Depression and Pain in Retired Professional Football Players

Department of Family Medicine, Depression Center, University of Michigan, Ann Arbor, MI 48109, USA.
Medicine &amp Science in Sports &amp Exercise (Impact Factor: 3.98). 05/2007; 39(4):599-605. DOI: 10.1249/mss.0b013e31802fa679
Source: PubMed


To assess the prevalence of depressive symptoms and difficulty with pain in retired professional football players, difficulties with the transition from active athletic competition to retirement, perceptions of barriers to receiving assistance for those difficulties, and recommended programs to provide such assistance.
Survey sent to 3377 retired members of the National Football League Players Association (NFLPA), with usable responses received from 1617 members (functional response rate, 48.6%).
Respondents were categorized as experiencing no to mild depression (N=1366; 84.5%) or moderate to severe depression (N=237; 14.7%). Respondents were also categorized according to whether they reported difficulty with pain as not or somewhat common (N=837; 51.8%) versus quite or very common (N=769; 47.6%). Respondents most frequently reported trouble sleeping, financial difficulties, marital or relationship problems, and problems with fitness, exercise, and aging, all of which were strongly correlated with the presence of moderate to severe depression and with quite or very common difficulty with pain. The same difficulties were even more commonly experienced by respondents who reported both moderate to severe depression and quite or very common difficulty with pain, compared with those who reported low scores in both domains.
Retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of difficulty with pain. The combination of depression and pain is strongly predictive of significant difficulties with sleep, social relationships, financial difficulties, and problems with exercise and fitness. A hypothesis explaining this association is that significant musculoskeletal disability and chronic pain interferes with physical activity and fitness during retirement and increases the risk of depression.

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    • "Our cohort of former collegiate athletes had a lower prevalence of moderate to severe depression, compared to a sample of former NFL players (4.7% vs. 14.7%) (Schwenk et al. 2007). Nevertheless, the findings contribute to a growing body of evidence that links the risk of depression to self-reported concussion history in former athletes. "
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    ABSTRACT: The existing research on the association between concussion and mental health outcomes is largely limited to former professional athletes. This cross-sectional study estimated the association between recurrent concussion and depression, impulsivity, and aggression in former collegiate athletes. Former collegiate athletes who played between 1987–2012 at a Division I university completed an online questionnaire. The main exposure, total number of self-recalled concussions (sport-related and non-sport-related), were categorized as: zero (referent), one, two, or three or more concussions. The main outcomes were the depression module of The Patient Health Questionnaire (PHQ-9), the Short Form of the Barratt Impulsiveness scale (BIS15); and the 12-item Short Form of the Buss-Perry Aggression Questionnaire (BPAQ-SF). Depression was categorized into a binomial severity classification that differentiated between no or mild depression (PHQ-9 scores <10) and moderate to severe depression (PHQ-9 scores ≥10). Impulsivity and aggression were kept as continuous outcomes. Binomial regression estimated adjusted prevalence ratios (PR). Linear regression estimated adjusted mean differences (MD). Of the 797 respondents with complete data (21.9% completion rate), 38.8% reported at least one concussion. Controlling for alcohol dependence and family history of depression, the prevalence of moderate to severe depression among former collegiate athletes reporting three or more concussions in total was 2.4 times that of those reporting zero concussions [95% Confidence Interval (CI): 1.0, 5.7]. Controlling for alcohol dependence, family history of anxiety, relationship status, obtaining a post-graduate degree, and playing primary college sport professionally, former collegiate athletes reporting two or more concussions in total had higher mean scores for impulsivity, compared to those reporting no concussions (2 concussions MD = 2.7; 95% CI: 1.2, 4.1; 3+ concussions MD = 1.9; 95% CI: 0.6, 3.2). Controlling for alcohol dependence, sex, and relationship status, former collegiate athletes reporting three or more concussions in total had a higher mean score for aggression, compared to those reporting no concussions (MD = 3.0; 95% CI: 1.4, 4.7). Our study found an association between former concussion and greater risk of severe depression and higher levels of impulsivity and aggression among former collegiate athletes. Additional prospective studies better addressing causality and ascertaining valid lifetime concussion histories and medical histories are needed.
    11/2014; 1(1):28. DOI:10.1186/s40621-014-0028-x
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    • "Such career uncertainty often further leaves athletes vulnerable to anxiety (Lavallee & Robinson, 2007). Athletes may also struggle with their changing bodies (Lavallee & Robinson, 2007) and depression associated with ongoing chronic pain resulting from injuries sustained during sporting careers (Schwenk et al., 2007). Accordingly, the retirement from elite sport can constitute a significant risk to athletes' psychological health and well-being. "
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    ABSTRACT: Retirement from elite sport can be highly distressing for athletes, and many report experiencing depression and anxiety in adjusting to this transition. In this article, a discursive psychological approach is employed to explore constructions of choice and identity around elite athletes’ retirements within Australian newsprint media. Within these accounts, three ‘types’ of retirements were identified: retirements occurring in relation to age, injury, or active choice. Retiring with individual agency and at an appropriate time was repeatedly privileged, whereas retiring in different ways was routinely problematised. In privileging particular ways of retiring, certain identity positions were made more accessible than others. Consequently, certain actions and choices are deemed appropriate (or not) for athletes, ultimately constraining decision-making around retirement. The implications of such limited identity positions and choices are explored in relation to the psychological distress and clinical concerns that emerge among many athletes in the transition out of elite sport.
    Australian Journal of Psychology 06/2013; 65(2):88-97. DOI:10.1111/j.1742-9536.2012.00060.x · 1.08 Impact Factor
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    • "One published US study [51] that surveyed college student-athletes found that the top rated reasons for not seeking help from counselling services were ‘no need’, not wanting to experience ‘personal discomfort’, worrying about the ‘perceptions of others’, and a lack of ‘time’. Another US study [52] of the opinions of older (M = 53.4 years) retired football players, found that these athletes reported the following as barriers to seeking help: not recognising they had a problem, embarrassment, feeling “weak” if they got help, no insurance, travel and time constraints, and a preference for relying on family and friends, or spiritual means for help. "
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    ABSTRACT: Background Adolescents and young adults experience a high level of mental disorders, yet tend not to seek help. Research indicates that there are many barriers and facilitators to help-seeking for young people in the general community. However there are limited data available for young elite athletes. This study aims to determine what young elite athletes perceive as the barriers and facilitators to help-seeking for common mental health problems. Methods Fifteen elite athletes aged 16–23 years each participated in one of three focus group discussions. In addition to written data, verbal responses were audio taped, transcribed and thematically analysed. Results Participants’ written and verbal data suggested that stigma was the most important perceived barrier to seeking help for young elite athletes. Other notable barriers were a lack of mental health literacy, and negative past experiences of help-seeking. Facilitators to help-seeking were encouragement from others, having an established relationship with a provider, pleasant previous interactions with providers, the positive attitudes of others, especially their coach, and access to the internet. Conclusions Intervention strategies for improving help-seeking in young elite athletes should focus on reducing stigma, increasing mental health literacy, and improving relations with potential providers.
    BMC Psychiatry 09/2012; 12(1):157. DOI:10.1186/1471-244X-12-157 · 2.21 Impact Factor
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