My Support; October 2010

People with bipolar disorder are more likely to be single, disabled, and have a lower income than people without the disorder, according to new research.

This often lowers their socioeconomic status than it would normally be, despite people with bipolar disorder often having more college education than those without the disorder.

These are the findings of a recent study completed by a group of Norwegian researchers that investigated how educational achievement relates to function in bipolar patients and which clinical factors are associated with level of education.

In past studies, there has been conflicting evidence regarding the importance of educational level as it relates to social and occupational functioning in the disorder, researchers noted.

Helle Schoeyen of Stavanger University Hospital and the research team explained that "in the general population, there is a strong correlation between degree of education and social and occupational function in later life."

Findings of the current study revealed that a significantly higher percentage of the bipolar patients were single, had low income, or were disabled when compared to those without the disorder.

Data from 257 bipolar patients was drawn from the Norwegian Bipolar Research and Innovation Network. Patients in the identified bipolar groups were at least 18 years of age.

Of these, 69 percent had had the most serious form of bipolar disorder (Bipolar I), 26 percent had a less severe form of the disorder (Bipolar II), and 5 percent had a form of bipolar disorder that didn't fit into either of these two categories.

A geographically-matched reference sample of 56,540 people was also taken from the general population on levels of education, marital status, income, and disability benefits.

The researchers found no notable difference in education. The average length of education was the same for bipolar patients and the general population - 12.6 years.

When the analysis was narrowed to college education, findings revealed that 32 percent of bipolar patients had completed some level of college while the same was only true for 27 percent of the general population.

Rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level, researchers wrote.

With respect to income, 35 percent of bipolar patients were found to have an income below the 10th percentile, compared to 10 percent of those analyzed from the reference sample.

Bipolar patients were also more likely to be single (66 percent) compared to the general population sample (39 percent). They were also more likely to receive a disability pension (48 percent) than the general population sample (11.5 percent).

"The main finding of this study was that bipolar disorder patients had the same level of education but significantly lower social and occupational function than the general population," the team concluded.

They added that the present findings suggest that early identification and adequate follow-up treatment of bipolar throughout the life span could prevent a decline in social and occupational function.

 A serious mental illness, bipolar disorder is characterized by extreme mood changes running the gamut from mania to depression. Risky behaviors are associated with bipolar disorder, and it often causes damage to relationships and careers, and even suicidal tendencies if not treated.

It is estimated that 5.7 million adults live with this disorder in the U.S., affecting all genders and ethnic groups.

The study can be found in the Journal of Affective Disorders

After more than 15 years of sitting in that seat, Pittman has come to one intensely sad conclusion:

"The moments when Barret really sounds like he's at his best are when he's incarcerated," Pittman said of the currently jailed former lineman. "He has a schedule he has to live by, they tell him what to do and they make him take his meds."
 
Robbins, best known for disappearing just two days before the Oakland Raiders' appearance in Super Bowl XXXVII and diagnosed with bipolar disorder, is no longer some athlete fed by the Superman complex that lives deep inside so many. He's just a man, troubled and, in some respects, frail. Help isn't offered; it's required.

McKinley saw very little regular season action with the Broncos.
It's the kind of help that might have kept Denver Broncos wide receiver Kenny McKinley(notes) from apparently killing himself last week. Like so many others in the NFL, it appears McKinley didn't seek assistance.

"In all my time playing and in 10 years of working with players since I retired, I can't remember one guy, not one, who asked for help," said Robert Bailey, who spent 11 seasons with six different teams as a defensive back and special teams ace and now is a marketing agent working with Drew Rosenhaus.

In the case of McKinley, whose funeral was in suburban Atlanta on Monday, authorities believe he shot himself in the head because he was depressed after his second straight season-ending knee surgery.

In today's NFL, ample services are offered to help players cope with their issues - financial, family or otherwise. The league provides those under the umbrella of its player development program. It includes free counseling sessions and trained staff people who are around every team on a regular or semi-regular basis. The NFL Players Association hands out cards with the number of a helpline. There are life skills classes, both mandatory and voluntary, taught on a regular basis.

Yet the league is littered with tragic stories, including All-Pros like Robbins and unknowns such as McKinley. There were former first-round picks such as Alonzo Spellman and Dimitrius Underwood, who have struggled severely with bipolar disorder. Former quarterback Art Schlichter was addicted to gambling.

Some, such as Miami Dolphins running back Ricky Williams(notes) and former Pro Bowl punter Greg Montgomery, get help and eventually find a solution. Many more succumb to the intense pressure that exists in the NFL.

"For me, it wasn't hard to seek help, but I think the hardest part is it's difficult to be introspective in this sport," said Williams, who has openly discussed his bouts with anxiety and depression. "This environment isn't conducive to that. There are all these external factors coming at you and you think that's what's affecting you. ... I had a chance to really sit down and say, 'It's not external, it's me. There's something I need to fix.'

"The nature of the job is inhumane. It's the most stressful job I can think of. There are jobs that are more dangerous, but the pressure to perform every day is intense, so it's easy to project that the pressure comes from outside and that the problem isn't you. Imagine that you're at work every day and someone is following you around with a camera the whole time and then you watch yourself as other people critique what you're doing."

Or, in McKinley's case, the pressure that goes with not performing. In two seasons after being a fifth-round draft pick in 2009, McKinley had scarcely played because of knee injuries. On Saturday, the Broncos held a service for him and McKinley's father recalled how his son, when he was just five, had once made a business card out of an index card that read, "Kenny McKinley, football player."

That type of self-imposed pressure may lead to trouble down the line.

"So much of what we try to do is about developing an identity outside of being a football player," said Williams, who sought counseling during his rookie season with the New Orleans Saints. "If your identity [is] wrapped up in you being a football player and you're in a sport where so many guys are replaceable, what's going to happen when you don't have football?"

Even more, there is a gladiator mentality. To show weakness is antithetical.

"You don't ever want to show that chink in the armor, that you're somehow vulnerable," Bailey said.

Conversely, "I would say that we're no different than what exists in general society," said Adolpho Birch, the NFL vice president of player development. "People have a reticence to engaging in mental health therapy."

After helping Denver teammates and McKinley's family deal with the immediate issues, Birch said the league eventually will examine the situation in hopes of finding out what else could have been done. Over the past decade, the league has tried to change the perception of counseling. Having counselors around teams regularly was one step the league took so that players would be more comfortable with them.

"You want counselors to get to know players in a friendly way, not just as someone who is around when things are going bad," Birch said.

Even then, recognizing problems is difficult.

Underwood had an abbreviated tenure with the Vikings.

In 1999, Underwood was a first-round pick by the Minnesota Vikings who went AWOL during training camp. He was cut and later claimed on waivers by Miami. During the Dolphins' bye week in September 1999, Underwood tried to kill himself, putting a knife to his throat. Less than 18 months later, after being released by the Dolphins and signed by the Dallas Cowboys, Underwood again attempted to take his own life by walking in front of oncoming traffic on a busy South Florida roadway.

Underwood was tormented by visions of the apocalypse. He used to write notes discussing the end of the world on pieces of paper the size of postage stamps. When he was in a normal state, he could be engaging in conversation. He was funny and intelligent. He also exuded physical confidence and had extraordinary talent.

"You're talking about people who are told that they can overcome anything, do anything, if they work at it," said Pittman, whose partner, Craig Domann, represented Underwood. "It's not just in athletes. You see the same thing in lots of people: doctors, lawyers, bankers. Athletes think they're stronger than anyone else. Doctors think they're smarter."

Moreover, even suggesting that someone get help is difficult.

"I know there were guys I played with who needed help and I'm sure that, privately, the team pulled them aside and took care of them," Bailey said.

Williams said the problem runs deeper.

"It's hard for loved ones to say something because they're probably getting something from us and don't want to hurt that relationship. For teammates, it's hard to put a hand on somebody's shoulder and say, 'Hey, I think you need help,' " he said.

Even if the help is there.

"All the player would have to do is pick up a phone and call the number on the card the [union] gives out and say, 'I don't know, but something ain't right' and he'd get plenty of help," Pittman said. "But that means he'd have to admit to himself, 'You mean I'm not tough enough to handle this?' "

Many outside observers like to think players' financial compensation makes up for all the pressures they endure. Sometimes, however, a lot of money for someone in their 20s has just the opposite effect. It adds to already enormous pressure.

Williams' journey of self-discovery and help has included suspensions for violating the league's substance abuse policy.

"I think when I really understood it is when I was talking to one of my players and we talked about how this is probably the only profession where you walk into the building and you say hi to somebody who, once they walk away and go to their office, is going to look at film trying to find somebody who is better than you," Pittman said. "Teams spend millions of dollars every year looking for somebody who is better than you. Could you imagine going to work like that every day, thinking that somebody you worked with was doing nothing but trying to replace you?"

That's to say nothing of the usual pressures that go with life, such as the player Pittman represents whom he has had trouble keeping track of lately.

Pittman won't identify the player, but describes him as one of the many fringe players who get churned around the league. Aside from the tension of keeping a job that could be lost simply with a missed tackle on a punt return, the player recently had a child with a girlfriend who has proved to be flighty.

The pressure proved to be too much for the player, who asked for his release in the offseason. Pittman didn't find out about it until he called the team. The player didn't return calls for weeks.

"He's dealing with a lot. He thought that the best way to raise his child was to be an NFL player and then he discovered it was too hard to do that, to try to hang onto that dream," said Pittman, a touch of concern evident in his voice.

There's a reason for that. Just as before, Pittman hasn't heard from the player in a while.

And that's cause for stress.