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Performance stress, concussions can lead to depression in pro athletes: experts

TORONTO - The apparent suicide of Wade Belak, the third NHL enforcer to die in the last four months, is raising questions about whether more needs to be done to protect the physical and psychological health of pro athletes engaged in tough-guy sports.

Belak, who retired recently after playing parts of 14 seasons in the NHL, hanged himself in an apparent suicide Wednesday. His death follows those of New York Rangers forward Derek Boogaard and Winnipeg Jets forward Rick Rypien.

Dr. Saul Miller, a Vancouver sports psychologist who has worked with a number of NHL and other professional teams, said he didn't know Belak but finds his death surprising compared to the other two enforcers who died.

"These are three very different incidences. One, in the case of Boogaard, it appears he combined alcohol and drugs, and it was presumably accidental," he said Thursday from Vancouver. "In the case of Rypien, it's perhaps a case of long-standing depression, which is unfortunate.

"This one seemed to come out of the blue. Retirement is a challenge for some players, but this fellow seemed to have opportunities and he had family and he had children and friends who had met him, according to what I read, even shortly before this happened who thought he was in good spirits."

But Miller said highly paid elite athletes are under extreme pressure to perform well, no matter the role they're assigned on the ice or the field.

"And the role of the enforcer is a little different in the sense that you're performing in a very physical, violent way. And I do think when that violence is a nightly phenomenon, it does kind of wear on the soul."

Miller said there is no one personality type that typifies an enforcer—he's worked with the outgoing, confrontational players, but also serious types and those who are quiet and reserved.

"But I do think they do share this thing about having to answer the bell and meeting a very physical challenge. It's like who's the fastest gun in the West? There's always some young guy who wants to create a reputation who's going to challenge you. And certainly there must be times when a player just doesn't feel like it, but that's their role, they have to respond in a violent way."

Dropping the gloves also carries the risk of concussions, and recent studies have shown that multiple head injuries can result in clinical depression and other mood disorders.

One study of retired NFL players found that those who had had three or more concussions had a three-fold higher incidence of depression compared to players who hadn't had that many brain injuries.

But Dr. David Goldbloom, senior medical adviser, education and public affairs, at the Centre for Addiction and Mental Health in Toronto, said it may be a mistake to try to find a pattern among the three men.

"As tempting as it is for some people to go down that road, I think it actually obscures a more common issue, which is that mental illness affects one in five Canadians every year in every conceivable walk of life, whether you happen to be an enforcer in the National Hockey League or a pastor at a church."

Each year, he said, about 4,000 Canadians kill themselves, mostly as a result of mental illness.

"And that means there is nothing about donning a professional jersey that insulates you from the possibility of developing an illness like depression," Goldbloom said. "And in the same way that sports jersey doesn't protect you, neither does a white lab coat.

"These are common illnesses which sometimes, and mercifully relatively rarely in relation to the number of people who experience depression, end up with very tragic outcomes like suicide."

The tough-guy persona of some pro athletes also means they may be reluctant to admit they are struggling with depression or other mental health issues and seek help.

"There's certainly a macho mindset," agreed Miller, and a player's perceived position in the sports hierarchy also can play a role.

"If you're a superstar, it's one thing, people know who you are and know you can do the job. But if you're a fringe player, somebody on the edge, maybe you're less likely to come forward."

Retirement can also be a huge challenge, he said.

"You're in a situation where you're earning a lot of money, you have the adulation of the masses, you have the comradery of teammates, you have the excitement of the game. A lot of things are suddenly not there for you, and I think that's a big adjustment."

Both Miller and Goldbloom said that the NHL and NHL Players' Association may need to do more to help their current and retired players with depression and other mental health issues.

According to Mike Gillis, general manager of the Vancouver Canucks, the NHL and NHL Players' Association have had a formal substance and behaviour program in place for a long time.

"It encompasses all sorts of different issues, not just substance abuse or alcohol abuse," Gillis told The Canadian Press. "It's also anger management and a full encompassing program with a lot of resources. They are very reactive. They act immediately on issues that come their way.

"It isn't just limited to current players. It's for former players as well. There is a very strong program in place. It's still evolving and I think we are all going to be involved in the evolution of it to make it as good as it can possibly be."

On Thursday, the NHL and NHLPA suggested in a statement that they will be reviewing the program, "and will make immediate modifications and improvements to the extent they are deemed warranted."

Still, Miller said it isn't only up to the league and the players association—players in trouble have to put aside the shame and discomfort, and seek help.

Goldbloom said society needs to up its own game with more public discussion about mental illness, which would go a long way to ending the stigma that surrounds it.

"We live in a celebrity culture, which means that when people who are well-known either acknowledge their own struggles publicly or have terrible things like this happen ... it creates a conversation or at least an opportunity for a conversation.

"When famous people acknowledge their own struggles, it somehow legitimizes it for the rest of us who are not famous."

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