116 3rd St SE
Cedar Rapids, Iowa 52401
IOWA CITY — Since first playing soccer in her suburban St. Louis backyard at age 3, soccer has become Sam Cary’s passion.
“I love soccer,” Cary said. “I know I do.”
But in the summer of 2020 — when Iowa women’s soccer team had practices and before the Big Ten canceled the season — the Hawkeyes’ starting left back wasn’t having fun.
“That’s what scared me the most,” Cary said.
After driving home from Iowa’s soccer complex, she often wasn’t doing the usual social things for a college student.
“I would just lay in my room, and I would think over every minute of practice,” Cary said. “’Well, I missed that pass.’ Or like, ‘I shanked that shot.’ I would just overthink those moments so much to a point where I started hating soccer.”
That’s when she sought help from the athletics department’s mental health staff.
Cary is not alone.
At Iowa and across the country, many collegiate athletes are grappling with mental health challenges — a battle with many obstacles, new and old, that is increasingly being destigmatized.
“Our demand is consistently high, which is great,” Iowa sports psychologist Aubrette Kinne said in a February presentation to the university’s Presidential Committee on Athletics. “It means our student-athletes are reaching out for services and utilizing them.”
Kinne said in February her department will provide “individual services” to about 200 athletes in a “typical year” — or about one in three athletes at Iowa. Iowa was at 250 by the end of 2021-22, Kinne said in May.
“I, by no means, think that’s the ceiling,” Kinne said in February. “I really think we can probably hit 60 or 70 percent utilization if we had unlimited resources.”
That’s roughly another 200 additional athletes seeking services each year if there were more resources available.
Kinne bases that number off schools with "pretty large sports psychology staffs,” but that number still might be understating it.
“Even then, they don’t even know if that’s the ceiling for them either,” Kinne said.
Kinne has taken the approach of considering mental health as “brain health.”
“And we should treat it as such,” Kinne said.
One doesn’t need to look far from Iowa to see the importance of this type of care.
Sarah Schulze, a star runner on Wisconsin’s track and field team, killed herself on April 13.
“Balancing athletics, academics and the demands of every day life overwhelmed her in a single, desperate moment,” her family said on a website dedicated to Schulze.
In March, the captain of the Stanford women’s soccer team, Katie Meyer, killed herself. Her parents told NBC’s TODAY Show there were “no red flags” before Meyer’s death.
For many college athletes, being an athlete is a large part of their personal identity.
“I was really consumed by my sport and what my coach thought of me,” said Leah Kralovetz, a runner on Iowa’s cross country and track and field teams. “My family — even though I know that they love me no matter what — I wanted to make them proud, and I thought I had to win to make them proud.”
That frequent desire to win prompts one of the mental health challenges athletes often experience.
On one hand is what is in the best interests — or at least seems to be in the best interests — of someone’s athletic endeavors. But that doesn’t always align with what actually is in the best interests for the athlete as a human.
In Denmark, Wis. — a rural community about 20 minutes southeast of Green Bay with a population of 2,804 — Kralovetz experienced that conundrum firsthand in high school.
The more weight she lost, the faster she seemed to be running.
“I started to just really control my diet and not really realizing what it was doing negatively to me,” Kralovetz said.
She stepped on a scale in the middle of her junior track season in high school and saw she was 12 pounds lighter “than I ever remember being.”
Kralovetz was a “little concerned” by the number on the scale although also content with the numbers she had on her runs. After all, she was a conference champion in cross country a few months earlier.
But her mother recognized the need for medical help and took Kralovetz to the doctor “right away.”
That’s when Kralovetz learned she had an eating disorder.
“I was like, ‘What? No, I don’t have an eating disorder. I don’t throw up. I don’t do any of that, and I’m still finding success,’” Kralovetz said.
The battle didn’t end with the diagnosis.
Kralovetz was “a little better” as a senior in high school at having some foods she was “totally cutting out” before, but her unhealthy eating habits persisted. It didn’t help when she arrived at Iowa that she felt increased pressure as a collegiate athlete.
Then, she reached a breaking point.
As a Hawkeye freshman, Kralovetz was diagnosed with osteoporosis, a condition where bones are weak enough to be easily broken.
People who are 50 or older are at the highest risk of having osteoporosis, according to the Cleveland Clinic. Kralovetz was 18.
“That was really the first time I had to face that there was something deeper going on, that I needed to stop this,” Kralovetz said. “I remember my doctor telling me like, ‘I really don’t want you to be like 50 years old and in a wheelchair already because you’re so fragile.’”
Her doctors used the time Kralovetz missed because of a torn ligament as an opportunity for her to gain weight, but “I wouldn't say I was fully recovered from my eating disorder.”
She eventually found out in the fall of 2021 she no longer had osteoporosis and now is comfortable eating “all the ice cream I want,” but she had two stress fractures in the meantime.
Other mental health challenges
The athletic-interests-versus-personal-interests paradox also applies, albeit in a less obvious manner, to athletes who are early enrollees.
The benefits of an athlete starting their first year of college in January rather than the following summer are well documented, particularly in football.
On the soccer pitch, Cary was so eager to make an impression as the “little fish in a big pond” that she drew blood on the first day of practices.
“I definitely made a girl leave with some cuts and bruises,” Cary said with a laugh. “I just wanted to leave a mark, and I quite literally did.”
But it comes at the price of athletes’ last semester of high school.
“Meeting friends in college and having to explain that I was going back home for my senior prom was really interesting to navigate,” said Cary, who enrolled a semester early in 2019. “I don't know how to be in college yet, and I don't know what this is.”
Along with being an 18-year-old competing against teammates who were, in some cases, four years older, Cary had some obstacles that didn’t have anything to do with her soccer skills.
She found out on her second day of college that she had dyslexia, anxiety and ADHD, or attention-deficit/hyperactivity disorder — something doctors hadn’t tested her for before “because I did so well academically.”
That year, eight Iowa athletes were early enrollees. Six were on the football team, and the other one was Cary’s roommate.
Iowa football head coach Kirk Ferentz still remembers a “bad experience” with someone enrolled early “whatever it was, about 10 years ago.” After about a month on campus, the prospect went back to his home “out east.”
“You hate to do that,” Ferentz said in at his February signing day news conference. “That's not good for anybody, most importantly him.”
Challenges in seeking help
Much of the college athlete community is undoubtedly well-versed in how to treat physical health.
“When you sprain your ankle, you get taped, you ice it,” Cary said. “You have all these physical remedies that you're taught.”
But athletes don’t always take possible mental health treatments with that same level of normalcy and ease.
After Cary “did therapy for a while,” she was recommended antidepressants.
“I was like, ‘Well, I’m not depressed. I don’t need antidepressants,’” Cary said. “Sure, I'll go to therapy for a month or two, and then I'll be fine.”
Accepting that recommendation, as Cary initially viewed it, “means I’m really messed up.”
Cary thought she was fine, stopped going to therapy and didn’t listen to the recommendation.
“I’m fixed,” Cary remembers thinking. “I’m fine. No more issues.”
But then after practices picked up for the spring 2021 season, her tendency of “overthinking the game” resumed. Drago Ceranic, Iowa’s volunteer assistant coach at the time, saw something was wrong and pulled her into his office.
Knowing Cary’s love for coffee, he had one ready for her, Cary recalled to The Gazette as she had a coffee in front of her.
“He was like, ‘What is going on with you? You’re not playing like you,’” Cary said. “I sat in his office and broke down. … He's like, ‘OK, well, how do we get that to stop?’”
That meeting helped her realize taking the medical advice about antidepressants was maybe “worth a shot.”
“I will fully admit, I'm proud to admit that I've been on antidepressants ever since then,” Cary said. “It’s been over a year now, and they’ve worked great.”
COVID-19 adds another wrinkle to challenge
The last two years of the COVID-19 pandemic have added stress to many collegiate athletes across the country.
An NCAA survey conducted in May 2020 found 27 percent of women and 14 percent of men “felt overwhelming anxiety” either “constantly” or “most every day.” Forty-two percent of women and 31 percent of men had difficulty sleeping.
Cary and Kralovetz made the best of the difficult situation, saying the time back home was a plus for their mental health.
But when they returned to campus, juggling sports, academics and some sort of a social life while avoiding COVID-19 was not easy.
“It was a really crazy time to be a college athlete,” Cary said.
Cary went five months without being able to see her boyfriend in person despite going to the same school.
“When we were in a strict quarantine, we were in a strict quarantine,” Cary said. “I think the whole team itself was the most mentally unwell we’ve ever been. … As much as we love each other, we started to hate each other. We were around each other too much.”
As Iowa’s gymnastics team won its first Big Ten championship in early 2021 — before vaccines were readily available — COVID-19 precautions kept the athletes from celebrating the accomplishment with their families.
“We couldn't even allow them to hug their parents,” Iowa gymnastics head coach Larissa Libby said. “To not share that moment with the most important people in your lives, it really stunk.”
Meet Mali, Iowa’s four-legged mental health resource
In an Iowa softball scrimmage before the season, senior pitcher Breanna Vazquez “had a little bit of a breakdown.”
“I literally look down, and Mali is right there just looking at me,” Vazquez said. “I’m like, ‘This is what I needed.’”
Mali has a good running stride and can get a good grip on a ball, but she won’t be playing shortstop any time soon.
She is the team’s goldendoodle therapy dog.
“She brightens everybody’s day,” Vazquez said. “When we’re stretching, she’ll go down the line and she’ll lick all of us and give us a paw.”
Michigan softball and North Carolina baseball have dogs, and Iowa volunteer assistant coach Erin Doud-Johnson already had Mali and was taking her to nursing homes.
“We need to have this for our team,” Iowa softball coach Renee Gillispie said. “Mental health is such a huge issue right now. We need to find a way to help our players through all that.”
So Doud-Johnson trained Mali to be Iowa’s first therapy dog — a “great addition to our team,” Gillispie said.
“To be able to just take a moment to pet a dog or to throw a ball and just realize that everything is going to be OK, it makes a world of difference in our practices,” Gillispie said.
Next steps for mental health at Iowa
Iowa’s athletics department also is “finalizing the hire” of a mental health director, an athletics department spokesman told The Gazette.
“The addition of the director will also help to create a really cohesive unit,” Kinne said, which will help “take our vision to completion and then some.”
Once that hire is complete, Iowa will have three full-time mental health care providers working with athletes, the spokesman told The Gazette.
Another two care providers work with the Hawkeyes as outside contractors. That includes Dr. Carmen Tebbe-Priebe, a sports psychologist with her own private practice who punter Tory Taylor said “has been a massive help for me since I got here for personal stuff and football-related things as well.”
Athletes helping athletes
The Iowa Student-Athlete Advisory Committee, known as ISAAC for short, has made mental health a point of emphasis.
ISAAC had a virtual event with Victoria Garrick, a former USC volleyball player who now is a vocal mental health advocate. About 80 athletes attended.
The group hosted an in-person event in April called “Hawk Identity.”
“Fighting stigma, finding confidence was our tagline,” Cary said.
The panel discussion had four current athletes, including Kralovetz and Cary, and men’s wrestling head coach Tom Brands. Former Iowa football offensive lineman Sean Welsh, who has been open about his battle with depression, also spoke.
Along with about 135 athletes, coaches from almost every program at Iowa were in attendance, Cary said, including Kirk and Brian Ferentz.
Iowa field hockey’s Lisa Cellucci was among the coaches in attendance.
“To try to normalize mental health and have it be something that's talked about more and more — it has to be in the world we’re living in right now,” Cellucci said. “I’ve learned a lot from my team and from some of the other really brave student-athletes that stood up and spoke.”
Cary and Kralovetz's openness about their mental health challenges has already helped their teammates.
“Some of them have really opened up about what they're going through, which has been super encouraging,” Kralovetz said.
Other times, it’s as simple as texting Kralovetz to thank her for sharing her experience or Cary to ask for Kinne’s phone number.
“I'm so happy with my journey, but also the ability that we've been able to pass that on,” Cary said.
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