More Seasons of NFL Play May Be Associated With Increased Risk of Cognitive Problems, Depression

The more seasons that NFL players spend playing in the league, the greater their risk of cognitive problems and depression, according to a study published today in The American Journal of Sports Medicine. Former NFL players who reported more concussion symptoms during playing years were at a particularly elevated risk for cognitive problems and depression and anxiety even 20 years after retirement compared with those who reported fewer symptoms, the authors noted.

“Our findings confirm what some have suspected—a consistently and persistently elevated risk for men who play longer and who play in certain positions,” lead author Andrea Roberts, Ph.D., of the Harvard T.H. Chan School of Public Health said in a press statement. “Our results underscore the importance of preventing concussions, vigilant monitoring of those who suffer them, and finding new ways to mitigate the damage from head injury.”

The findings were based on analysis of the responses of 3,506 former NFL players (average age 53 years) to a survey sent by mail or email. Former players were asked about the positions they most often played professionally, the number of seasons they played, and the number of times they experienced concussion symptoms during their careers. The players were also asked how often they experienced cognitive difficulties over the past week and whether they experienced symptoms of depression or anxiety over the past two weeks and/or were taking medication for depression or anxiety. (Cognition-related quality of life was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition–General Concerns. The Patient Health Questionnaire-4 was used to measure depression and anxiety symptoms.)

One in eight survey respondents was categorized as having poor cognition-related quality of life/severe cognitive impairment. Every five seasons of professional play was associated with a nearly 20% increased risk of cognitive problems—with running backs, defensive lineman, and line backers at a more elevated risk of cognitive impairment than kickers and punters. About 1 in 4 respondents reported symptoms or was taking medications for depression or anxiety, and nearly 1 in 5 respondents reported symptoms or was taking medications for both conditions. Length of career also increased risk of depression, with every five years of professional play increasing risk by 9%; there was no relationship between length of career and risk of anxiety.

Former players reporting the greatest number of concussion symptoms were found to be at a 22.3-fold greater risk of cognitive impairment, 6.0-fold greater risk of depression, and 6.4-fold greater risk of anxiety compared with the former players with the lowest number of concussion symptoms, the authors reported.

Roberts and colleagues highlighted several limitations of the study, including the fact the findings relied on respondents’ ability to recall events that for some occurred decades earlier. Nonetheless, they concluded, “Concussion history and life in football appear to be associated with cognitive and mental health complaints. … Active players, along with medical professionals who care for them, might consider their future health in deciding whether to continue a football career following concussion.”

For related information, see the Psychiatric News article “Study Finds High Prevalence of CTE, Other Disorders in Former Football Players.”

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