The Disturbing Link Between Brain Trauma and Suicides

(TFC) – Like a lot of important reckonings, the one happening in the world of high-impact sports feels overdue. The incredibly high likelihood of concussions and other brain traumas in football and other sports has become a political and social flashpoint.

Unfortunately, athletes are far from the only members of the public who stand to experience brain trauma — nor the only ones to fall victim to its several possible outcomes, one of which is suicide. Even among the public, the link between injuries to the brain and death by suicide is becoming clearer and clearer.

What Science Understands About This Link

Even if scientists have long suspected a link between brain injuries — including concussions — and suicidal thoughts and actions, formal research on the subject is relatively new territory. That’s what makes a major Canadian research study that tracked the progress of “ordinary people” over a span of decades so important. Although studying athletes is instructive and revealing, the researchers felt it was essential to apply this line of inquiry to the general population.

The results were breathtaking. Using health insurance databases and hospitalization records for more than 230,000 people, the researchers looked for a correlation between patients who had had concussions and people who later took their own lives. What they found was a rate of 31 deaths per 100,000 patients, which is three times higher than in the general population. Moreover, concussions sustained on the weekend raised an individual’s risk of suicide by four times the rate observed in the general populace.

“The magnitude of the increased risk surprised me,” said Donald Redelmeier, physician and leader of the research team. “I always had my doubts about whether individuals fully recover from concussions, but I never thought I’d find a three-fold increase in risk.”

High-Profile Cases Spark Interest and Action

In one particularly startling case, after a 21-year-old quarterback for Washington State University took his own life, brain scans revealed the young man had the brain health of somebody three times his age — a 65-year-old man. The culprit in this tragedy, according to Tyler Hilinski’s parents and the doctors they conferred with, is something called chronic traumatic encephalopathy (CTE), a well-recognized and highly degenerative brain disease. It’s also typical of athletes far older than Hilinski.

This story, and the countless others like it, are typical — insofar as something only recently studied in earnest can be called “typical” — of suicides linked to brain trauma. Tyler Hilinski had no history of depression and didn’t display any of the typical red flags associated with suicidal thought. In every respect, this was a sudden and entirely unexpected turn of events.

And as we’ve seen, the trend has captured the attention of nations and governments. Jeff Miller, VP for health and safety with the NFL, admitted before a Congressional hearing that the football industry in America is aware of the connection between football and CTE, citing the suicide death of Junior Seau, a Hall of Fame footballer who took his own life.

A Wisconsin football organization also recently settled a lawsuit after Joseph Chernach, who’d been playing football regularly since the age of 11, killed himself by hanging in 2012. An autopsy revealed signs of CTE.

In response to stories like these, some parents are keeping their students from taking part in organized sports until more is known about this link. Others have pursued a less extreme middle-ground, such as the parents of a Garfield High School footballer, who bought their son Sam a $1500 helmet that claimed better protection against impacts in full-contact sports. Naturally, the prohibitively high price tag puts this type of equipment out of reach of the average household and the average public school district.

Concussion, Correlation and Causation

Redelmeier and the rest of his research team are confident the results of their Canadian study are representative of the population of the United States, given the numerous similarities between the two nations and the cohorts being studied.

But while the picture that’s coming together looks convincing and underscores just how crucial further study and sustained public interest have both become, the actual brain mechanics at work here are not very well understood.

This study is instructive as far as the type and scope of the problem and provides additional insight into a long-recognized correlation between injured brain anatomy and impulse control, including suicidal thoughts and attempts. It has also increased in instances where neuropsychologists and other health professionals are called upon to give expert testimony about CTE or traumatic brain injury (TBI) cases and the resulting liability — even if the physiological underpinnings of the phenomenon so far elude thorough understanding.

Between the medical community and the public, this issue clearly has traction and interest. But beyond “being informed,” how can the public respond?

Prevention is key, say researchers. Whether that’s improving safety equipment or taking part in a less physically intensive sport, it’s clear there are options for athletes young and old who want to give sporting their all without significantly increasing their risk of brain injury and self-harm.

But wherever and whenever prevention fails or isn’t realistic, athletes, parents and medical examiners all bear a share of the burden for making sure the correct treatments and prevention are observed. Redelmeier admits he was surprised when he found out that about half the people whose records he studied had contact with healthcare professionals within the last week of their life — without any red flags about their condition or the likelihood of its escalating into an actual attempted suicide.

In conclusion, Redelmeier offered this: “Look after your brain. People just don’t take concussions seriously.”

He was keen to remind the public that seeking treatment for concussions, taking the appropriate amount of downtime and, in general, keeping concussions top-of-mind in our medical histories can all significantly reduce the risk of brain trauma becoming something even worse.