Nine-Year Risk of Depression Diagnosis Increases With Increasing Self-Reported Concussions in Retired Professional Football Players
ABSTRACT Concussions may accelerate the progression to long-term mental health outcomes such as depression in athletes.
To prospectively determine the effects of recurrent concussions on the clinical diagnosis of depression in a group of retired football players.
Cohort study; Level of evidence, 2.
Members of the National Football League Retired Players Association responded to a baseline General Health Survey (GHS) in 2001. They also completed a follow-up survey in 2010. Both surveys asked about demographic information, number of concussions sustained during their professional football career, physical/mental health, and prevalence of diagnosed medical conditions. A physical component summary (Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being [SF-36 PCS]) was calculated from responses for physical health. The main exposure, the history of concussions during the professional playing career (self-report recalled in 2010), was stratified into 5 categories: 0 (referent), 1 to 2, 3 to 4, 5 to 9, and 10+ concussions. The main outcome was a clinical diagnosis of depression between the baseline and follow-up GHS. Classic tabular methods computed crude risk ratios. Binomial regression with a Poisson residual and robust variance estimation to stabilize the fitting algorithm estimated adjusted risk ratios. χ(2) analyses identified associations and trends between concussion history and the 9-year risk of a depression diagnosis.
Of the 1044 respondents with complete data from the baseline and follow-up GHS, 106 (10.2%) reported being clinically diagnosed as depressed between the baseline and follow-up GHS. Approximately 65% of all respondents self-reported sustaining at least 1 concussion during their professional careers. The 9-year risk of a depression diagnosis increased with an increasing number of self-reported concussions, ranging from 3.0% in the "no concussions" group to 26.8% in the "10+" group (linear trend: P < .001). A strong dose-response relationship was observed even after controlling for confounders (years retired from professional football and 2001 SF-36 PCS). Retired athletes with a depression diagnosis also had a lower SF-36 PCS before diagnosis. The association between concussions and depression was independent of the relationship between decreased physical health and depression.
Professional football players self-reporting concussions are at greater risk for having depressive episodes later in life compared with those retired players self-reporting no concussions.
[Show abstract] [Hide abstract]
ABSTRACT: Over the past decade, there has been significant debate regarding the effect of cumulative subconcussive head impacts on short and long-term neurological impairment. This debate remains unresolved because valid epidemiological estimates of athletes' total contact exposure are lacking. We present a measure to estimate the total hours of contact exposure in football over the majority of an athlete's lifespan. Through a structured oral interview, former football players provided information related to primary position played and participation in games and practice contacts during the pre-season, regular season, and post-season of each year of their high school, college, and professional football careers. Spring football for college was also included. We calculated contact exposure estimates for n=64 former football players (n=32 college football only, n=32 professional and college football). The Head Impact Exposure Estimate (HIEE) discriminated between individuals who stopped after college football, and individuals who played professional football (P<0.001). The HIEE measure was independent of concussion history (P=0.82). Estimating total hours of contact exposure may allow for the detection of differences between individuals with variation in subconcussive impacts, regardless of concussion history. This measure is valuable for the surveillance of subconcussive impacts and their associated potential negative effects.
[Show abstract] [Hide abstract]
ABSTRACT: Abstract Objective: This study reviewed several topics related to post-concussion syndrome and psychological factors associated with concussion. Topics include neurobiological perspectives, psychological predictors of post-concussion syndrome including pre-morbid anxiety, anxiety sensitivity and cognitive biases and misattribution. In addition, the iatrogenic effects of excessive rest are reviewed and treatment options are discussed briefly. Main results: Animal models of concussion and mild traumatic brain injury suggest that a concussion can result in anxiety and fear reactions. The pathophysiology of depression following a concussion appears to be consistent with the cortico-limbic model of depression. Additionally, some individuals may be at risk for neurobiological depression and/or anxiety following a concussion. The literature also demonstrates that pre-morbid and concurrent anxiety increases the risk for prolonged concussion recovery. Cognitive biases and misattribution of symptoms contribute to lengthy recovery from concussion. In addition, medically prescribed excessive cognitive and physical rest may contribute to a protracted concussion recovery. Supervised and graduated physical activity, the introduction of anxiety reduction techniques and cognitive-behavioural therapy of cognitive biases and misattribution are effective means of shortening the length of post-concussion syndrome. Conclusions: Understanding, assessing and treating the psychological factors associated with concussion are effective means of preventing or shortening the length of post-concussion syndrome.Brain Injury 11/2014; 29(2):1-10. DOI:10.3109/02699052.2014.974674 · 1.86 Impact Factor
[Show abstract] [Hide abstract]
ABSTRACT: The use of clinical neuropsychological tests in the evaluation of National Football League (NFL) players has been ongoing for more than two decades. Prior research has demonstrated that the NFL population may perform differently than the general population on standard paper and pencil neuropsychological tests. Given the increased interest in the longitudinal and long-term assessment of neurocognitive functioning in this group of athletes, we reviewed the published neuropsychological literature in an attempt to compile an initial compendium of available normative data on paper and pencil as well as computerized neuropsychological tests for this group of football players. Thirteen published studies met the inclusion criteria, and the results are presented by athlete status (active vs. retired) and classified by neuropsychological domain. Suggestions for potential core batteries with this population are discussed, as are directions for future research. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: email@example.com.Archives of Clinical Neuropsychology 01/2015; 30(2). DOI:10.1093/arclin/acv003 · 1.92 Impact Factor