Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players

Kerr, Zachary Y.; Marshall, Stephen W.; Harding, Herndon P.; Guskiewicz, Kevin M.

doi:10.1177/0363546512456193

Cited by 282Traumatic Brain Injury ResearchSports injuries and preventionCOVID-19 and Mental Health

Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players

Kerr, Zachary Y., Marshall, Stephen W., Harding, Herndon P., Guskiewicz, Kevin M.·2012·The American Journal of Sports Medicine

DOI 10.1177/0363546512456193

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Abstract

BACKGROUND: Concussions may accelerate the progression to long-term mental health outcomes such as depression in athletes. PURPOSE: To prospectively determine the effects of recurrent concussions on the clinical diagnosis of depression in a group of retired football players. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Members of the National Football League Retired Players Association responded to a baseline General Health Survey (GHS) in 2001. They also completed a follow-up survey in 2010. Both surveys asked about demographic information, number of concussions sustained during their professional football career, physical/mental health, and prevalence of diagnosed medical conditions. A physical component summary (Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being [SF-36 PCS]) was calculated from responses for physical health. The main exposure, the history of concussions during the professional playing career (self-report recalled in 2010), was stratified into 5 categories: 0 (referent), 1 to 2, 3 to 4, 5 to 9, and 10+ concussions. The main outcome was a clinical diagnosis of depression between the baseline and follow-up GHS. Classic tabular methods computed crude risk ratios. Binomial regression with a Poisson residual and robust variance estimation to stabilize the fitting algorithm estimated adjusted risk ratios. χ(2) analyses identified associations and trends between concussion history and the 9-year risk of a depression diagnosis. RESULTS: Of the 1044 respondents with complete data from the baseline and follow-up GHS, 106 (10.2%) reported being clinically diagnosed as depressed between the baseline and follow-up GHS. Approximately 65% of all respondents self-reported sustaining at least 1 concussion during their professional careers. The 9-year risk of a depression diagnosis increased with an increasing number of self-reported concussions, ranging from 3.0% in the "no concussions" group to 26.8% in the "10+" group (linear trend: P < .001). A strong dose-response relationship was observed even after controlling for confounders (years retired from professional football and 2001 SF-36 PCS). Retired athletes with a depression diagnosis also had a lower SF-36 PCS before diagnosis. The association between concussions and depression was independent of the relationship between decreased physical health and depression. CONCLUSION: Professional football players self-reporting concussions are at greater risk for having depressive episodes later in life compared with those retired players self-reporting no concussions.

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The third finding, on the effects of recurrent injuries, is broadly consistent with the emerging literature on the adverse consequences of sports and combat-related neurotrauma.
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From Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes (2016) · cites this paper as [12]
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From Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes (2016) · cites this paper as [12]

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Authors: Kerr, Z. Y., Marshall, S. W., Harding, H. P., & Guskiewicz, K. M.
Affiliations: University of North Carolina at Chapel Hill (US)
Florida State University (US)
ORCID: Kerr, Zachary Y.
Marshall, Stephen W.
Guskiewicz, Kevin M.
Venue: The American Journal of Sports Medicine
Publisher: SAGE Publications
Published: 2012-08-24
Volume: 40
Issue: 10
Pages: 2206-2212
ISSN: 0363-5465 (ISSN-L)
1552-3365
DOI: 10.1177/0363546512456193
OpenAlex: W1983025973
Cited by: 282
References: 44
Citations by year: 2026: 11 · 2025: 4 · 2024: 15 · 2023: 19 · 2022: 13 · 2021: 37 · 2020: 27 · 2019: 25 · 2018: 25 · 2017: 27 · 2016: 23 · 2015: 29 · 2014: 13 · 2013: 11 · 2012: 3
FWCI: 13.30
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: The American Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
Funders: National Football League Players Association
Brain Injury Research Center
Topics: Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
Keywords: depression, concussion, recurrent concussion, National Football League, long-term mental health outcomes, dose-response relationship, physical health, physical component summary, SF-36, sports-related brain injury
MeSH terms: Athletic Injuries, Brain Concussion, Depression, Follow-Up Studies, Football, Humans, Male, Prospective Studies, Recurrence, Retirement, Risk Factors, Self Report

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Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players

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