Adults who have been concussed are at an increased risk of suicide, a recently released study in Canada has found.
The study, which had a focus on military personnel as suicide is a leading cause of death in that community, identified more than 235,000 patients diagnosed in Ontario from 1992 to 2012. Some 667 suicides occurred, the equivalent to 31 deaths per 100,000 - or three times the population norm.
The study, authored by doctors Michael Fralick, Deva Thiruchelvam and Donald Redelmeier, concluded: "Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented."
The authors acknowledged that "mild" concussions in adults posed an "uncertain" risk, severe head trauma resulting in admission to hospital "has also been associated with an increased risk of suicide".
The findings showed that no particular demographic was affected worse than others and that half had visited a physician in the last week of their life.
While not targeting sports per se, the study referenced an article co-authored by New Zealander Steve Marshall.
"[The article]provides a follow up of 1044 retired NFL players after a median interval of nine yearsand observes a nine-fold increase in subsequent depression for those with multiple concussions," Redelmeier told the Herald via email
The findings could alter the way sporting bodies view head injuries, particularly those in contact sports whose athletes are more frequently exposed to them.
At its essence, follow-up care around concussion has focused on ensuring an athlete has recovered from the symptoms of concussion before playing again. The long-term implications are rarely factored in until a player suffers several head injuries and is struggling to shake concussive symptoms such as headaches, loss of balance and poor sleeping patterns.
The more evidence of the long-term dangers of concussion, including cognitive disorders and suicide, then the more onus will be placed on the sports to provide appropriate and in some cases long-term follow-up care.
The NFL has been hit by a rash of suicides recently, many linked to chronic traumatic encephalothopy, a dementia-type brain disease that is the focus of the recent movie Concussion.
Dave Duerson (2011) and Junior Seau (2012), both Pro Bowl defenders and legendary tough men, shot themselves in the chest so their brains, on request, could be evaluated. Both came back positive for CTE.
Most shockingly, Kansas City Chief linebacker Jovan Belcher in 2012 shot his girlfriend Kasandra Perkins and them drove himself to the Chiefs training facility where he shot himself in front of coaches and staff. His body was later exhumed and he was discovered to have been also suffering from CTE.
In 2012 also Ray Easterling, an Atlanta Falcon in the 1970s who was suffering from dementia, killed himself.
Last year, Adrian Robinson, just 25, hanged himself. His family later announced that a posthumous diagnosis of CTE.
Rugby has not been untouched by this type of tragedy either.
Taranaki and Waikato rugby player Ryan Wheeler committed suicide in Sydney aged just 27 in 2000.
His family and friends believe Wheeler was depressed following a horrific head injury in a Ranfurly Shield match against Otago the year before, when he was accidentally kneed in the side of the head and had to be stretchered from the field.
His life had become a series of migraine headaches and he had difficulty concentrating.
Where to get help:
• Lifeline: 0800 543 354 (available 24/7)
• Suicide Crisis Helpline: 0508 828 865 (0508 TAUTOKO) (available 24/7)
• Youth services: (06) 3555 906
• Youthline: 0800 376 633
• Kidsline: 0800 543 754 (available 24/7)
• Whatsup: 0800 942 8787 (1pm to 11pm)
• The Word
• Depression helpline: 0800 111 757 (available 24/7)
• Rainbow Youth: (09) 376 4155
• CASPER Suicide Prevention
If it is an emergency and you feel like you or someone else is at risk, call 111.