negative Consequences from Use (Within the Last 12 Months) Consequence Yes Had a hangover 64% Forgot where you were or what you did 35% Done something you later regretted 31% Had unprotected sex 27% Experienced interrupted sleep or sleep loss 25% Been criticized by someone you know 21% Got into an argument 21% Note: Data restricted to student-athletes who consumed alcohol within last year.

Self-Reported Consequences of Alcohol Consumption (Within the Last 12 Months) Females Experienced the following when drinking alcohol: Males STUDENTATHLETES NONATHLETES Did something you later regretted 41% 36% 40% 36% Forgot where you were or what you did 36% 31% 40% 33% Had unprotected sex 23% 21% 27% 21% Physically injured yourself 14% 16% 15% Notes: Yellow indicates a significant within-sex difference between athletes and non-athletes (p>. 001). Data restricted to those who indicated having consumed alcohol within last 12 months. Non-athletes are full-time undergraduate students between the ages of 18 -24 attending NCAA-member institutions who do not identify as varsity athletes. American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

Marijuana Use by Division (Within the Last 12 Months) 35% 33% 30% 25% 20% 26% 22% 19% 17% 18% 15% 10% 2005 2009 Division II 2013 Division III 2017

Reasons for Marijuana Use (Within the Last 12 Months) Division III Social use 76% 71% 80% To aid sleep 22% 26% 27% Anxiety or depression 24% 26% 20% Pain management 20% 23% 17% Other 16% 17% 16%

Prescription Drug Use (Within the Last 12 Months) Narcotic Pain Medication 2009 2013 WITH a prescription 13. 7% 18. 0% WITHOUT a prescription 5. 1% 5. 8% ADHD Stimulants 2009 2013 WITH a prescription 4. 5% 5. 7% WITHOUT a prescription 6. 7% 8. 7% 2017 10. 5% 2. 9% 2017 6. 6% 7. 5%

Summary • Substance misuse is highest among Division III student-athletes and among male studentathletes. • Excessive • Reported drinking is declining. marijuana use has increased in all three divisions.

Mental Health and Sexual Violence

FEMALES: Connecting Mental Health and Sexual Violence (SV) Feelings of Depression and Suicide Student-Athlete Non-Athlete No SV in last year (N=7, 730) Experienced SV last 12 mo. (N=1, 237) No SV in last year Experienced SV last 12 mo. Hopelessness 44% 69% 55% 74% Mental exhaustion 80% 92% 87% 95% Debilitating Depression 29% 53% 39% 63% Intentionally harmed self, considered or attempted suicide 10% 27% 13% 31% % reporting experiencing within last 12 months: American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

MALES: Connecting Mental Health and Sexual Violence (SV) Feelings of Depression and Suicide Student-Athlete Non-Athlete No SV in last year (N=4, 503) Experienced SV last 12 mo. (N=227) No SV in last year Experienced SV last 12 mo. Hopelessness 33% 48% 44% 65% Mental exhaustion 63% 75% 86% Debilitating Depression 22% 43% 31% 55% 8% 20% 11% 28% % reporting experiencing within last 12 months: Intentionally harmed self, considered or attempted suicide American College Health Association-National College Health Assessment, Fall 2015, Spring 2016, Fall 2016, Spring 2017, Fall 2017 [data file]. Hanover, MD: American College Health Association [producer and distributor]; (2018 -11 -15).

Intersection of Mental Health Concerns Maryland College Life Study, May 2013

In Summary • Mental health occurs on a continuum. • Suicide is the third leading cause of death for student-athletes. • Substance misuse is implicated in the leading cause of death, i. e. accidents. • Intersections of mental illness and substance use can negatively impact academic and career success. • Experiencing sexual violence dramatically increases risk of depression and suicide. • Although student-athletes do not report higher rates of depression and anxiety, the challenge for athletics is to create a stigma free environment where help-seeking is the norm and an environment that supports mental well-being.