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