“These results suggest that medical professionals should be especially attentive to a retired athlete’s comorbid medical history and physically related conditions,” wrote Benjamin Brett, Ph.D., of the Vanderbilt Sports Concussion Center and colleagues. “If a retired athlete reports an extensive history of SRC [sport-related concussion] and somatic or depressive symptomatology, referral to a sports psychiatrist or clinical neuropsychologist is recommended for further assessment … and to differentiate depressive symptoms as purely somatic, psychiatric, or mixed.”
Brett and colleagues assessed data from 43 retired NFL players who had received comprehensive neuropsychological exams as part of a large neurological study. The exams included the Beck Depression Inventory II (BDI-II) to screen for depression and the Patient Health Questionnaire-15 (PHQ-15) to screen for somatic symptoms. The players self-reported an average of 8.7 sport-related concussions.
Of the 43 players, 29 reported minimal depressive symptoms, nine reported symptoms of mild depression (BDI-II score of 14 to 19), three reported symptoms of moderate depression (BDI-II score of 20 to 28), and two reported symptoms of severe depression (BDI-II score of 29 to 63). The average PHQ-15 score was 5.35.
Brett and colleagues found that there was no connection between concussion history and depressive symptoms in the players whose PHQ-15 scores were below average. In contrast, former players with average PHQ-15 scores did tend to have worse depression with greater somatic symptoms, and this association between concussion history and current depression was even greater among players with above-average PHQ-15 scores. The researchers also calculated that the presence of somatic symptoms contributed about twice as much to an individual’s depression as the concussions.
“Our results allow us to conclude that there are moderating factors that can affect the strength and nature of the relationship between [sport-related concussion] and depression,” the researchers concluded. “If somatic symptoms can be mitigated, it is possible that the risk and/or severity of depression may be decreased.”
For related information, see the Psychiatric News article “Can Sertraline Help Prevent Depression Following a TBI?”