For the Ohio State community, Thanksgiving weekend ended in tragedy when 22-year-old football player Kosta Karageorge was found dead of apparent suicide. Karageorge, who had been missing since Nov. 26, was found on Nov. 30 in a dumpster near the school's campus in Columbus, along with a gun and what police said appeared to be a self-inflicted gunshot wound.
According to the Washington Post, Karageorge's mother told police that her son had suffered from several concussions. The Columbus Dispatch reported that a few days before his body was found, Karageorge had texted his mother, saying, "I am sorry if I am an embarrassment but these concussions have my head all [messed] up.”
This week, an Ohio coroner ordered a special examination of Karageorge's brain to look for signs of traumatic brain injury.
The national conversation around traumatic brain injury in football -- concussions, but also chronic traumatic encephalopathy (CTE), a degenerative brain disease that has been linked to repeated head traumas -- is now expanding beyond retired and longtime NFL players to include student athletes.
Karageorge's death has not yet been linked to concussions. But some research has found that traumatic brain injury and suicide are connected -- at least among young people. Earlier this year, a Canadian study found that teenagers who had suffered traumatic brain injury at some point in their lives were three times more likely than the general teen population to attempt suicide.
Another recent study found that one season of high school football is enough to cause significant brain changes similar to those caused by mild traumatic brain injury, even in the player doesn't suffer an actual concussion.
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Infographic by Jan Diehm for The Huffington Post.
Concussions accounted for only about 9 percent of sports-related injuries in one survey of nine high school sports, the Centers for Disease Control reported, but the injuries are not insubstantial: In the 2008-2009 school year, American high school athletes suffered an estimated 400,000 concussions, according to Cleared to Play, a nonprofit that raises awareness of concussion prevention and treatment.
In the short term, concussions can cause symptoms including depression, nausea, insomnia, poor memory, dizziness, confusion, sensitivity to light and noise, and temporary loss of consciousness. These symptoms may not show up immediately, and can last for hours to months.
If an athlete emerges unscathed from years of play during school, effects from concussions can also show up years later. Research has found that decades after the injury, concussions can cause memory lapses and abnormal brain wave activity.
Research is still emerging on younger players, but according to Dr. Robert Cantu, a neurosurgeon at the Boston University School of Medicine, young athletes may be more vulnerable to the impacts of head trauma because their brains are still developing.
"Our intellect and our emotions that we were genetically given are being maximally formed during those [adolescent] years," Cantu told The Huffington Post. "You injure the brain during those years, and you can alter what may be the genetic endowment you were born with. You can alter your IQ. You can alter your ability to function intellectually. You can alter what your emotions are going to be. ... There are huge implications."
However, more data -- particularly longitudinal data -- is needed to get a clear picture of the long-term risks of head trauma for young athletes. The NCAA recently launched a three-year longitudinal study examining roughly 37,000 college athletes to gain more insight into concussion risk factors and treatment.
"The real answer is that we don't know. These are very difficult questions," said Dr. Stefan Duma, a professor of biomedical engineering and mechanics at Virginia Tech who has studied the effectiveness of helmets in reducing sports-related concussions in young people. "The basic question is: How much [impact] is too much?"
Findings on adult players are shedding light on the possible dangers professionals can face during the course of their careers. One study found that 40 percent of professional football players with unreported mild concussions still experienced brain damage -- including damage to the brain-blood barrier, which serves to protect the brain from harmful chemicals. This type of damage can lead to the deterioration of nerve cells in the brain, which can contribute to the development of degenerative disorders like Alzheimer’s and Parkinson's.
In September, the NFL said in federal court documents that nearly a third of retired players were likely to develop long-term cognitive problems. In the past few years, brain injuries have been brought up in connection with the deaths of several players.
After former San Diego Chargers player Paul Oliver committed suicide earlier this year at the age of 29, a lawsuit against the NFL claimed that Oliver's suicide was a "direct result" of suffering caused by repeated head trauma, and insisted that the league had misled players about the long-term consequences of concussions.
Famously, former Chicago Bears player Dave Duerson suffered at least 10 reported concussions during his career. Before taking his own life at the age of 50, Duerson left a note requesting that his brain be studied. Scientists found evidence of moderately advanced CTE, with "severe involvement of areas that control judgment, inhibition, impulse control, mood and memory," one neuropathologist said.
Experts say more research is still needed into the effects of concussions on adolescents -- in addition to efforts to increase awareness among athletes, parents, football coaches and medical professionals. Duma said that concussions must be prevented and managed on three levels: The rules laid out by organizations like Pop Warner and NCAA, the football coaches, and the equipment -- making sure that athletes are wearing the best possible helmets.
And in a culture of tough play, athletes may feel obligated to overcome these symptoms to get back on the field: More than 15 percent of football players who experience a concussion severe enough to cause a loss of consciousness return to play that same day, according to Cleared to Play.
"Coaches should be aware that their attitudes and behavior towards concussed athletes may encourage players to conceal symptoms," J. Scott Delaney, a sports medicine specialist and research director in the Department of Emergency Medicine at the McGill University Health Centre, said in a release about his recent research on concussions.
"Our study found that some athletes did not reveal symptoms because they were afraid it would affect their standing with the team," he said.
Duma said current research and awareness is moving in a positive direction.
"We're asking the right questions," said Duma. "If you look at what the NFL and Pop Warner are doing in terms of rule changes, we're moving in the right direction. The concern and heightened awareness will go a long way in making these sports safer -- and there is a risk of head injury in every sport."