Former Chicago Bears defensive back Dave Duerson. Former Atlanta Falcons safety Ray Easterling. Former San Diego Chargers linebacker Junior Seau. These are just a few of the former NFL players who have taken their own lives. All three were found to have signs of chronic traumatic encephalopathy (CTE), a degenerative condition largely believed to result from repetitive blows to the head.
These are tragic examples of the long-term effects of brain injuries in sports. Are high school or middle school athletes without those long playing careers at risk for suicide and other mental health problems as well?
We have long feared that concussions and other traumatic brain injuries (TBI) could be more damaging for adolescents since their brains are still developing. A younger patient with a traumatic brain injury could be more likely to suffer repeat injuries and risk persistent headaches, memory loss and more.
A study published this month in the scientific journal Plos One suggests that parents have reason for concern about their children’s mental health after traumatic brain injuries.
Adolescents with TBI and mental health
Researchers surveyed close to 5000 7th through 12th grade students in Ontario, Canada. They asked each adolescent about his or her history of suffering a brain injury as well as a variety of questions designed to assess mental and emotional health. While the authors asked about all brain injuries and not just those occurring in sports, parents of young athletes should pay attention. Sports are thought to be a leading cause of TBI among adolescents in the United States.
19.5% of those adolescents reported suffering at least one TBI that caused either loss of consciousness for at least five minutes or required overnight hospital admission.
More worrisome were the relationships between those brain injuries and mental health and behavior. Students with prior TBIs were more likely to admit psychological distress, seek help from a crisis helpline or website, and take medications for anxiety or depression than those who had not suffered a brain injury.
The injured students were more likely to be bullied or cyber-bullied at school. They had greater chance of being threatened with a weapon than kids with no prior brain injury. Likewise, adolescents with a prior brain injury were far more likely to bully other students.
Most shocking, though, were the results when youngsters were asked about suicide. The odds of a student contemplating suicide were 1.68 times greater than non-TBI students. The odds of students attempting suicide were 2.89 times greater among athletes with a traumatic brain injury.
It has been estimated that somewhere between 1.6 to 3.8 million sport-related concussions occur in young athletes each year in the United States. Not all of them involve loss of consciousness or require admission to a hospital, but they are all still dangerous injuries.
Parents should look for signs of trouble
Much of the attention given to concussions has focused on return to play. We preach education of the signs and symptoms of these injuries, such as headaches, dizziness, nausea, vomiting and sensitivity to light. Athletes with any of these symptoms should be held out of sports until they have fully resolved.
Parents should look for emotional and behavioral problems in their children in the weeks and months after head injuries as well. Maybe their normally outgoing daughter has become withdrawn and quiet after a concussion in soccer. Maybe their high school son seems angrier and lashes out more often after a concussion in football. And parents should ask coaches and teachers if they have noticed these types of changes in their kids.
Just as the physical symptoms of a concussion should indicate that parents seek medical attention for their son or daughter, these mental health questions should as well. Consider taking the young athlete to a counselor or even a psychiatrist. If you have access to a neurologist familiar with concussions in sports, take the child for an exam. Or at the very least, take your child to his regular pediatrician or family doctor.
Early recognition and treatment just might prevent a tragic outcome after a brain injury in sports.
Note: A modified version of this post appears as my sports medicine column in the May 1, 2014 issue of The Post and Courier.
Ilie G, Mann RE, Boak A, Adlaf EM, Hamilton H, Asbridge M, Rehm J, Cusimano MD. Suicidality, Bullying and Other Conduct and Mental Health Correlates of Traumatic Brain Injury in Adolescents. PLOS ONE. April 2014. Volume 9, Issue 4.