“The greatest strength you will ever develop is the ability to recognize your own weaknesses, and to learn to ask for help when you need it.” Olympic cyclist Kelly Catlin wrote this in a column for VeloNews in late February. Less than two weeks after the column was published, Kelly took her own life. Kelly’s death shocked the cycling and athletic communities. The silver medal winner was known for her focused demeanor and hard-working spirit. On top of her athletic commitments, she was a determined student at Stanford striving towards a career in Silicon Valley. When hearing about tragic stories like Kelly’s, of driven champions identified by the strength and ferocity they display on the competitive field, it can be easy to point to mental illness as the primary factor behind their death. This person was apparently so strong on the outside, it could have only been some type of long-standing, undiagnosed health condition affecting their brain that caused them to take their own life. But Kelly Catlin’s death has shed necessary light on how concussions and traumatic brain injuries can play a factor in suicide.

Understanding the impact of concussions

Even though the public is more aware of the larger health implications of concussions, there is still a lingering misconception that concussions are injuries that are most commonly sustained by individuals that play contact sports including football, soccer and hockey. However, in reality, anyone can suffer a concussion without even knowing it.

The Centers for Disease Control and Prevention define a concussion as “a type of traumatic brain injury—or TBI—caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth.” A running back whose head collides with that of a defensive lineman can suffer a concussion. A pedestrian who is strolling down the sidewalk while texting on their phone and is bumped in the head by an opening door can experience a concussion. A driver who suffers whiplash after being rear-ended can face the effects of a concussion, just because the collision caused their brain to move back and forth rapidly inside their skull. Because people don’t often realize they have suffered a concussion, they are not aware of or concerned with the negative health impacts that come with such traumatic brain injuries. In the days or weeks following the event, they may not be able to remember things as clearly, have trouble maintaining balance, and show difficulties communicating and conveying emotion, all without knowing that a concussion or multiple concussions may have played a role. This lack of awareness of what constitutes a concussion is alarming, considering a single traumatic brain injury can cause mental health afflictions often shared by individuals at risk for suicide. Repeated concussions can cause chronic traumatic encephalopathy, known as CTE, and experts have suggested a link between the presence of CTE and depression, which in some cases has resulted in suicide. And if there is enough damage caused to the brain, concussions can result in death entirely on their own.

A person could suffer a concussion in their day-to-day life and not recognize or experience symptoms until further down the road. Knowing the potential hazards of a concussion can motivate a person to seek treatment and avoid future harm to their health, even if they feel fine or show no symptoms immediately following their injury.

Suicide can be caused by both mental illness and brain trauma

Shortly after Kelly’s death, Dr. Mark Catlin, a pathologist and the father of the late Olympic cyclist, wrote that a concussion that his daughter suffered in early January was a factor in her suicide, but not the only factor. In a memo published in Bicycling magazine, Dr. Catlin stated that “Kelly’s death was a combination of:

1) Kelly’s personality

2) Overtraining + additional stresses

3) Concussion

4) Additional hypoxic brain and cardiac damage from the first suicide attempt.”

A mental health disorder, like depression or anxiety, can manifest as a result of a concussion. Similarly, the symptoms of a pre-existing mental illness, like mood swings associated with bipolar disorder, can be exacerbated after a person suffers a traumatic brain injury. Studies have shown that traumatic brain injuries can have an independent impact on suicide risk outside of other mental health conditions and that experiencing a concussion and/or a mild TBI was associated with higher suicide risk overall. For Kelly, there are multiple ways her January concussion could have factored into her suicide. The concussion could have amplified the additional stresses she had been under, contributed to an earlier suicide attempt and the hypoxic brain and cardiac damage sustained from it, and exacerbated any other illness that she may not have known about. Mental illness or concussions cannot be treated as the determining factor of suicide. Both can work both independently of, and in conjunction with, other health factors that may have impacted a person taking their own life.

What can be done to help

A person can only be diagnosed with CTE after they have died, although new technologies are being developed. This makes it difficult to evaluate just how much damage a single concussion or series of traumatic brain injuries has had on a person and if they have a higher risk of suicide because of undiagnosed CTE. But there are still ways in which doctors and researchers can evaluate concussion damage and work to improve lives. Through neurofeedback, and 19 Channel electroencephalogram (EEG), practitioners can evaluate something called “connectivity,” where they see just how well one part of the brain is communicating with another. In addition, these tests can help show if a brain is firing neurons too quickly or not fast enough, and use all this information to determine what specific part of the brain has been damaged.

For example, compared to a normal database there is Amplitude Asymmetry where Alpha, Theta, and Delta brain waves are commonly located more in the back of the head. If a board certified technician performing an EEG were to notice those waves at the front of someone’s brain, they could tell something was dysregulated. They know what types of symptoms may affect what parts of the brain and an EEG can shed insight into whether or how much a concussion caused or affected a certain mental affliction.Neurofeedback/EEG biofeedback is non-invasive, but it is also something that can only be done after at least one month or more after the person has suffered a traumatic brain injury. Until then, individuals who have experienced concussions can still meet with health officials like physicians and nutritionists to work on improving the brain and avoiding more harmful afflictions in the future. Additionally, it is important to understand that individuals who have suffered concussions, especially those who have as competitive athletes, may experience suicidal ideation. Suicide is not normal, but the ideation itself can be a natural effect of a concussion or traumatic brain injury and a sign that further help is necessary. There are treatments available to help concussion victims, but the most important step they can take is seeking treatment in the first place. Concussions are not incidents that are limited to athletes like Kelly Catlin, and the damage caused by them can be long-lasting and potentially fatal. It is important that any person who suffers a concussion, no matter how small it or harmless it may initially seem, seek medical attention to ensure any current or future damage caused to the brain is addressed.

Lori Russell-Chapin, a professor of counseling at Bradley University’s Online Masters of Counseling program and an expert on neurofeedback and brain-based counseling methods.