association with higher odds of attempting suicide. help-seeking behaviors there is a stigma associated with mental health in athletes. many barriers are present for athletes to find treatment for their mental health issues. it may be considered weak, and they should be conditioned to 'push through' the psychological pain and obstacles. another barrier may be explaining to the athlete their right to privacy, though it is sometimes the athlete's trainer, coach, or team physicians who provide the resources for the athlete to seek help. it has been hypothesized in previous studies that athletes underutilize mental health services, which may be concerning due to the level of depression in athletes particularly. health care professionals and/or a sports medicine staff working with the athlete may play a key role in identifying the signs of depression or other mental illnesses in athletes and refer them to the proper resources such as a sports psychologist. there are many sport psychology interventions that may be helping maintain athletes' mental health and preventing any psychological disorder. sport practitioners and researchers focus on mindfulness and resilience as two key factors that contribute to an athlete's well-being. mindfulness has been shown to help with the general well-being of an athlete and also aid in the enhancement of athletic performance. interventions based on mindfulness have been shown to assist both clinical and subclinical psychological concerns in athletes. by having poor mental health student athletes are stripped from their peak athletic performance, their ability to fully engage with their academics, and it amplifies the pressure they put on themselves. this creates a low self-compassion student athlete who struggles to find the good in themselves and the ability to deal with their own problems. many student athletes fear they will be stigmatized by their coaches, teammates, and fans if they reach out to mental health centers. so instead of getting help they hold their negative thoughts within trying to fight off their mental state. negativity from outside voices control their self -esteem and diminishes whatever they have left that keeps them going throughout the day. ultimately, this can result in the athlete struggling with their mental health before it is too late to reel them back in to get help. this could lead the athlete to taking their own life and or thinking very negatively about themselves because of unrealistic expectations. supplements/steroids anabolic steroids are artificially produced hormones called androgens, which are essentially male-type sex hormones in the body. the most powerful of the androgens is testosterone. another group of steroids are steroidal supplements, a weaker form of androgens. steroids and supplements are controversial when used for sports because of the health risks associated with them. some serious and long-term effects on the body are hair loss, dizziness, mood swings, delusions, paranoia, high blood pressure, and increased risk of heart disease, stroke, and even cancer. more recent studies also suggest that steroid users have an increased risk of depression and alcohol use later in life. doctors call this the 'snowball effect' of steroid-related health problems. injury patterns suggest that joint ligaments are not able to adapt to steroid-enhanced muscles, leading to injury. heat illness heat illness and dehydration are typically brought on by high temperatures and high humidity. these conditions carry increased risk for young athletes, particularly at the beginning of a season, when they are less fit. other factors that increase vulnerability include: heat-retaining clothing, recent illness, previous experience with heat illness, chronic conditions, and sleep deprivation. additional precautions should be taken if a child is taking supplements or using cold medication. heat illnesses are among the primary causes of sports-related death or disability. they require immediate medical attention. symptoms to watch for are as follows: dry or sticky mouth headache dizziness cramps unusual fatigue confusion loss of consciousness injury sports injuries are often the result of overuse or trauma to a part of the body. an issue unique to youth athletics is that the participants' bones are still growing, making them especially at risk for injury. around 8,000 children are rushed to the emergency room daily because of sports injuries. high school athletes sustain approximately 715,000 injuries annually. in american football, for instance, five times as many catastrophic injuries happen in high school as in college-level competition. injuries include heat illness and dehydration, concussions, and trauma-related deaths. heat illnesses are a rising concern in youth athletics. these illnesses include heat syncope, muscle cramps, heat exhaustion, heat stroke and exertional hyponatremia. each year, high school athletes sustain 300,000 head injuries, of which 90% are concussions. by the start of high school, 53% of athletes will have already suffered a concussion, but fewer than 50% of them say anything because they are concerned they will be removed from play. ice hockey, soccer, lacrosse, wrestling and basketball have a high risk of concussion, with football carrying the most risk. a history of concussion in a football player can contribute to sports-related sudden death. prevention to prevent an injury, proper warm-up is extremely important, because it lets athletes increase their heart rates. according to an article by nsmi.org.uk: "warming up before a sport" they state that, "the warm-up should gently prepare the body for exercises by gradually increasing the heart rate and circulation; this will loosen the joints and increase blood flow to the muscles" (warming 1). proper warm-up also increases muscle temperature. warm muscles are less susceptible to injuries because they can contract more forcefully and relax more quickly. as a result, both speed and strength can be enhanced. also, the probability of over-stretching a muscle and causing injury is much lower. warm-ups also increase body and blood temperature, which allows more oxygen to reach the muscles, improves muscle elasticity, and reduces the risk of strains and pulls. other forms of prevention include strengthening muscles, increasing flexibility, taking breaks, weight training, and playing safe. mental preparation is also important before practice or games. clearing the mind and visualizing skills and strategy can relax the athlete's muscles and build concentration. along with mental preparation, drinking plenty of water before games is very important. staying hydrated is how to prevent injuries like heat illness. post-injury response post-injury response creates more stressors, including coping and adjustment, as well as a combination of psychological and physical rehabilitation which lead to the process of returning to play. the integrated model of psychological response to the sport injury and rehabilitation process is one example of a cognitive appraisal and stress process during injury. this model shows how the injury becomes another stressor in the athlete's life, which, in return, leads to a process of cycles that include thoughts, feelings, and actions. post-injury management would reflect a healthier outcome if the proper steps are taken with regards to mental health resource availability, such as a sports psychologist. past research on sports medicine and sports science, observed from a biopsychosocial view, showed a better understanding of mental and physical health in injured athletes with regards to the best practices for psychological intervention and management efforts. one of the best interventions is an interpersonal intervention such as solution-focused brief counseling and social support from coaches and teammates. this support takes place during the injury and also post-injury throughout the rehab and back to play processes. stress plays a major role in an athlete's response to rehabbing an injury and the process of returning to play. the psychological response to an injury may trigger various mental health issues including depression and/or suicidal ideation, anxiety, disordered eating, and substance abuse. concussions the pattern of depression following concussions is different between collegiate and high school athletes. a study done on high school and college athletes found that for high school athletes, depression levels returned to a near baseline level two weeks prior to the concussion. conversely, collegiate athletes experienced peak depression levels two weeks following the initial implication. this is most likely due to the heightened investment in the athlete's sports performance in the college environment paired with the rigorous academic load that many students endure at universities. scholarships can also play a part in that collegiate athletes are concerned with their return-to-sport times and contributions to their teams. it is said to be very important to properly monitor depression levels following concussions as they can hinder the athlete's recovery time. another study considered the white matter integrity of retired nfl athletes who had endured a number of concussive and subconcussive injuries. monitoring the players over time resulted in a rough relationship between white matter disruption and depressive symptoms. in a similar study, former nfl players were also examined and their bdi-ii scores were considered using the buckley three-factor model. the results portrayed that the cognitive factor was the only one which was seemingly related to the number of concussions sustained by the player. this concluded that the cognitive symptoms of depression, ranging from sadness to guilt, are influenced by head trauma. upon the communication of the results to the test subjects, it became clear that many of them had not sought help for their depression due to the fact that they were unable to self-diagnose the symptoms. to fully understand the role of concussions as opposed to other physical injuries, a different study compared the psychological effects of concussions and acl injuries. the conclusion was drawn that athletes with acl injuries demonstrated higher emotional disturbance levels than athletes with concussions . it was observed that concussed athletes underwent mood disturbances as well as depressive symptoms, whereas acl injury subjects only underwent depressive changes. this is most likely due to the neurological impacts that concussions have on thought processes. acl injuries have psychological effects, but there is no physical injury to the brain. sports-related death sometimes sports injuries can be so severe that they lead to death. in 2010 48 youths died from sports injuries. the leading causes of death in youth sports are sudden cardiac arrest, concussion, heat illness and external sickling. cardiac-related deaths are usually due to an undiagnosed cardiovascular disorder. trauma to the head, neck and spine can also be lethal. among young american athletes, more than half of trauma-related deaths take place among football players, with track and field, lacrosse, baseball, boxing, and soccer also having relatively high fatality rates. mental health crisis throughout the past few years, there has been a dramatic increase in mental health issues among student athletes. student athletes report feeling overwhelmed, experiencing a lack of energy, anxiety, depression and other various mental health issues. in the past year, five student athletes have taken their own lives in part due to mental health challenges they were facing. there are varying opinions on the best way to approach mental health issues within the student athlete community. some believe that schools should provide mental health counselors available for student athletes. others believe that student athletes do not feel comfortable enough seeking mental health help due to the stigma surrounding it. instead, they believe that work needs to be done towards eliminating the stigma surrounding mental health, and work to ensure athletes and universities value mental health the same as physical health.