Ed Zurga / AP file

Kansas City Chiefs inside linebacker Jovan Belcher, shown in a September game, two months before the 25-year-old killed his girlfriend and committed suicide.

Four months after the NFL sought to curb domestic violence in its ranks by launching a crisis hotline, a bolstered mental-health program and fresh encouragement for troubled players to seek help, that fortified safety net could not prevent the murder-suicide Saturday involving Jovan Belcher. The Kansas City Chiefs linebacker, 25, shot his girlfriend Kasandra Perkins, 22, at their home, then drove to Arrowhead Stadium and killed himself in front of two coaches and the team's general manager.

After the high-profile suicide of retired NFL superstar Junior Seau, 43, last May — two years after Seau drove his car off a cliff following his assault on a girlfriend — NFL commissioner Roger Goodell installed the 24-hour hotline for players and a reinforced mental-health initiative on July 26. That same week, following a spate of NFL-related domestic attacks — at least six other family violence cases in the NFL have been reported since 2010 — Goodell met with the player’s union to discuss possible solutions. 

Yet even as the league was taking steps to help mentally troubled players and their families, the Kansas City Chiefs were aware of Belcher's problems, Kansas City police spokeswoman Sgt. Marisa Barnes told NBC News.

And Police Sgt. Richard Sharp told the Kansas City Star that team officials "were bending over backwards" to help the couple.

The Belcher murder-suicide is the type of nightmarish incident the league has been working harder to prevent, said Robert Gulliver, the NFL’s executive vice president of human resources/chief diversity officer. 

“One of the biggest things that we are trying to do here (in the NFL) is to change the culture, where people realize that it’s OK to seek out help for mental health issues,” Gulliver told NBC News. “We were very deliberate in ... making the point that mental health is part of total wellness, that it’s OK to seek out help for mental health issues because that’s part of your overall well-being."

In addition to help from the team's counselors, Belcher and his girlfriend Perkins, who was mother of his 3-month-old daughter and shared his home, would have had access to the hotline and the league's mental health program. 

At the end of July, the NFL emailed information on its new crisis line and on the league's available mental-health help to the home of every NFL player, Aiello said, adding: "The information is sent with the idea that the player's wife also sees it. If a player's girlfriend sees it, it would be the same thing."

What's more, all 32 NFL teams employ a player development director to help encourage use of the programs, Aiello said.

In addition, the NFL Players Association — the labor union for players — staffs its own 24-hour, toll-free hotline for players to use "if they need any support whatsoever," said George Atallah, NFLPA spokesman. "If a player has an alcohol-addiction problem (for example), he calls in and we route that call to a facility near them, and (facility members) then come pick him up and give him the assistance he needs. That goes for any depression issues and mental health issues." The NFLPA also offers counseling services to players, and it employs a group of retired players "to get a pulse of what’s going on in the locker rooms, handle situations confidentially, and provide support when necessary."

As part of what the NFL calls its “new comprehensive health program” — formally dubbed NFL Total Wellness — Goodell and the league worked with former U.S. Surgeon General David Satcher last summer to strengthen its mental health tools and assistance. The new program encourages players and their families to seek support for behavioral issues, provides health and safety information and offers confidential, free advice via telephone and the Internet. That aid is available to all players and “all members of the NFL family” who find themselves “in times of need,” the NFL says. The same experts who operate the "NFL Life Line" run a similar emergency system for members of the U.S. military.

However, even with best intentions, the NFL remains essentially an elite club in which players have long been trained to hide physical pain — if not injuries — to keep their jobs. That environment could keep players from truly opening up about possible symptoms of depression, anxiety or other mental-health woes.

Gulliver declined to say how many players have phoned the hotline and tapped into the league’s enhanced mental-health program via the web since its launch.

"We don’t publicize the actual usage or percentage numbers," Gulliver said.

As the program has become more widely known by players, however, Satcher said: "The usage of it is increasing."

Gulliver wouldn't comment whether Belcher, his family, friends or any Chiefs players called the crisis line ahead of the murder- suicide, or tried to contact the league’s new mental health services professionals about Belcher.

“That, too, is information that we do not publicize. There are lots of privacy laws that we make sure we uphold. The program is actually administered by the third-party provider so it’s not information that comes into the NFL office. We wanted this to be independent and completely confidential for the members for the NFL family," Gulliver said. 

He added: "Our hearts really hurt for the tragedy that has played out in Kansas City. And we absolutely want to make sure that we provide resources so that people realize there is another way that they can get the help that they need."

Seau’s suicide last May served as the ultimate spark for the new hotline and the league's extra mental-health measures.

“It really did prompt us to step back and say: What more could we be providing for our players and for the NFL family?” Gulliver said. 

But even with a beefed-up program available to players and their spouses, it's difficult to predict this kind of tragedy, Satcher said, adding: "I don’t know that anybody could." 

The American Foundation for Suicide Prevention lists warning signs that someone may be considering suicide due to depression:

• Relentlessly low mood; pessimism; hopelessness; desperation; anxiety or inner tension
• Withdrawal; sleep problems
• Increased alcohol and/or other drug use
• Recent impulsiveness and taking unnecessary risks; threatening suicide or expressing a strong wish to die
• Making a plan; giving away prized possessions
• Sudden or impulsive purchase of a firearm; obtaining other means of killing oneself such as poisons or medications
• Unexpected rage or anger.

Anyone can call the National Suicide Prevention Hotline at 1-800-273-8255.

During the planning meetings for the NFL’s revamped mental-health platform, Satcher said he and league leaders discussed the hot-button issue of chronic concussions sustained by NFL players — and the behavioral instability those injuries are known to carry.

“The brain is a delicate organ and, therefore, head-to-head contact can no longer be viewed as acceptable. The hits start early - in junior high and high school," said Satcher, head of the Satcher Health Leadership Institute at the Morehouse School of Medicine in Atlanta. 

Satcher called the NFL's around-the-clock telephone “lifeline” and the other added mental-health backstops “a major advance” for the league.

Since 2010, these high-profile domestic violence cases have involved NFL players:

• Chad Johnson was released by the Miami Dolphins during the team’s 2012 training camp after the receiver was arrested in early August for allegedly striking his wife in the head.
• Erik Walden, a Green Bay Packers linebacker, was jailed during Thanksgiving 2011, originally charged with a felony after he allegedly assaulted his girlfriend. Later, he received a deferred judgement and agreed to do community service work.
• Dez Bryant, a receiver for the Dallas Cowboys, was arrested in July after allegedly shoving his mother. He was charged with a misdemeanor.
• Seau, a linebacker who spent most of his career with the San Diego Chargers, allegedly assaulted his girlfriend in 2010, two years before he shot himself to death.
• Chris Cook, a cornerback for the Minnesota Vikings, was arrested in October 2011 for domestic violence after he allegedly choked his girlfriend. He was acquitted at trial.
• Brandon Marshall, a wide receiver for the Chicago Bears, has a history of domestic crimes dating back to 2004. In March, he was accused by a 24-year-old woman of punching her in the eye. Marshall’s attorney said Marshall’s wife was the woman injured and that Marshall was a victim in the assault.

The National Suicide Prevention Hotline number is 1-800-273-8255.

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Members of the military exposed to blasts in combat can develop the same brain disease as professional athletes who experience multiple concussions, a new study suggests.

Researchers found evidence of chronic traumatic encephalopathy, or CTE, in the brains of all four deceased U.S. military veterans they examined. The men were exposed to blasts or to multiple concussions during combat.

CTE is a degenerative brain disease previously seen mainly in professional athletes, including boxers, hockey players and football players. It is usually caused by repeated blows to the head, but results from the new study suggests that exposure to a single blast equivalent to that of a improvised explosive device (IED) can result in CTE. The condition causes symptoms such as impaired learning and memory, and has been linked with suicide, the researchers said.

"Our study, for the first time, shows military personnel that have experienced blast exposure exhibit CTE that's basically indistinguishable from the athletes we've looked at," said study researcher Patric Stanton, a cell biology professor at New York Medical College in Valhalla, N.Y.

The findings indicate that brain injuries with different causes — concussions and exposure to blasts — may trigger the same disease in the brain, Stanton said.

The link between CTE and suicide can be seen in the case of former National Football League star Dave Duerson, who committed suicide last year. An examination of his brain after his death revealed he had CTE, as he suspected. CTE has also been suspected of playing a role the suicide of NFL player Junior Seau earlier this month.

The new findings suggest that blasts on the battlefield may lead to suicidal thoughts in veterans, Stanton said. Blasts may be a factor in the recent rise in military suicides, he said, and researchers should investigate this..

Degenerative brain disease
The researchers analyzed the brains of four male military veterans, ages 22 to 45 (CTE can be diagnosed only after death). Three of the men had been exposed to at least one blast from an IED, and two of them had concussions earlier in life. One soldier experienced four concussions throughout his life, although he was not exposed to a blast.

All the men had symptoms such as headaches, irritability, difficulty sleeping, depression and short-term memory loss.

One man died from a brain aneurysm, one from a brain hemorrhage and one from a self-inflicted gunshot wound. The fourth man inhaled foreign material while under the influence of pain medication and later died from lung complications. About two years had passed between their last brain injury and their death.

The researchers also examined the brains of three football players, a professional wrestler and four men of similar ages with no history of blast exposure or concussions.

Signs of CTE were seen in the brains of the military veterans and the professional athletes. One characteristic of CTE is abnormal deposits of a protein called tau, which can kill brain cells, Stanton said.

Mouse model
It can be difficult to say whether CTE was definitely caused by a blast, by previous events in a person's life, or a combination of both, Stanton said.

To study CTE in a more controlled environment, the researchers created a mouse model and simulated blasts from an IED.

The rapid movement of air that occurs after an explosion may play the biggest role in causing blast-related brain injuries, Stanton said. This blast wind can be stronger than the winds of a hurricane, and can rapidly shake the head back and forth, compressing the brain, Stanton said.

About two weeks after exposure to a simulated blast, the mice showed learning and memory problems. These problems were averted when the animals' heads were prevented from moving during the blast, the researchers said.

The findings provide a new pathway for developing methods to prevent blast-related brain injuries, the researchers said.

The study is published today (May 16) in the journal Science Translational Medicine. Study experiments were conducted by researchers at Boston University, New York Medical College and the Veterans Affairs Boston Healthcare System.

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Stephen Dunn / Getty Images

Junior Seau, former linebacker for the San Diego Chargers, was found dead in his home Wednesday in what police are calling an apparent suicide.

Former NFL star Junior Seau’s death on Wednesday is fueling debate over whether football’s big hits leave some players with lingering brain damage that can lead to depression and possibly even suicide.

The police have yet to determine whether the 43-year-old linebacker did, in fact, commit suicide. But because his death follows so closely on the heels of two high-profile suicides in former NFL defensive backs, many are wondering if the concussions Seau sustained during his 20 years as a hard-hitting star, known mostly for his stint with the San Diego Chargers, including the 1994 Super Bowl team, were implicated in his death. 

In February 2011, former Chicago Bear Dave Duerson committed suicide at age 50, choosing to shoot himself in the chest so that scientists could look for signs of chronic traumatic encephalopathy (CTE), a brain disease linked to head blows that can culminate in dementia and other symptoms. And just last month, former Atlanta Falcon Ray Easterling, who had sued the NFL for mismanaging players’ concussions, shot and killed himself at age 62.

Experts interviewed by msnbc.com were mixed in their opinions on whether Seau’s concussions could have led to his apparent suicide. All agreed that there should be more research on the impact of head injuries on the risk for depression and suicide.

“I think the evidence is very strong in both human and animal studies that repeated concussions that occur very close in time can result in depression and other emotional disorders that can lead to suicide,” said David Hovda, a professor of neurosurgery and director of the University of California, Los Angeles, Brain Injury Research Center. “Whether they are the sole reason for the suicide, I don’t think can be determined.”

Hovda believes it’s possible that Seau shot himself in the chest so that he, like Duerson, might leave his brain for scientists to study.

Dr. Douglas Smith was more cautious.

“There’s beginning to be an assumption that repeated exposure to head injuries can make you suicidal,” said Smith, a professor of neurosurgery and director of the Center for Brain Injury and Repair at the Perelman School of Medicine at the University of Pennsylvania. “It’s certainly suspicious and something that we should absolutely look into.”               

But Smith cautioned that people shouldn’t assume that concussions will always lead to permanent brain damage. “There are many highly functioning individuals who have had a series of concussions -- captains of industry, politicians -- who are doing very well,” he said.

The issue is a lot more murky for Pittsburgh Steelers' team neurosurgeon, Dr. Joseph Maroon, who was quick to point out the high incidence of depression among Americans who haven’t ever had an injury to their brains.

“Depression is one of the most common diseases that affect people in the United States,” said Maroon, a professor of neurosurgery and the Heindl Scholar in Neuroscience at the University of Pittsburgh. “Some 10 to 15 percent of American who have not played football will have pathologic depression at some time in their lives. The most commonly prescribed drugs in the United States are antidepressants.

“Given that, we also know that there may be a relationship in some individuals between multiple blows to the head, or even a single blow to the head, that can result in abnormal and pathological behavior. In an individual case, in this one for instance, from what I’ve read so far, I don’ t think there’s any way you can definitively say that this was directly related to football.”

Nevertheless, Maroon said, people are taking concussion damage far more seriously these days. “There’s been a major cultural shift in the recognition and appreciation of post-concussive effects,” he said.

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Courtesy of the Napadano family

Sam Napadano spent months learning how to talk and walk again after he suffered a traumatic brain injury during a motocross accident three years ago when he was 13.

Mark Napadano watched in horror as his 13-year-old son slammed head first into the hard ground after a motocross accident.  In seconds he was at the side of his son, Sam, terrified by the sight of the junior high athlete so full of life just moments before lying limp in front of him - and not breathing. “It was like a nightmare,” Mark remembers.

At the hospital doctors examined Sam and gave Mark the frightening news: Sam had a large pocket of blood pooling near the top of his head and two smaller bleeds in the front and two in the back. “They didn’t say he was going to die, but they didn’t say he was going to live,” recalls the 45-year-old car dealer from Butler, Pa.

Sam was in a coma for days and in critical care for almost a month. By the time he was released to a rehab facility the 5-foot-4-inch teen had dropped from a trim and muscular 114 pounds to just 84. For months Mark and his wife, Sue, watched as their son learned to talk and walk for a second time.  

Now, three years after the wreck Sam is almost back to where he was before, Mark says. Sam returned to school three months after the accident and kept up his rehab for two years. He still has some short term memory problems and though his working memory has improved, it can be a challenge if too many commands are thrown his way at the same time.

While conventional wisdom is that children have a great capacity to overcome damage from a severe traumatic brain injury, or TBI, because their brains are still developing and “plastic,” a new study shows that many may actually end up with some lasting deficits. The study followed 56 children for 10 years after they’d sustained a TBI between the ages of 2 and 7.

During the study, the Australian researchers repeatedly examined the children’s intellectual abilities, as well as social and behavioral skills, according to the report published in Pediatrics. 

The report confirmed earlier research showing that most kids with mild TBIs recover completely, but the prognosis for children with more severe injuries is less predictable.

These new data suggest that “the majority of these kids will have long-term problems,” says the study’s lead author Vicki Anderson, a researcher at the Murdoch Children’s Research Institute in Melbourne. “And while there was some ‘spontaneous’ recovery, those who had access to rehab did better.”

Story: ER visits for kids' concussions on the rise

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Three years after his accident, Sam Napadano, now 17, still has some short-term memory problems, says his father, Mark Napadano. "I tell people that he's 80 to 90 percent back to where he was," he says.

Anderson and her colleagues found that kids did continue to improve for years. “It appears that, after a protracted recovery period, these children gradually stabilize and begin to make some developmental gains, suggesting that even many years post-insult, intervention may be effective,” they write.

What researchers like Anderson can’t say is which kids will recover best after a severe injury.

“It’s difficult to predict outcome,” Anderson explains. “But a quality home environment and access to ‘appropriate’ rehabilitation is critical to maximize outcomes.”

The new research echoes Dr. Douglas Smith’s experience. “Kids do recover better than adults,” says Smith, director of the Center for Brain Injury and Repair and professor of neurosurgery at the Perelman School of Medicine, University of Pennsylvania. “And the younger [kids] tend to do better than the older ones. That’s because the younger you are the more plastic your brain is. That makes it easier for the brain to rewire.”

The most important factor impacting recovery is the type of brain injury, Smith says. If the injury sites are isolated the prognosis is better than if the whole brain is involved, with connections everywhere being twisted and ripped.

For Dr. Christopher Giza, an associate professor of pediatric neurology and neurosurgery at the University of California, Los Angeles, the study raises “a hopeful note that suggests that these kids are still able to advance and develop. And it may suggest that even a long time after the injury there is room for intervention.”

One of the reasons that researchers have assumed that kids are resilient enough to recover from severe TBIs is the many examples of children with epilepsy who have had large parts of their brains surgically removed – and have still gone on to live normal lives because the remaining brain rewired to take over the job of the regions that were removed.

The difference between that scenario and the aftermath of some TBIs may be explained by the fact that a TBI can hurt cells all over the brain, making rewiring difficult.

Q&A: Concussion crisis often a game changer, authors reveal

When it comes to severe TBIs in kids, parents need to realize that their children may require long-term rehab, says Mandeep Tamber an assistant professor of pediatric neurosurgery at the University of Pittsburgh School of Medicine and the Children’s Hospital of Pittsburgh. That rehab will help the brain to continue to rewire and also help the child to come up with strategies to compensate for lasting problems like short term memory deficits, Tamber says.

That makes sense to Ryan Bradley’s dad.

Three years ago, Ryan climbed up on the roof of a three story building with some friends and slipped, falling nearly 40 feet to the cement floor of a carport. Along with a host of other serious injuries, 11-year-old Ryan suffered a severe TBI. 

Like Sam Napadano , Ryan spent days in a coma and then years in intensive rehab. He had to learn to walk and talk again. And today most of the injuries to the Santa Monica boy’s body have been repaired, but the damage to his brain has left some lasting deficits.

He’s in high school now, but needs accommodations to make it through the course work.

“There is a program tailored to him,” says Ryan’s dad, Kevin Bradley, 48. “He gets tutoring and teachers know that he sometimes needs longer on tests and breaks during the day.”

Ryan is working towards graduation and plans to go to college, but he will likely have to battle the lingering effect of the brain injury every day of his life.

“There are always some processing issues,” his dad says. “He gets a little information overload at times. He’s learned techniques to help him take better notes.  He has techniques to help him be prepared for class.”

Kevin Bradley’s advice to parents with kids who’ve suffered a brain injury is simple: “Don’t give up hope. Be involved with your child’s care."

Do you know someone who has battled to come back from a severe brain injury? Tell us on Facebook.

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