Link between sports-related head injuries, brain disease sought

As soon as David Hovda, director of UCLA’s Brain Injury Research Center, heard about Junior Seau’s suicide on May 2, he knew the phone calls from the media would start pouring in.

Everyone was looking for answers as to why Seau, a former 10-time All-Pro linebacker known for his passionate and relentless playing style, would kill himself.

“When I got the news about Junior Seau, I was afraid that everybody was going to leap to the conclusion that it was because of the concussions,” Hovda said.

“It very well could be and that is what we study here. But it is more likely that it was a combination of things and that repeat concussions just added to it.”

The view that concussions aggravate already-existing factors contributing to depression is one that Hovda shares with Dr. Christopher Giza, an assistant professor of pediatric neurology and neurosurgery at the Brain Injury Research Center. Player suicides are clearly linked to depression, but their connection to head injury is much murkier.

Autopsies on the brains of several deceased NFL players in recent years have found that nearly all of the players studied suffered from chronic traumatic encephalopathy, a progressive degenerative brain disease that may lead to dementia or depression later in life.

The findings, along with the recent similar suicides of Seau, former Chicago Bears safety Dave Duerson and former Atlanta Falcons safety Ray Easterling, have lead to widespread speculation among many in the NFL community and the media that the numerous concussive and sub-concussive hits sustained by profession football players cause CTE and depression.

“I see what’s going on around the NFL with the head injuries. Junior Seau was a good friend of mine. I believe what transpired (May 2) with Junior can most likely be traced back to multiple head injuries,” said UCLA football coach and former NFL coach Jim Mora.

However, while there have been a series of case reports on professional athletes who suffered from CTE, no definitive link has been shown between the degenerative disease and depression.

Since CTE can only be diagnosed post-mortem, proving that any connection to depression exists or that the disease is common among football players has been difficult to do.

“There is clearly a bias because they all have to have died, and in general, they are fairly high-profile athletes with multiple exposures,” Giza said.

“The behavioral characterization is done after the fact. It does not mean there is not a relationship, but just a low bar for finding a relationship. They had to die under unusual circumstances to get in, and so there were likely some behavioral problems before hand.”

Although there is a very real possibility that numerous concussions may lead to CTE, a clearer common denominator between Seau, Duerson, Easterling and many other professional athletes who have committed suicide is depression.

A Sports Illustrated article published in May titled “Uncertain Connections” highlights a study by neuroscientist Kevin Guskiewicz, director of the University of North Carolina’s Center for the Study of Retired Athletes, which has surveyed more than 3,000 athletes since 2001.

Guskiewicz found that 14 percent of former NFL players between the ages of 35-44 suffered from depression compared, to 8 percent of all males in the same age group.

While concussions tend to get most of the attention and blame, there are a number of additional reasons why a former professional football player may be experiencing depression.

Personal issues, substance abuse, lingering pain from injuries, financial struggles and difficulties transitioning away from playing professionally can all take a toll on retired athletes.

The NFL Player Engagement program, which offers assistance and guidance to current and former players, includes a “Next” phase that specifically offers services to help professional athletes transition into retirement.

The league’s Player Development Program also offers boot camps in specific topics such as broadcasting or the business of music and keeps a directory of internships available to retiring NFL players.

While the NFL has extensive programs that offer financial assistance and job opportunities to former players, psychological and emotional counseling for outgoing players is less widely available.

“When an athlete retires from the NFL, he goes from being somebody that is very well paid in a very high-profile position to retirement. That can be a pretty big transition for some of the players, and there are a lot of life-changing experiences that go with that,” Hovda said.

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