High School Football and Risk for Depression and Suicidality in Adulthood: Findings From a National Longitudinal study.
Iverson GL, Terry DP. Front Neurol. 2022;12. doi:10.3389/fneur.2021.812604
Participation in football before and during high school may not increase the risk of mental health disorders in men later in life. However, adolescent mental health concerns may predict who will experience mental health disorders during adulthood.
Participating in football, especially as an adolescent, continually raises concerns over the potential long-term health consequences of repeated concussive and sub-concussive blows. These concerns include mental health disorders later in life. However, we know very little about the relationship between participation in high school football and long-term mental health concerns in the general population.
The authors used publicly available data from a prospective cohort study to determine if former high school football players experience mental health disorders later in life at a greater rate than their non-football counterparts. Furthermore, the authors aimed to identify if mental health difficulties during adolescence increased the risk of mental health disorders in adulthood.
The authors accessed publicly available data from the National Longitudinal Study of Adolescent to Adult Health, which enrolled students from 7th to 12th grade in the mid-1990s. During this initial interview, participants indicated if they participated or planned to participate in football. These participants then completed a follow-up interview from 2016 to 2018 when they were 34-44 years old. The authors analyzed data from 1,805 men that answered questions about depression and suicidality during the follow-up interview.
Someone with a history of football participation had a similar chance of reporting a depression diagnosis(14 vs. 18%), an anxiety diagnosis (13 vs. 16%), attending psychological counseling in the prior year(10 vs. 12%), suicidal ideation in the past year (6 vs. 7%), and feelings of depression in the prior week (4 vs. 6%) as a person without a history of football. The need for psychological counseling or suicidal ideation during adolescence increased the odds of mental health disorders during adulthood.
This study, along with several others, supports the notion that participation in high school football does not increase the risk of mental health disorders later in life. As with any survey-based study, a participant may introduce bias when selecting an answer that does not truly represent their actions. For example, the authors relied on male students who actively participated in football and those who indicated they planned to participate in football. Therefore, some individuals never participated in high school football, making the football group look more like those who never played football. Nonetheless, for those who did participate in football, protective factors related to sports participation (e.g., decreased obesity, improved self-confidence) may help prevent the onset of these mental health concerns. Furthermore, youth sport participation improves healthy-living behaviors during adulthood, including exercise, which bolsters these protective factors.
While football may not be related to an increased risk for mental health concerns, sports medicine professionals must remain vigilant for mental health disorders because more than 1 in 8 men report a diagnosis. A sports medicine professional should develop a robust mental health referral network, emergency action plan, and wellness education to treat and prevent persistent symptoms throughout the lifetime.
Questions for Discussion
What, if any, procedures have you established to ensure an adequate mental health referral network? How have you navigated athlete mental health needs in your facility? How do you think other clinicians (and yourself) can improve patient outcomes following a mental health diagnosis?
- We Need to Break the Stigma of Seeking Mental Health Services among Student-Athletes
- Many NCAA Clinicians Fail to Screen Mental Health
- Playing High School Football May Not Lead to Impaired Cognition or Depression
Written by: Cade Watts
Reviewed by: Jeffrey Driban
I believe it is important for every institution to have a mental health referral network. As an athletic trainer we are usually the first person athletes such as football players come to with any of their problems, so it is imperative we know how to handle and refer any situation. Personally, when athletes talk to me about mental health problems I listen with non-judgement and offer the best advice I can give. If I notice red flags or the need for an immediate referral I would talk to my preceptor about following the correct procedures.
This serves as a great example for how athletic training students (ATSs) should address the difficulties surrounding mental health concerns during clinical rotations. The approach you mentioned regarding non-judgement and open communication is critical for athletes as we are certainly some of the first people to hear about any mental health challenges. Oftentimes, there is no established mental health emergency action plan established, but hopefully this starts to changes as we continue to realize ‘mental health is health’. These skills will serve you well throughout your career! Thanks for the comment and read!
There is an obvious need to address mental health in adolescent athletes. I think researching what mental health providers are available in the community to begin a referral network is helpful. In the secondary setting, utilizing both school resources and outside community resources. There are a wide range of online resources, infographics, and hotlines that can be posted throughout ATRs to continue to try and end the stigma against mental health as well as promote self-efficacy in seeking help. Another way I have seen athlete mental health addressed in my facility is through the inclusion of numerous mental health screenings during pre-participation exams. I also think it is beneficial for staff to have written procedures for routine referral as well emergent referral, identifying key stakeholders and chain of command with proper documenting and reporting. I think that outcomes following mental health diagnosis will continue to improve as society normalizes talking about mental health. The more we humanize athletes and talking about mental health, the more we will see patients speak up.
I’m glad to hear that mental health examinations have become a part of your facility’s pre-participation exam. This is a trajectory many organizations should be taking so healthcare professionals know more about their clients needs. Your mention of other resources within the school system is crucial. It seems that people forget that many, if not all, school counselors are trained to mental health. There are some great organizations helping to fight the stigma too (such as The Hidden Opponent). Finally, I agree that as the stigma continues to reduce, more athletes will come forward which will only help break down more and barriers to mental healthcare access.
Mental health has been a massive threat to college students and college athletes. I believe to establish an excellent mental health referral network; institutions should have a specific policy and guidelines along with an EAP specifically for mental health. We have specific policies and produces for events such as cardiac arrest to ensure the best practices and steps are taken to save a life, and we should have the same requirements for mental health. A specific policy and procedures related to mental health will give clinicians a quick and practical step-by-step process of what to do if they believe an athlete is having a mental health crisis. Additionally, all clinicians should be taught how to recognize signs and symptoms of mental health disorders and should be comfortable with having these difficult conversations with athletes. Following a mental health diagnosis, I think clinicians should have a weekly check-in with the patient, whether it’s an in-person conversation or having the athlete fill out a POC. This way, the clinician can stay on track with the athlete’s feelings and status, quickly identify if a decline is happening, and provide additional resources to ensure the athlete gets the support they need.