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Cited by 107Traumatic Brain Injury ResearchSports injuries and preventionPosttraumatic Stress Disorder Research

Association between concussion and mental health in former collegiate athletes

Open access
Kerr, Zachary Y, Evenson, Kelly R, Rosamond, Wayne D, Mihalik, Jason P, Guskiewicz, Kevin M, Marshall, Stephen W·2014·Injury Epidemiology
DOI 10.1186/s40621-014-0028-xPMC PMC5005582
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Abstract

BACKGROUND: The existing research on the association between concussion and mental health outcomes is largely limited to former professional athletes. This cross-sectional study estimated the association between recurrent concussion and depression, impulsivity, and aggression in former collegiate athletes. METHODS: Former collegiate athletes who played between 1987-2012 at a Division I university completed an online questionnaire. The main exposure, total number of self-recalled concussions (sport-related and non-sport-related), were categorized as: zero (referent), one, two, or three or more concussions. The main outcomes were the depression module of The Patient Health Questionnaire (PHQ-9), the Short Form of the Barratt Impulsiveness scale (BIS15); and the 12-item Short Form of the Buss-Perry Aggression Questionnaire (BPAQ-SF). Depression was categorized into a binomial severity classification that differentiated between no or mild depression (PHQ-9 scores <10) and moderate to severe depression (PHQ-9 scores ≥10). Impulsivity and aggression were kept as continuous outcomes. Binomial regression estimated adjusted prevalence ratios (PR). Linear regression estimated adjusted mean differences (MD). RESULTS: Of the 797 respondents with complete data (21.9% completion rate), 38.8% reported at least one concussion. Controlling for alcohol dependence and family history of depression, the prevalence of moderate to severe depression among former collegiate athletes reporting three or more concussions in total was 2.4 times that of those reporting zero concussions [95% Confidence Interval (CI): 1.0, 5.7]. Controlling for alcohol dependence, family history of anxiety, relationship status, obtaining a post-graduate degree, and playing primary college sport professionally, former collegiate athletes reporting two or more concussions in total had higher mean scores for impulsivity, compared to those reporting no concussions (2 concussions MD = 2.7; 95% CI: 1.2, 4.1; 3+ concussions MD = 1.9; 95% CI: 0.6, 3.2). Controlling for alcohol dependence, sex, and relationship status, former collegiate athletes reporting three or more concussions in total had a higher mean score for aggression, compared to those reporting no concussions (MD = 3.0; 95% CI: 1.4, 4.7). CONCLUSIONS: Our study found an association between former concussion and greater risk of severe depression and higher levels of impulsivity and aggression among former collegiate athletes. Additional prospective studies better addressing causality and ascertaining valid lifetime concussion histories and medical histories are needed.

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  • Unique challenges such as the long-term impact of concussions could elevate the mental health risk for the college athlete population.

    “Unique challenges such as the long-term impact of concussions (traumatic brain injury) on the neural system could also elevate the mental health risk for the college athlete population [2,3].”

    From Mobile-Delivered Mindfulness Intervention on Anxiety Level Among College Athletes: Randomized Controlled Trial (2024) · cites this paper as [2]

    The Conclusions report an association between prior concussion and greater risk of severe depression, impulsivity, and aggression among former collegiate athletes, while cautioning that causality needs further study. This supports the hedged mental-health concern, but the study does not establish a neural-system mechanism or directly study current college athletes. (LLM, conf=0.82)

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Authors
Kerr, Z. Y., Evenson, K. R., Rosamond, W. D., Mihalik, J. P., Guskiewicz, K. M., & Marshall, S. W.
Affiliations
University of North Carolina at Chapel Hill (US)
Corresponding author
Kerr, Zachary Y
ORCID
Venue
Injury Epidemiology
Publisher
Springer Science and Business Media LLC
Published
2014-11-17
Volume
1
Issue
1
Pages
28-28
ISSN
2197-1714 (ISSN-L)
DOI
10.1186/s40621-014-0028-x
PMC
PMC5005582
OpenAlex
W2148244860
Cited by
107
References
42
Citations by year
2026: 3 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 8 · 2021: 22 · 2020: 9 · 2019: 7 · 2018: 16 · 2017: 10 · 2016: 5 · 2015: 5
FWCI
5.05
Type
journal article
Language
en
Open access
Licence
Locations
  • Injury Epidemiology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • IUScholarWorks (Indiana University) (submittedVersion, cc-by-nc-nd)
Funders
  • Centers for Disease Control and Prevention (R49CE001495)
  • Injury Prevention Research Center
  • 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 › Posttraumatic Stress Disorder Research
Keywords
concussion, mental health, depression, impulsivity, aggression, recurrent concussion, sports-related concussion, alcoholism, family history of depression, Barratt Impulsiveness Scale, Buss-Perry Aggression Questionnaire, PHQ-9, professional athletes, risk factors for depression, risk factors for aggression

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