 Well, how do you thank you so much. And next time I see you, we can spend a little bit time about the greatness of the Green Bay Packer football team up next to close out our first panel session is Dr. Gloria beam. Dr beam is the current co chair of the United States Olympic Committee sports medicine medical advisory group. She is a proud graduate of the University of California at San Diego School of Medicine, based in beautiful La Jolla, California, which explains why she loves surfing and water sports. And she is also an expert at making animal balloons. So Dr beam, welcome. Thank you so much. And thank you, Dr. Philip on and Dr. Nubon and the rest of the Stedman Philip on Research Institute, as well as the US OPC. It is truly an honor to address such an esteemed group of colleagues. So my talk is about suicide. What does that have to do with sports medicine and injury prevention? Well, around the world, the incidence of suicide is on the rise, but it's not just a lost or lonely that it affects our sports medicine patients and athletes who look like they have it all together, who have become known for their superior performance, who are celebrated for what they have achieved. They may be suffering too. If one of these athletes blows out their knee, me and just about every other doc on this call would be there in a minute. But if they struggle mentally or emotionally, then what are we doing to support them? Many athletes would certainly say not nearly enough. As an orthopedist, I do not pretend to be an expert in mental health. However, I do want to focus on the subject as it affects all of us in some way, whether through our patients or family and friends, we all have been touched in some way by suicide. The definition of suicide is death caused by injuring oneself with the intent to die. It's a major public health problem, and often it is preventable. Suicide attempts is when someone harms themselves with intent to end their life, but fail to die. For every suicide, there are 30 attempts. This is also preventable. This is also preventable. 2.5% of the global population makes at least one suicide attempt per lifetime. The statistics from 2017 reveal that greater than 800,000 suicides per year occurred worldwide. This is projected to be 1.5 million in 2020. And with the current COVID crisis, this might actually be real. There were 47,000 deaths in the US. It was the 10th leading cause of death and the 15th leading cause of death worldwide. That's 120 suicides a day in this country, one every 11 minutes. 1.8% of all deaths in the US are from suicide. Some regions have higher rates than others. South East Asia has been the highest, yet Europe and the US are far greater than the global average. In the US, 10.6 million seriously considered suicide. 3.2 million made a plan. 1.4 million attempted. 2 to 10% of adolescents attempted suicide. Females are more likely to attempt and males are more likely to complete suicide. So what are the risks? Thank you so much. According to CDC violence prevention resources, the populations with the highest rates are among American Indian and Alaska Natives, non-Hispanic whites, veterans, military personnel, and then people in construction, the arts, entertainment, media, and of course sport. In Europe and the US, men are much more likely to commit suicide than women. But in Eastern Mediterranean and Western Pacific regions, women are catching up. And this may be underestimated due to reporting issues. It's often misclassified or under reported due to taboo. Boys with previous suicide attempts have a 30-fold increase in suicide risk compared to boys with no history of suicide attempts. Girls have a three-fold increase. Other risk factors include family history, people who have experienced violence, social isolation, economic hardship, mental health problems, alcohol and substance abuse, and lack of easy access to healthcare. Other risk factors include too many stressors such as school, sport, and other activities, and then in athletes with high expectations from parents, coaches, teams, and peers. Other stressors including school problems, which accounts for 14% of suicides, drifting between school and jobs, acute conflicts with parental figures, 40% of suicides, other bullying, cyberbullying, mental, physical, and sexual abuse, as well as disciplinary trouble, most commonly with substance abuse. And then finally, personal loss. One-fifth of youth suicides are due to some type of personal loss, whether it's relationship breakups, death of a close family member or close friends, peer rejection, job loss, and athletes' inability to compete. Thinking mental health disorders are found to contribute between 47 and 74% of suicide risk. 90% have suffered from at least one mental disorder, 15% with major depression, and 25% untreated bipolar, substance abuse, eating disorders, and schizophrenia. So what are the warning signs? Following a loss or painful event, talking about suicide, threatening suicide, looking for means to harm oneself, sudden changes in mood or behavior, feeling hopeless, escalating use of alcohol or drugs, altered sleeping or eating habits, engaging in risky behaviors, saying permanent goodbyes to loved ones, giving away personal belongings, distancing themselves, and preoccupation with death, dying, or violence. Thank you so much. What are the consequences of suicide? Well, it affects the health of others in the community. Shock, guilt, anger, depression can affect all of us. The economic toll on society, $70 billion a year. Consequences of attempted suicide, serious injuries, long-term effects on health, increases risk of another suicide attempt. This is a big one. And then depression, other mental health problems, and even respiratory problems. Now let's talk about suicide and athletes. Suicide risk in athletes. Extreme aggression can be turned inward. Sound body, not always synonymous with sound mind. Even the athletes who are not quitters may contemplate suicide. BOM in 2005 revealed over a 34-year period, 71 athletes who had either contemplated, attempted, or completed suicide. 66 did complete. Among risk factors that appeared to have a major influence were injury, psychosocial stressors, the pressure to win, substance abuse, retirement, access one psychopathology, and anabolic steroid use. Other factors are seen here as well. Post-concussive syndrome is a potential etiology. There's 1.5 million high school football players per year, 250,000 concussions per season, and this is likely under-reported. Depression, anxiety, panic disorder, ADHD, substance abuse, PTSD, and psychosis can all occur after a concussion. There is three times the normal rate of suicide with these diagnoses. Thank you. Bipolar, ADHD, depression, eating disorders, these are all part of the possible etiology for suicide. The mortality rate in anorexia is 9 to 12 percent. One-third of these are from suicide. Gymnast, Christy Henrich, just missed the 1988 Olympics. She weighed 60 pounds at her death at age 22. As compared to age-matched heterosexuals, homosexuals between the age of 15 and 24 had a 2 to 3 times increased risk of suicide. Greg Luganus had 3 suicide attempts prior to age 18 due to being teased from the sports that he enjoyed doing. Thank you so much. The NCAA includes 450,000 athletes per year. Over a nine-year period, Ralph found 35 cases out of 477 student-athlete deaths. That's 7.3 percent. The rate is lower than the general and collegiate population, and this may confer a protective effect against suicide for college athletes. Males are significantly at higher risk than females, and football athletes are at greatest risk as well. Injury or inability to compete increases risk of depression and suicidal behavior. There was a cross-sectional anonymous online survey done by the Australian Institute of Sport in 17-year-olds and older. They looked at psychological distress, probable caseness, which is mental health symptoms that would usually warrant a need for care by a healthcare professional. Risky alcohol consumption, body weight and shape dissatisfaction, self-esteem, life satisfaction, and a gambling problem. Thank you. Compared to general community peers, athletes were significantly more likely to report psychological distress and had higher probable caseness. Conversely, alcohol gambling, body dissatisfaction were all lower in athletes, and the athletes also showed higher self-esteem and life satisfaction. Since the first modern Olympics in 1896, 120 Olympians committed suicide worldwide. Recently, Kelly Catlin, a 23-year-old cyclist, died after her second suicide attempt. Michael Phelps is an impactful mental health advocate and recalled feeling suicidal after the 2012 games. As all of us do, he worries about the mental health of many athletes as a result of postponing the 2020 Games. Thank you. The NCAA Sports Science Institute provides educational resources to promote and support the health and well-being of student athletes. The U.S. Olympic and Paralympic Committee has formed an external mental health task force to support Team USA. This includes athletes, coaches, medical doctors, and psychologists spanning many different areas of specialization. Thank you so much. Recent publications in our field signals the growing interest in the support of athletes' mental health as well. Mental health resources, including trained mental health professionals, mental health officers, IOC, mental health assessment tools, mental health emergency action plans, internal working groups, telehealth, mental health training for staff athletes, coaches, and families. Athletes' support webinars, as well as peer-to-peer support groups, are available. The more we are aware of them, the better we can help support our athletes. Protective factors serve as a buffer against certain risk factors. We need to work together to identify and manage these risks. We need to strengthen access and delivery of care. Help create protective environments in stable living situations. Help promote connectedness with family and community support. Teach coping and problem-solving skills. Identify and support at-risk individuals. And reduce harms and prevent future risks. Thank you so much. My hope is that this brief talk and others like it will bring more attention to behavioral health. Help destigmatize it and attract resources so that we as a medical community will be able to do better in protecting the health and the lives of these, our patients. Let's also remember that Mental Health Awareness Month begins Friday. Thank you again for this amazing opportunity. I'm really honored to be a part of this esteemed panel. And thank you for your attention.