The authors wrote, “Participation in American-style football (ASF) has been linked to chronic traumatic encephalopathy neuropathological change (CTE-NC), a specific neuropathologic finding that can only be established at autopsy. Despite being a postmortem diagnosis, living former ASF players may perceive themselves to have CTE-NC. At present, the proportion and clinical correlates of living former professional ASF athletes with perceived CTE who report suicidality are unknown.”
The objective of this cross-sectional study was to ascertain the percentage, clinical correlates, and suicidality of living former professional ASF players with perceived CTE.
The study involved former NFL players who contracted with a professional league from 1960 to 2020 and volunteered to complete a baseline survey. It was conducted from 2017 to 2020 by a team including Mass General Brigham researchers who are part of the Football Players Health Study at Harvard University. Data for this study were analyzed from June 2023 through March 2024.
Among 4,180 former professional ASF players who volunteered to complete a baseline survey, 1980 (47.4%) provided follow-up data with an average age of 57.7 years. Perceived CTE was reported by 681 participants (34.4%).
The researchers noted that subjective cognitive difficulties, low testosterone level, headache, concussion signs and symptoms accrued during playing years, depressive/emotional and behavioral dyscontrol symptoms, pain, and younger age were significantly correlated with perceived CTE.
Additionally, suicidality was reported by 171 of 681 participants with perceived CTE (25.4%) and 64 out of 1,299 without perceived CTE (5.0%). Even after adjusting for established suicidality predictors like depression, men with perceived CTE remained twice as likely to report suicidality (odds ratio, 2.06; 95% CI, 1.36-3.12; P <.001).
Based on their findings, the authors concluded that the study revealed that an estimated one-third of living former professional NFL players reported perceived CTE, and men with perceived CTE had higher rates of suicidality and were more likely to experience cognitive impairment–related health issues compared with those without perceived CTE.
“Perceived CTE represents a novel risk factor for suicidality and, if present, should motivate the diagnostic assessment and treatment of medical and behavioral conditions that may be misattributed to CTE-NC,” the authors concluded.
Co-author Ross Zafonte, president of Spaulding Rehabilitation, chief of the Departments of Physical Medicine and Rehabilitation at Massachusetts General Hospital and Brigham and Women’s Hospital, and principal investigator of the Football Players Health Study at Harvard University, stated, “As complex human beings, our beliefs can exert a strong impact on our health. The symptoms that raise CTE concerns are real, and CTE concerns are valid, but it’s critical to understand that having persistent fears about this condition can take a toll on mental health. When these concerns discourage former NFL players from receiving effective treatments for other or interrelated conditions related to physical and emotional health, it’s our responsibility to intervene.”
Lead author Rachel Grashow from the Harvard T.H. Chan School of Public Health stated, “A key takeaway from this study is that many conditions common to former NFL players such as sleep apnea, low testosterone, high blood pressure, and chronic pain can cause problems with thinking, memory, and concentration.”
Dr. Grashow added, “While we wait for advances in CTE research to better address living players’ experiences, it is imperative that we identify conditions that are treatable. These efforts may reduce the chances that players will prematurely attribute symptoms to CTE, which may lead to hopelessness and thoughts of self-harm.”
The researchers also noted, “Since CTE can currently only be diagnosed on autopsy, the researchers cannot rule out the possibility that some of the players who reported concerns do, in fact, have CTE-related brain changes,” adding, “It’s important for former players and their clinicians to focus on the things that can be treated.”
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