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Concussion May Lead to High Depression Rate in Retired NFL Players


SAN DIEGO—Among older retired players from the National Football League (NFL) who have a history of concussion, about 40% have mild to moderate symptoms of depression, a rate nearly three times higher than that of the general population, according to research presented at the 65th Annual Meeting of the American Academy of Neurology.

Concussions in the former football players were specifically related to cognitive symptoms of depression, such as sadness, feelings of worthlessness or self-criticism, and suicidal thoughts, reported Nyaz Didehbani, PhD, and colleagues from the University of Texas at Dallas and University of Texas Southwestern Medical Center. In addition, somatic complaints were more prominent in the athletes compared with other items on the Beck Depression Inventory–II (BDI–II), even though the symptoms were not significantly correlated with concussions.

“Overall, results indicated that individuals having sustained concussions in early adulthood may be at a higher risk for developing depression as they age, compared to the general population,” stated Dr. Didehbani, a research psychologist at the Center for BrainHealth, University of Texas at Dallas. “More specifically, concussions were related to cognitive symptoms of depression, and it is possible that the high endorsement of somatic symptoms may be related to pain or other factors.”

Postconcussion Effects in Former NFL Players
Previous research has shown that concussions can lead to cognitive and mood disturbances, though few studies had explored the effects that may occur as players age. Dr. Didehbani’s group compared 30 retired NFL veterans who had had a concussion with 29 age-, education-, and IQ-matched healthy controls without a history of concussion. In both groups, ages ranged from 41 to 77, with a mean of 59 in the athletes and a mean of 60 in controls.

The investigators performed detailed neuropsychologic examinations in all participants to rule out cognitive impairment. All subjects completed the BDI–II, and participants’ scores were assessed according to a three-factor model of depressive symptoms (cognitive, affective, and somatic). Data regarding concussions were retrospectively obtained with use of the American Academy of Neurology Practice Parameter for grading concussions.

A Significant Correlation Between Concussion and Depression
The researchers found a significant correlation between the number of lifetime concussions in the former players and total scores on the BDI–II. In addition, the number of concussions was significantly correlated with cognitive symptoms on the BDI–II (r = 0.56). BDI-II scores were not associated with age, education, IQ, or the number of years played. Furthermore, the former athletes had significantly higher scores regarding cognitive, affective, and somatic symptoms.

Twelve of the 30 players (40%) had mild to moderate symptoms of depression, compared with the national average rate of 15% in older adults. The athletes had more symptoms on every BDI–II item, and on 13 of the 21 items the rate of symptoms was at least 20% higher, compared with controls. The largest differences between athletes and controls were observed in reports of problems with concentration (53% vs 19%, respectively), changes in appetite (47% vs 13%), loss of energy (60% vs 29%), changes in sleep (57% vs 26%), and decreased interest in sex (43% vs 16%).

Overall, the findings “highlight the need to educate individuals and families about somatic and psychologic symptoms associated with depression and to thoroughly assess depressive symptoms throughout the lifespan in professional athletes,” concluded Dr. Didehbani.

—Colby Stong

Suggested Reading
Didehbani N, Munro Cullum C, Mansinghani S, et al. Depressive symptoms and concussions in aging retired NFL players. Arch Clin Neuropsychol. 2013 May 3 [Epub ahead of print].
Hart J Jr, Kraut MA, Womack KB, et al. Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players: a cross-sectional study. JAMA Neurol. 2013;70(3):326-335.

[To listen to an audiocast with Nyaz Didehbani, click here.]

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