Cited by 112Suicide and Self-Harm StudiesTraumatic Brain Injury ResearchSports injuries and prevention

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Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons

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Lehman, Everett J., Hein, Misty J., Gersic, Christine M.·2016·The American Journal of Sports Medicine

DOI 10.1177/0363546516645093PMC PMC5048489

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Abstract

BACKGROUND: There is current disagreement in the scientific literature about the relationship between playing football and suicide risk, particularly among professional players in the National Football League (NFL). While some research indicates players are at high risk of football-related concussions, which may lead to chronic traumatic encephalopathy and suicide, other research finds such a connection to be speculative and unsupported by methodologically sound research. PURPOSE: To compare the suicide mortality of a cohort of NFL players to what would be expected in the general population of the United States. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A cohort of 3439 NFL players with at least 5 credited playing seasons between 1959 and 1988 was assembled for statistical analysis. The vital status for this cohort was updated through 2013. Standardized mortality ratios (SMRs), the ratio of observed deaths to expected deaths, and 95% CIs were computed for the cohort; 95% CIs that excluded unity were considered statistically significant. For internal comparison purposes, standardized rate ratios were calculated to compare mortality results between players stratified into speed and nonspeed position types. RESULTS: Suicide among this cohort of professional football players was significantly less than would be expected in comparison with the United States population (SMR = 0.47; 95% CI, 0.24-0.82). There were no significant differences in suicide mortality between speed and nonspeed position players. CONCLUSION: There is no indication of elevated suicide risk in this cohort of professional football players with 5 or more credited seasons of play. Because of the unique nature of this cohort, these study results may not be applicable to professional football players who played fewer than 5 years or to college or high school players.

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BackgroundInfluential
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Background
Chronic Traumatic Encephalopathy in a National Football League Player
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Self-citation
Long‐term Consequences of Repetitive Brain Trauma: Chronic Traumatic Encephalopathy
Stern, R. A., Riley, D., Daneshvar, D. H., Nowinski, C. J., Cantu, R. C., & McKee, A. C. (2011) · PM&R · doi:10.1016/j.pmrj.2011.08.008 · Cited by 598 · cited 1×
“Those who question the football play/concussion/CTE/ suicide connection most commonly reference the significant limitations of the evidence used to support the connection: the selection bias of cases examined for CTE, the lack of information about preexisting or comorbid conditions, and the incomplete ascertainment of…”
Background
Emerging histomorphologic phenotypes of chronic traumatic encephalopathy in American athletes
Omalu, B., Bailes, J., Hamilton, R. L., Kamboh, M. I., Hammers, J., Case, M., & Fitzsimmons, R. (2011) · Neurosurgery · doi:10.1227/neu.0b013e318212bc7b · Cited by 381
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Show all 32 references

Research works printed but not linked: 3

Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health (NIOSH), 1994, National Football League Players Mortality Study
Weir DR, 2009, National Football League Player Care Foundation: Study of Retired NFL players
World Health Organization, 1992, ICD-10 Classifications of Mental and Behavioural Disorder: Clinical Descriptions and Diagnostic Guidelines

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Background
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Background
Introducing LTASR, a new R package based on the NIOSH Life Table Analysis System
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Chronic traumatic encephalopathy neuropathologic change is uncommon in men who played amateur American football
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“For example, our environment may contain factors that influence our genetics through epigenetic mechanisms that adversely influence endothelial function [17] When the cerebral blood vessels are affected in this manner, there is an increased risk of brain infarcts and attendant cognitive decline.”
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Mental Health Outcomes Following Sport-Related Concussion
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“Notably, suicidality was not a commonly described feature of historical cases of dementia pugilistica 32,33 ; an epidemiological study following former National Football League players through 2013 demonstrated lower rates of suicide than expected in a comparable general population 34 .”
Clinical Outcomes and Tau Pathology in Retired Football Players
Banks, S. J., Yhang, E., Tripodis, Y., Su, Y., Protas, H. D., Adler, C. H., Balcer, L. J., Bernick, C. B., Mez, J., Palmisano, J. N., et al. (2024) · Neurology Clinical Practice · doi:10.1212/cpj.0000000000200263 · Cited by 6
Suicide in Older Adult Men Is Not Related to a Personal History of Participation in Football
Iverson, G. L., Deep‐Soboslay, A., Hyde, T. M., Kleinman, J. E., Erskine, B., Fisher‐Hubbard, A., deJong, J. L., & Castellani, R. J. (2021) · Frontiers in Neurology · doi:10.3389/fneur.2021.745824 · Cited by 6
“Lehman and colleagues (13) examined suicide mortality in a cohort of 3,439 NFL players who played between 1960 and 2013 and identified 12 who had died by suicide (0.”
Background
Neuropsychologists' perspectives of chronic traumatic encephalopathy (CTE)
Kanser, R. J., Kretzmer, T. S., Soble, J. R., & Hanks, R. A. (2023) · The Clinical Neuropsychologist · doi:10.1080/13854046.2023.2241191 · Cited by 6
“Suicide rates have been shown to be reduced relative to the general population in TBI prone populations (e.g. NFL players; Lehman et al., 2016).”
Case Studies in Sports Psychiatry
Runswick, O. R. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187 · Cited by 5
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Post-concussion Syndrome: Persistent Post-concussive Symptoms (PPCS) or Persistent Symptoms after Concussion (PSaC)
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Participation in Professional American-Style Football and Suicide Mortality: 1979–2019
Grashow, R. G., Konstantinides, N. A., Anderson, B. C., Leung, M., Fung, E. N., Baggish, A. L., Daneshvar, D. H., Grove, W., ZAFONTE, R. D., & Weisskopf, M. G. (2026) · Journal of Neurotrauma · doi:10.1177/08977151251408496 · Cited by 3
“Previous studies have shown reduced suicide mortality in elite athletes when compared with general populations, 15,39 – 41 but many differences between elite athletes and general populations (e.g., history of exercise and training, access to health care, salary discrepancies) complicate efforts to…”
Cardiovascular disease in retired NFL players: a systematic review
Sisk, M. R., Medawar, N. G., McClure, M., Cooke, B., Cannon, R., Kufner, D., D’Almeida, S., Jardaly, A. H., Asif, I. M., Momaya, A. M., et al. (2024) · The Physician and Sportsmedicine · doi:10.1080/00913847.2024.2315929 · Cited by 4
“Neurologic and psychiatric studies have evaluated anatomic changes [2–5], psychiatric disease [6,7], and neuro-degenerative disease [8,9] in this population.”
Considerations for Present and Future Research on Former Athlete Health and Well-being
Kerr, Z. Y., Chandran, A. S., & DeFreese, J. D. (2019) · JAMA Network Open · doi:10.1001/jamanetworkopen.2019.4222 · Cited by 4
Neurodegenerative mortality among National Football League Players
Luster, C. B., Abdolmohammadi, B., Mastrodicasa, M. J., Nowinski, C. J., Feigel, E. D., Finegan, B., White, A. J., Connors, E. J., Rovito, C. A., ZAFONTE, R. D., et al. (2026) · EClinicalMedicine · doi:10.1016/j.eclinm.2026.104051 · Cited by 2
“27 However, mental health remains a critical consideration for NFL players, influenced by factors such as adverse childhood experiences, lower socioeconomic status during childhood, and the stigma associated with seeking care.”
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Suicide in Elite Sport
Gorczynski, P. F., & McCabe, T. (2024) · Advances in Psychiatry and Behavioral Health · doi:10.1016/j.ypsc.2024.05.009 · Cited by 3
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Kindliches Schädel-Hirn-Trauma – Gehirnerschütterung
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Sports and Suicide
Reider, B. J. (2016) · The American Journal of Sports Medicine · doi:10.1177/0363546516670626 · Cited by 2
Chronic Traumatic Encephalopathy
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Neurodegenerative Disease Death Certification Among National Football League Players With Dementia
Luster, C. B., Nowinski, C. J., Abdolmohammadi, B., Feigel, E. D., Mastrodicasa, M. J., Finegan, B., Goldstein, L. E., Katz, D. I., Cantu, R. C., Dwyer, B. C., et al. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.31614 · Cited by 1
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Alosco, M. L., & Yaffe, K. S. (2024) · JAMA Neurology · doi:10.1001/jamaneurol.2024.3078 · Cited by 1
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Background
Appendix: International Society for Sports Psychiatry Curriculum 2018
Mistry, A. D., McCabe, T., & Currie, A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108767187.013

Authors: Lehman, E. J., Hein, M. J., & Gersic, C. M.
Affiliations: Centers for Disease Control and Prevention (US)
Corresponding author: Lehman, Everett J.
Venue: The American Journal of Sports Medicine
Publisher: SAGE Publications
Published: 2016-07-20
Volume: 44
Issue: 10
Pages: 2486-2491
ISSN: 0363-5465 (ISSN-L)
1552-3365
DOI: 10.1177/0363546516645093
PMC: PMC5048489
OpenAlex: W2345347046
Cited by: 112
References: 32
Citations by year: 2026: 5 · 2025: 6 · 2024: 10 · 2023: 12 · 2022: 5 · 2021: 9 · 2020: 25 · 2019: 17 · 2018: 9 · 2017: 11 · 2016: 3
FWCI: 17.85
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: The American Journal of Sports Medicine (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (CC999999)
Topics: Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Health Sciences › Medicine › Clinical Neurology › Traumatic Brain Injury Research
Health Sciences › Medicine › Orthopedics and Sports Medicine › Sports injuries and prevention
Keywords: suicide mortality, National Football League players, professional football, chronic traumatic encephalopathy, standardized mortality ratio, suicide risk, former athletes
MeSH terms: Adolescent, Adult, Football, Humans, Male, Middle Aged, Retirement, Seasons, Suicide, United States, Cohort Studies

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Suicide Mortality Among Retired National Football League Players Who Played 5 or More Seasons

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