Former professional football players who believe they have chronic traumatic encephalopathy (CTE) are more than twice as likely to report suicidality, a study in JAMA Neurology has found.
However, there is a catch: chronic traumatic encephalopathy neuropathological changes (CTE-NC) can only be determined at autopsy, so there is no way to tell whether living former football players who perceive themselves as having CTE actually have biological changes indicative of the condition.
“Football players, lay people, clinicians, and popular media outlets often refer to CTE as a singular entity occurring in living and deceased individuals to represent CTE-NC and/or TES [traumatic encephalopathy syndrome – a proposed clinical diagnosis characterized by cognitive impairment and problems controlling behavior] interchangeably,” wrote Rachel Grashow, Ph.D., M.S., of the Harvard T.H. Chan School of Public Health and colleagues. “CTE is often presented as manifesting in living people as cognitive impairment, mood disorders, and suicidality, even though depression and suicidality are not part of the TES core clinical features.”
The researchers examined data from 1,980 participants in the Football Players Health Study, a longitudinal cohort of 4,180 former professional football players launched in 2015. Without providing a definition of CTE, researchers asked the participants in the study sample whether they thought they had the condition. The participants also completed the 9-item Patient Health Questionnaire, which includes a question on recent suicidality.
Overall, 34.4% of the participants in the study sample reported perceived CTE, and of those, 25.4% reported suicidality, compared with 5% of participants without perceived CTE. After adjusting for other predictors of suicidality such as depression, the researchers found that participants with perceived CTE had 2.06 times the odds of reporting suicidality compared with those without perceived CTE.
Participants with perceived CTE were also more likely to have:
- Higher concussion signs and symptoms
- Subjective cognitive difficulties
- Worse symptoms of depression
- Higher pain intensity
- Difficulties regulating actions or emotions
- Low testosterone
The researchers urged caution in interpreting the results because of the way the media and public discourse routinely implicate “CTE” as the underlying cause of suicide and psychiatric problems among former professional football players.
“While the exact effect of this media coverage remains uncertain, it is possible that this has contributed to former [football] players and their physicians concluding that CTE is directly responsible for myriad postcareer health problems,” Grashow and colleagues wrote. “[I]t is critical that the results presented here not contribute to personal, scientific, or societal misattribution of suicidal ideation as a premortem manifestation of CTE-NC.”
For related information, see the Journal of Neuropsychiatry and Clinical Neurosciences article “Characterizing Neurobehavioral Dysregulation Among Former American Football Players: Findings From the DIAGNOSE CTE Research Project.”
(Image: Getty Images/iStock/gorodenkoff)
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