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A football practice in 2012 at Toronto’s St. Michael’s College School, which performs baseline concussion tests on all athletes. New research presented at 2013’s Heads Up Conference has drawn a link between sports concussions and substance abuse and suicidal thoughts.

Fred Lum/The Globe and Mail

Concussions are connected with substance abuse and suicidal thoughts in adolescents, new research presented at a St. Michael's Hospital conference on sports-related brain injuries revealed Saturday.

The hospital's third annual concussion conference, now called the Heads Up Conference, explored the relatively new terrain of connecting mental health issues with concussions, which commonly occur from playing sports such as hockey, soccer and baseball.

Dr. Robert Mann from the Centre for Addiction and Mental Health presented his findings, collected from the 2011 Ontario Student Drug Use and Health Survey, at the hospital's Li Ka Shing Knowledge Institute, explaining that students in grades 7-12 who had suffered at least one concussion in their lifetime were two to four times more likely to use alcohol, cannabis, ecstasy, cocaine, methamphetamine, or to binge drink. They were also two to three times more likely to be identified with an alcohol, cannabis or drug problem than students who had not had a concussion.

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But Dr. Mann warned that the study could not conclude a cause-and-effect relationship. It remains unclear whether concussions led to a greater risk of substance abuse or if those who used drugs or alcohol were more likely to suffer concussions.

"We don't really understand the pathways involved," he said.

More than 9,000 students were surveyed and about 20 per cent reported suffering a concussion at least once in their lifetime. About 60 per cent of concussions in boys were sports-related, and just under 50 per cent for girls.

Dr. Gabriela Ilie, a psychologist for St. Michael's, also used the 2011 survey to conclude that students with prior concussions were two times more likely than other students to experience psychiatric distress, such as anxiety or depression. They were three times more likely to attempt suicide and two to three times more likely to commit crimes such as arson, theft or assault with a weapon. They were also twice as likely to be bullied.

Again, she stressed that though the connection between concussions and depression and anti-social behaviour was clear, "We do not know which comes first. That's something we need to disentangle."

The survey also found that students with prior concussions received lower grades in school.

The findings are not surprising to former American Hockey League player Max Taylor, who started seeing a psychiatrist after suffering four concussions in two years.

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"I didn't realize how serious it was until I started having suicidal thoughts," he told the audience.

Taylor suffered two concussions during a playoff game in 2008 and then another two in 2009 after being cleared to play each time.

It's important to emphasize the link between concussions and mental health or delinquency, Dr. Ilie said, because many parents of youth who play sports tend to forget about the concussion since it isn't a clearly visible injury.

"There is no cast, most of the time," she said. "When psychological symptoms come up, we don't make the association."

Dr. Ilie said one gap with the research is that the sample includes youth only in public or Catholic schools. It did not consider teenagers in institutions where delinquent youth are often sent, such as correctional facilities.

NHL player Derek Boogaard died in 2011 after he accidentally overdosed on prescription painkillers and alcohol. Boston University researchers analyzed his brain and found evidence of early stages of Chronic Traumatic Encephalopathy (CTE), a neurodegenerative disease linked to repeated brain trauma. Bob Probert, who died of a heart attack in 2010, is another former NHL player who struggled with drugs and alcohol. He also suffered from CTE.

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