By Barbara Bronson Gray
THURSDAY, Nov. 14 (HealthDay News) -- Will Heininger was a 295-pound defensive tackle for the University of Michigan at the end of his freshman year when he realized he had a big problem: He was severely depressed.
Surrounded by a collegiate culture of superathletes in a sport known for its toughness, Heininger was afraid to let anyone know how desperate he was.
"I had consuming thoughts from the time I woke up to the time I went to bed," he said. "My parents had gotten divorced the year before, we were in a new house and nothing seemed happy. Nothing seemed worthwhile."
For a long time, Heininger was able to hide his depression. "I was functioning at such a high level, going to football workouts, going to work and going to class -- keeping it all in," he said. "Then I broke down."
First, Heininger opened up to his mother and she helped him find a therapist. But the relationship wasn't a good fit, he said. The therapist recommended that Heininger quit football, the only thing he really cared about at the time. So Heininger decided to try to cope on his own.
Not long after that, at football practice, he suddenly became completely overwhelmed. His athletic trainer noticed something was wrong, Heininger recalled.
The athletic trainer brought him to a therapist who was part of the university's athletic program.
"I hadn't even known she was there," Heininger said.
He sat down with her and started to cry. "That was a big turning point for me. It started the healing process, one of the hardest things I've ever had to go through," he said.
Heininger started daily therapy and was given medication to help treat the depression. He gradually began to open up to his fellow athletes and friends. Now, five years later, he works in the financial services industry in Chicago, and has overcome his depression.
Heininger isn't alone. The National Athletic Trainers' Association (NATA) estimates that about one in four U.S. youths meets the criteria for having a mental-health disorder.
To help professionals working with college athletes recognize and refer students with psychological issues, the NATA recently published guidelines in the Journal of Athletic Training.
The guidelines highlight the need to take away the stigma of mental health issues and teach people working with student-athletes how to spot psychological concerns early and get the necessary help.
"We're addressing a public-health issue, and if we can shed more light on what athletes go through we can help educate the public," said Timothy Neal, the author of the guidelines and the assistant director for sports medicine at Syracuse University.
Neal said the vast majority of schools need to develop plans for dealing with mental health issues among student-athletes.
"There are unique stressors for student-athletes," Neal said. "They're compelled to exercise, miss holidays, miss summer vacations, and their failures and successes -- in athletics and in school -- stand out." They also spend long hours with the same group of teammates, he added.
The culture of athletics also demands a certain toughness and rigor that makes it hard for students to feel comfortable admitting they have problems or weaknesses.
"We have to de-stigmatize mental health issues," Neal said. "I tell athletes it is normal to have these kinds of situations; if you hurt your knee you're going to go to a specialist. In the same way, an athletic trainer can refer you to a mental health professional to see if you need help."
That "culture of resistance" was noted in a report released last month by the U.S. Institute of Medicine. Despite evidence that concussions cause some degree of brain injury, many athletes don't report their head injuries.
Although football-related concussions have been in the news recently, mental-health issues among student-athletes are not as well known, Neal said. Yet the risk of mental-health issues is higher among athletes than is the chance of getting a concussion, he said.