BUDAPEST, Hungary (AP) — Olympic gold medalist Tori Bowie’s autopsy included an easy-to-overlook, one-line notation beneath the heading “Medical History:" Bipolar disorder.

In and around track circles, where the champion sprinter’s absence is hitting particularly hard heading into Saturday’s opening in Hungary of the first world championships since her death, Bowie’s mental health struggles were more than an afterthought.

They were a stark reality that came to light during training over the years. They also revealed themselves in the Florida neighborhood where police found her body days after the 32-year-old, who was eight months pregnant, died at home due to what the coroner said were complications of childbirth.

“It’s not that she slipped through the cracks,” her one-time coach, Al Joyner, told The Associated Press last month. “I think people didn’t take it seriously enough.”

Other news Olympic sprinter Tori Bowie died from complications of childbirth, autopsy report concludes

Bipolar disorder, a mental-health condition that causes extreme mood swings, can be treatable with medication and counseling. However, t he National Institute of Mental Health cites studies that say that of the some 4.4% of U.S. adults who experience the disorder, 82.9% encounter “serious impairment.”

Though Bowie had access to mental-health services through both the U.S. Olympic and Paralympic Committee and USA Track and Field, officials at both organizations said she did not avail herself of those in the months and weeks before her April 23 death.

The officials said they believe Bowie’s mental health played a role in how she handled what became an increasingly difficult pregnancy, one she dealt with without much assistance from friends, family or medical professionals. They spoke on condition of anonymity to discuss the confidential information.

The AP spoke with Joyner as well as six other USA track and Olympic officials or team members who knew Bowie over her decade-plus as a prize-winning sprinter, then during her retirement. AP also reviewed autopsy and police records, including a 911 call from a family acquaintance who had been asked to check on Bowie at her house after no one heard from her in days.

“Last time I spoke to this girl, it was over three weeks ago. I saw her here at her home and she was living without power,” said the acquaintance, whose name is redacted from the 911 recording. “I reported to her family that I was concerned about her mental health.”

There were other red flags.

Neighbors saw Bowie sleeping on the floor at a local recreation center and another time, sleeping on a bench with groceries near her feet at a park near her house. The neighbors spoke on condition of anonymity to reveal the disturbing details of Bowie’s case.

One of the neighbors called the U.S. Olympic committee with their concerns and the committee notified USA Track and Field. Track officials reached out to Bowie’s agent, Kimberly Holland, but Holland said Bowie was not in need of help.

Holland told the AP this month that Bowie had access to health care. “I didn’t have any red flags,” she told The Washington Post in June, adding that Bowie was insistent on not delivering her baby in a hospital.

Police went to Bowie’s house on May 2 after receiving several calls, including the 911 call from the acquaintance, who told the dispatcher she didn’t feel safe entering because of the smell emanating from the residence.

Earlier this month, a lawsuit was filed seeking foreclosure on Bowie’s Winter Garden, Florida, house, saying she had been delinquent on payments since Oct. 1, 2022, nearly seven months before her death.

When the autopsy came out, it indicated there were no signs of foul play or drug use. Bowie’s bipolar disorder didn’t make many headlines, nor did another detail — her weight: 96 pounds, even at eight months pregnant. In her heyday, the 5-foot-9 sprinter was a wall of muscle and weighed 130.

More was made of what the coroner listed as complications related to childbirth: among them, eclampsia, which results in seizures that can lead to coma and stems from high blood pressure during pregnancy.

According to the U.S. Centers for Disease Control, Black women are three times more likely to die from pregnancy-related issues than white women. Bowie was the third woman on the 2016 U.S. Olympic gold-medal relay team who suffered complications in childbirth. All three were Black. But while Allyson Felix and Tianna Tashelle delivered in a hospital, Bowie died alone.

The news of her death hit hard around track-and-field circles.

“There’s just a very heavy sadness that I think everybody feels, like, ‘Wow, this could have been preventable.’ Or, ‘I didn’t get to tell Tori how I felt,’” said retired decathlete Trey Hardee, who has struggled with mental health issues of his own.

Placed in a foster home as a baby, Bowie was taken in and raised by her grandmother — a formative episode that Joyner said shaped her life.

“It seemed like she was always out to prove something,” Joyner said. “And then when she did prove something, it was never good enough. ... That’s a dangerous thing. Everybody’s been taught the same way: ‘If I do this, it’s going to be easy street.’ But then when you do all those things and it’s not happening, it makes you stop believing in fairy tales.”

Yet, in many ways, Bowie’s career was a fairy tale.

Fast on her feet and able to jump high, Bowie gravitated to basketball as a kid growing up in Sand Hill, Mississippi. Urged to give track a try, she and everyone around her quickly found out just how good she was. She went to Southern Miss, where she won the NCAA long jump title in 2011.

A few years later, she was among the top sprinters in the world. She won silver in the 100 and bronze in the 200 at the 2016 Rio Games, then capped off the Olympics by teaming with Felix and Co. for the relay gold.

A year later, at the world championships, Bowie reeled in the competition over the final 20 meters, leaned at the line then went tumbling over it to win the 100-meter title.

“I didn’t want to come back saying, ‘Oh, I should’ve done this. I should’ve done that,’” Bowie said, beaming as she discussed her victory, the scrapes from the fall still fresh on her legs.

After that win, Bowie became a frequent visitor to red carpets and was gaining a reputation as an icon in fashion and modeling.

But a 2018 Instagram post told a less glamorous, but unflinchingly honest story. Titled “The Cost of Success,” it followed with a list: “1. Late Nights. 2. Early Mornings. 3. Very Few Friends. 4. Being Misunderstood. 5. Feeling Overwhelmed. 6. Questioning Your Sanity. 7. Being Your Own Cheerleader.” It concluded: “But Guess What? It Will Be Worth It.”

The post came six months after Bowie was involved in a physical altercation in February 2018 with training partner Shaunae Miller-Uibo at their training center in Florida. Bowie, in an interview with the track publication FloTrack, said the fight left her bleeding from the head. Both sprinters were asked to seek psychological counseling.

Bowie left Florida for the U.S. Olympic committee-run Elite Athlete Training Center in Chula Vista, California. But when she showed up to start the 2019 season, she was told she owed $6,000 to the facility — a bill she said she did not expect and led to her leaving the center.

Bowie told FloTrack she lost trust in her coach Joyner, and agent, Holland, neither of whom, she said, had her back in the dispute over the money.

“I haven’t really discussed this because I’m not sure how they even allowed me to get treated this way. So, I’m very disappointed,” Bowie said in the 2019 interview.

Joyner conceded the rift between himself and the sprinter splintered their relationship.

“At that time, me and Tori, we had a great relationship and it cost us that,” Joyner said. “She thought I was somewhere involved. ... It took her into a tailspin to the point where everybody was the enemy. I became the enemy. It was never the same. I was just heartbroken.”

After finishing fourth in the long jump at world championships in 2019, Bowie posted on social media that she was looking forward to the Tokyo Olympics. The COVID-19 pandemic delayed the games by a year and Bowie did not try to qualify for the U.S. team in 2021. World Athletics lists her as having run only one race in 2022 — on June 4 in Florida where she clocked a 23.60 in the 200 meters, nearly 2 seconds off her personal best.

Joyner’s sister, heptathlon and long-jump great Jackie Joyner-Kersee, discussed the implications of people falling out of touch — and said that’s why she always picks up the phone.

“I need to hear your voice. I can’t hear it in a text,” Joyner-Kersee said. “Because you may text you’re doing good, but your voice may tell me something different.”

Until the last few years, the stigma attached to mental illness was so great that virtually no athlete would dare bring it up in public.

Gymnast Simone Biles and sprinter Noah Lyles were among those in the Olympic space who helped change that dynamic. Their openness about their struggles at the Tokyo Games helped shift the conversation.

Despite the occasional post on social media discussing the sacrifices pro athletes have to make, Bowie was never much part of that conversation.

Had she sought medical or emotional counseling, there were places for her to turn. In the wake of sex-abuse scandals that rocked the Olympic world, along with the COVID-19 pandemic, the U.S. Olympic committee doubled down on mental-health services for its athletes — adding doctors, hot lines, support groups, experts who travel with the teams and dozens of other resources for athletes who need help dealing with the strains of competition and daily life.

“I don’t always need to talk to the athlete, I need to talk to the person who can get through to them,” said Jess Bartley, the Olympic committee’s director of mental health. “And I will spend hours and hours with that person about how to have a five-minute conversation to connect that athlete to the right resources.”

At one point, Joyner might have been that person. He said there was a time when he thought Bowie had so much talent, she could have ended up on a pedestal with all-time greats, including his sister, Joyner-Kersee, and his late wife, 100-meter world-record holder Florence Griffith-Joyner.

“Because Tori just loved trying to be the best. She was like a sponge,” Joyner said. “You can’t think of Tori without thinking about her smile.”

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