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. 2019 Oct;47(12):2871-2880.
doi: 10.1177/0363546519868989. Epub 2019 Aug 30.

Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study

Andrea L Roberts  1 , Alvaro Pascual-Leone  1 , Frank E Speizer  1 , Ross D Zafonte  1 , Aaron L Baggish  1 , Herman Taylor Jr  1 , Lee M Nadler  1 , Theodore K Courtney  1 , Ann Connor  1 , Rachel Grashow  1 , Alexandra M Stillman  1 , Dean A Marengi  1 , Marc G Weisskopf  1
Affiliations

Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study

Andrea L Roberts et al. Am J Sports Med. 2019 Oct.

Abstract

Background: Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes.

Hypothesis: It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety.

Study design: Descriptive epidemiology study.

Methods: The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%).

Results: Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play.

Conclusion: The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.

Keywords: anxiety; cognitive function; depression; football; postconcussion syndrome; sports injuries.

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Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: A.P.-L. was partly supported by the Sidney R. Baer Jr Foundation, Defense Advanced Research Projects Agency, the Football Players Health Study (FPHS) at Harvard University, and Harvard Catalyst | The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences/National Institutes of Health, UL1 RR025758); serves on the scientific advisory boards for Neosync, Neuronix, Starlab Neuroscience, Neuroelectrics, Magstim Inc, Constant Therapy, and Cognito; and is listed as an inventor on several issued and pending patents on the real-time integration of transcranial magnetic stimulation with electroencephalography and magnetic resonance imaging. A.L.B. has received funding from the National Football League Players Association (NFLPA), the American Heart Association, and the American Society of Echocardiography and receives compensation for his role as team cardiologist from US Soccer, US Rowing, the New England Patriots, the Boston Bruins, the New England Revolution, and Harvard University. R.D.Z. received royalties from Oakstone for authorship of an educational CD and from Demos Publishing for serving as coeditor of Brain Injury Medicine; serves on the scientific advisory boards of Myomo, Oxeia Biopharma, ElMindA, and Biodirection; and evaluates patients in Massachusetts General Hospital’s Brain and Body–Trust Program, which is funded by the NFLPA. All other authors are either partially or fully supported by the FPHS at Harvard University, which is in turn sponsored by the NFLPA. Note that the NFLPA had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.

Figures

Figure 1.
Figure 1.
Poor cognition-related quality of life (QOL) by number of professional seasons and playing position among former National Football League players: Football Players Health Study (n = 3474). Poor cognition-related QOL was defined as a Neuro-QOL score ≤2 SD below the US population mean (T score ≤30). Positions were grouped according to the mean concussion symptoms per season for each position across all players in that position: low (≤2 symptoms/season: kickers, punters, and quarterbacks), medium (>2 to 3.3 symptoms/season: wide receivers, defensive backs, linemen, tight ends), and high (>3.3 symptoms/season: running backs, linebackers, special teams). Neuro-QOL, Quality of Life in Neurological Disorders: Applied Cognition–General Concerns.
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