By now most of us in the higher-education community have heard of Kosta Karageorge, the Ohio State University wrestler and football player who apparently committed suicide last month. We read about his text messages to his mom saying he was sorry if he was an embarrassment, but concussions had messed up his head. We watched as his picture was prominently displayed at an Ohio State football game, asking for information on his whereabouts. We waited for his return, with the hope that he would be safe. We were saddened when his body was found in a dumpster, with an apparent self-inflicted gunshot wound to the head.
We listened to stories of how friendly, exuberant, and full of life he had been. And we felt helpless. We wanted to know what could be done to prevent something like this from happening again.
Concussions have been linked to changes in mood and behavior, including an increased risk of depression. But we just don’t have enough information to know whether they contributed to Karageorge’s apparent suicide. Despite that lack of clarity, his situation and the resulting helplessness have reinvigorated the discussion around concussions management on college campuses—and that, at least, is a good thing.
Here is what we do know: In 2010, the NCAA required colleges and universities to have concussion-management plans with four key provisions:
1. Athletes must be educated annually about concussions and must acknowledge their role in reporting concussion symptoms.
2. Athletes who exhibit signs or symptoms of concussion must be removed from play and evaluated.
3. Athletes diagnosed with a concussion must not resume participation for at least the rest of the calendar day.
4. Prior to resuming participation, athletes must receive clearance from a medical doctor or the doctor’s designee.
The rules are supposed to be binding for all NCAA member institutions. More recently, the NCAA has released a set of best-practice guidelines.
This fall, my colleagues and I published in the American Journal of Sports Medicine the first examination of institutional concussion-management policies at NCAA institutions. We found that although the vast majority of colleges reported having concussion-management plans, a handful of them indicated they had no plan in place. Among those that did have them, the presence of specific components, such as athlete concussion education, lagged behind the presence of the concussion-management plan itself.
Furthermore, study participants suggested a variety of ways in which concussion management could be improved on their campuses, most notably the need for better coach and athlete concussion education and increased staffing in the sports-medicine department. Almost all participants in the study thought that their colleges’ concussion-management strategies did a good job of protecting athletes, but the majority of those who were concerned that their plans weren’t working well were coaches of contact sports at Division I schools.
Over all, we found that concussion-management practices at NCAA colleges have come a long way but that there is still plenty of room for improvement. Recent incidents—like the letter written by members of the Columbia University football team to the administration accusing the then-head coach of dismissing athletes’ concussion symptoms—reinforce that conclusion, particularly as it applies to football teams.
Beyond concussions, Kosta Karageorge’s story also raises important questions about the availability and accessibility of mental-health services on college campuses. The NCAA has taken some strong steps to respond to mental-health issues, and Brian Hainline, the NCAA’s chief medical officer, has said athlete mental health is a top priority. Recently, the NCAA released Mind, Body, Sport, a compilation of articles on the mental-health challenges faced by athletes, including: anxiety and depression, suicidal thoughts, post-concussion syndrome, and the effects of injuries on mental health. The athletics environment can play an important role in athletes’ mental health and their appropriate use of mental-health services.
For example, while physical activity can help improve mood, the amount of time spent on sports activities and the pressure to perform can induce stress in athletes. Confronting this and other issues specific to athletes will be crucial to improving mental health among these students. But that improvement may pose particular challenges in a collegiate athletic culture where “toughing it out” and “playing through pain” are so ingrained.
I hope Kosta Karageorge’s story increases awareness of the need for a productive conversation between the NCAA and its member institutions about the importance of concussion management and mental-health services. In fact, having a plan and offering services are good initial steps, but ensuring that they are well established and appropriately used is equally crucial. It is clear that we still have a lot of improving to do if we exist in a world where an athlete feels like suicide is his best answer.
It is also clear that this will take a group effort. Scientists must continue to work toward a better understanding of concussions and their short- and long-term mental-health implications. Sports teams and coaches must embrace a culture in which injured and ill athletes know that it is important to seek medical care. And the NCAA as well as colleges and universities must work together toward productive structural solutions to improve athlete health and well-being. Kosta Karageorge’s death leaves me with this: Loving a sport isn’t enough to save its athletes; we have to do more.
