Concussions, More Than Meets the Eye: NATA Study Finds Increasing Risk of Suicide Ideation With Second Concussion

By Mark Mendeszoon, DPM

In 2007, one study estimated there were 300,000 sports-related traumatic brain injuries in high school and collegiate athletes. Sports brain injuries and concussions were second only to motor vehicle accidents amongst people aged 15-24.¹ Fast forward to a 2018 study using data from the Youth Risk Behaviors Survey where 15.1% of students (~2.5 million) reported having at least 1 concussion during the prior 12 months, and 6.0% reported 2 or more concussions.² Are there really that many more concussions, or is it increased awareness of symptoms, greater fear of now-known consequences, or better reporting mechanisms? It’s probably a little bit of each, but it’s all important because we’re learning that the term “mild” when placed in front of Traumatic Brain Injury may be a misnomer.

While recent studies have shown a direct correlation between concussions and depression and even suicide in teenagers, a new study from the National Athletic Trainers’ Association has been able to shine a light on the seriousness of the correlation: the November 2023 study³ shows students who reported 2 or more concussions in 1 year were at 2-fold greater odds of reporting suicide attempts when compared to students reporting a single concussive event in that timeframe. (See Story on page 15).

As we enter 2024, high school athletes have become bigger, stronger, and faster with better nutrition, strength programs, diet supplements, early sports specialization, and the pressure to succeed. Most high school student-athletes believe that they will compete at the NCAA level, but the reality is that only 7% of high school athletes compete in college, and only 2% receive athletic scholarships.

Unlike sprains, strains, and fractures that are physically obvious, concussions do not present so readily. The field medical personnel and athletic trainers are responsible for initially recognizing the signs and symptoms of a concussion, which can include balance and gait dysfunction. The medical team covering sports is well versed and trained in recognizing, evaluating, testing, and initially treating those athletes who sustain a head injury. As healthcare providers, we must protect the student-athlete from any injury, including concussions, and then get them to the proper sports medicine specialist or a neurologist for evaluation and treatment.

As a team physician for the last 28 years, I have a stringent policy for not returning athletes to competition after a noted head injury. Despite the pleas of the athlete and pressures from the coaching staff and parents to get their child back into the game, it is ultimately the doctor’s (my) responsibility to prevent long-term complications, which can lead to mental status changes, depression, and yes, even suicidal tendencies and suicide. There have been several episodes in the heat of the moment where I have been cursed at, pushed, and even spat on for refusing to allow the athlete to return.

Concussion protocol has been rigorous over the last few decades, especially in young athletes. Classes, webinars, and education have increased tremendously for medical professionals and the coaching staff. Early recognition is a key to preventing long-term consequences for an individual with a concussion. As soon as a head injury is visualized, that athlete immediately goes through the initial concussion protocol. Then, depending on the severity of the head injury, the athlete is sent to a sports medicine specialist or neurologist who does further testing and evaluation of the athlete. After passing physical and mental acuity testing the athlete is slowly allowed to get back to activities. Today’s concussion protocols have been established to determine the safe return of an athlete back to sports.

It is important to note that concussions also occur in sports that are not considered contact, such as soccer, field hockey, and running. Thus, coaches, athletic trainers, medical personnel, and parents/guardians need to recognize the early warning signs of concussions. The long-term sequella of concussions has been directly linked to chronic traumatic encephalopathy (CTE).

From countless news outlets we’ve seen the stories of former big name football players who have suffered with CTE. Athletes who have suffered from CTE typically struggle mentally for years, becoming a shell of their former selves and battle depression, irrational thoughts and actions, alcohol and drug abuse, suicidal tendencies, and even death. This latest NATA study shows us how early the damage can begin and why our job is so critical on the field—and anywhere we treat young athletes. Those potential outcomes are not worth getting the game-winning shot, homerun, or touchdown in high school.

Mark Mendeszoon, DPM, is a senior partner at Precision Orthopaedic Specialties Inc. located in Chardon, OH. He is the Fellowship Director at University Hospitals Advanced Foot & Ankle Center as well as Assistant Professor at Iowa State University, Kent State University, Miami University, and Ohio University. He also serves as President of the Great Lakes Region of the American College of Foot & Ankle Surgeons and is the owner of the Achilles Running Shop in Willoughby, Ohio and Erie, Pennsylvania.