Self-Reported Cognitive Function and Mental Health Diagnoses among Former Professional American-Style Football Players.

Franziska Plessow,Alvaro Pascual-Leone,Theodore K Courtney,Frank E Speizer,Jillian Baker,William P Meehan,Ross D Zafonte,Marc G Weisskopf,Supriya Krishnan,Lee M Nadler,Ann Connor,Aaron Baggish,Herman A Taylor,Caitlin M Mccracken

doi:10.1089/neu.2019.6661

Abstract

Clinical practice strongly relies on patients' self-report. Former professional American-style football players are hesitant to seek help for mental health problems, but may be more willing to report cognitive symptoms. We sought to assess the association between cognitive symptoms and diagnosed mental health problems and quality of life among a cohort of former professional players. In a cross-sectional design, we assessed self-reported cognitive function using items from the Quality of Life in Neurological Disorders (Neuro-QOL) Item Bank. We then compared mental health diagnoses and quality of life, assessed by items from the Patient-Reported Outcome Measurement Information System (PROMIS®), between former professional players reporting daily problems in cognitive function and former players not reporting daily cognitive problems. Of the 3758 former professional players included in the analysis, 40.0% reported daily problems due to cognitive dysfunction. Former players who reported daily cognitive problems were more likely to also report depression (18.0% vs. 3.3%, odds ratio [OR] = 6.42, 95% confidence interval [CI] [4.90–8.40]) and anxiety (19.1% vs. 4.3%, OR = 5.29, 95% CI [4.14–6.75]) than those without daily cognitive problems. Further, former players reporting daily cognitive problems were more likely to report memory loss and attention deficit(/hyperactivity) disorder and poorer general mental health, lower quality of life, less satisfaction with social activities and relationships, and more emotional problems. These findings highlight the potential of an assessment of cognitive symptoms for identifying former players with mental health, social, and emotional problems.

Highlights

Mental health and quality of life among professional American-style football (ASF) players beyond their active playing years has become a key area of interest in sports medicine
Former professional players with daily problems in cognitive function were more likely to have a diagnosis of depression, anxiety, memory loss, or ADD/ADHD (Table 3)
These effects remained significant after adjusting for age and sleep apnea: depression: aOR = 6.17, 95% confidence interval (CI) [4.67–8.15]; anxiety: aOR = 5.06, 95% CI [3.93–6.52]; memory loss: aOR = 21.13, 95% CI [11.57– 38.58]; and ADD/ADHD: aOR = 4.73, 95% CI [3.22–6.95]

Summary

Introduction

Mental health and quality of life among professional American-style football (ASF) players beyond their active playing years has become a key area of interest in sports medicine. The Football Players’ Health Study at Harvard University is designed to pursue research that can lead to improvements in health and quality of life among former professional ASF players.[14,15] A core element of our research approach is the close collaboration among scientists, former professional ASF players, and their families when identifying, prioritizing, and pursuing medical problems of interest. In the course of the study, our focus groups revealed that, whereas former professional players are willing to report cognitive difficulties, which are viewed by many as related to repeated impacts to the head during play, they are reluctant to report mental health problems, such as depression and anxiety. A recent qualitative study interviewing 25 current and former NFL players together with 27 family members revealed in 15 interviews that concerns around managing mental health challenges created a barrier to seeking support for experienced mental distress.[16]

Methods

Results

Conclusion