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      Chronic traumatic encephalopathy, suicides and parasuicides in professional American athletes: the role of the forensic pathologist.

      The American Journal of Forensic Medicine and Pathology
      Adult, Brain, pathology, Brain Injury, Chronic, diagnosis, Football, Forensic Pathology, Humans, Immunohistochemistry, Middle Aged, Neurofibrillary Tangles, metabolism, Neuropil Threads, Plaque, Amyloid, Self-Injurious Behavior, Suicide, United States, Wrestling, tau Proteins

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          Abstract

          We present 5 cases of professional American contact sport athletes who committed parasuicides and suicides aged 50, 45, 44, 36, and 40 years old. Full forensic autopsies and immunohistochemical analyses of the brains revealed chronic traumatic encephalopathy (CTE). The brains appeared grossly normal at autopsy without gross evidence of remote traumatic injuries or neurodegenerative disease. Brain immunohistochemical analyses revealed widespread cerebral taupathy in the form of neurofibrillary tangles and neuritic threads without neuritic amyloid plaques. CTE refers to chronic cognitive and neuropsychiatric symptoms of chronic neurodegeneration following a single episode of severe traumatic brain injury or repeated episodes of mild traumatic brain injury. CTE can only be definitively diagnosed by direct tissue examination. Without full autopsies and immunohistochemical brain analyses these cases would never have been identified. Forensic pathologists will play a vital and central role in the emerging disease surveillance of CTE in professional American athletes, in the identification of CTE cases, and in the establishment of the epidemiology of CTE, with the goal of eventually developing preventive and interventional therapeutic protocols for CTE outcomes.

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          Recurrent concussion and risk of depression in retired professional football players.

          The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) yr and an average professional football-playing career of 6.6 (+/-3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (chi2=71.21, df=2, P<0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.
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            Identification of suicide risk factors using epidemiologic studies.

            Suicide is a complex outcome of multiple, inter-related factors. This article presents the epidemiology of completed and attempted suicide and discusses the known risk factors for suicide within a framework designed to encourage a systematic approach to theory testing and prevention. Mental and addictive disorders, frequently in co-occurrence, are the most powerful risk factors for suicide in all age groups, accounting for over 90 percent of all completed suicides. In combination with proximal risk factors such as access to firearms or other lethal means, recent and severe stressful life events, and intoxication, they can form the necessary and sufficient conditions for suicide.
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              A review of the literature on the epidemiology of parasuicide in the general population.

              The author reviewed recent literature on the epidemiology of parasuicide in the general population. Major risk factors are also discussed. Parasuicide was defined as suicide attempts and deliberate self-harm inflicted with no intent to die. Articles in English on rates of parasuicide in the general population from 1970 through June 2000 were identified by keyword searches of the PsycINFO and MEDLINE databases. Studies that provided data from a representative population sample and provided incidence or prevalence rates were included in the review. Articles focusing on subsamples such as adolescents or psychiatric patients were excluded. Twenty studies were analyzed. Although methodological problems constitute a major limitation in interpretation of the results, the literature indicates that parasuicide is a serious public health problem. Reported annual rates of parasuicide in recent decades range from 2.6 to 1,100 per 100,000, and lifetime prevalence rates range from 720 to 5,930 per 100,000. The most important risk factors identified were younger age and female gender. Others included being single or divorced, being unemployed, having a recent change in living situation, having a mental disorder, and having a previous parasuicide incident.
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