Concussions and Mood Disorders: A Complex Relationship

Research involving retired NFL athletes found there was no connection between concussion history and depressive symptoms among those players who did not exhibit physical symptoms.

But the research, published in the Journal of Neuropsychiatry and Clinical Neurosciences, did find that physical problems such as body pain are a key pathway between sport-related concussions and depression.

“Our interest arose from the amount and type of media coverage focusing on the mental health of retired NFL athletes and possible mood symptoms often attributed to chronic traumatic encephalopathy,” study authors Scott L. Zuckerman, the co-director for research at the Vanderbilt Sports Concussion Center, and Benjamin Brett, a postdoctoral research fellow the Medical College of Wisconsin, told PsyPost.

“While it often gets portrayed that sustaining sport-related concussions while playing contact sports at any level will increase the risk of future mental health problems in former athletes, clinicians who are in the field treating these individuals know that it is a much more complex process and the source of psychiatric symptoms can be multifaceted.

“In other words,” the authors continued, “Not all former athletes who sustained a sport-related concussion (or multiple) will inevitably develop mood symptoms, such as depression, later in life and other factors likely play a role in this process. In that light, we wanted to further investigate the relationship between the number of self-reported concussions and depression symptoms in former NFL athletes, examining additional factors (i.e., somatic or physical symptoms) that may have an influence or moderate this relationship.”

The research involved having 43 former NFL players complete a battery of surveys, which were designed to measure clinical depression and somatic symptoms such as pain, dizziness and shortness of breath. The researchers also received a detailed head injury and concussion history from each player.

The players reported an average of 8.7 sport-related concussions. Concussions and depressive symptoms were significantly moderated by somatic symptoms. “In other words, former NFL players with more concussions tended to report more somatic symptoms, which in turn was associated with depression,” the researchers reported.

“We hope the average person takes away that the discussion of whether participation in contact sports can lead to later-life mental health and neurocognitive problems is complex, with many more questions than answers,” Zuckerman and Brett said.

“As our paper showed, the association between concussion history and depression, which is often portrayed as a causal relationship, was influenced by additional factors. In reality, the amount of bodily or somatic complaints had a larger effect than the number of concussions sustained by former NFL athletes.

“Further, the amount of bodily or somatic symptoms endorsed moderated the relationship between sport-related concussion history (number of concussions) and depressive symptoms. If you had minimal to no bodily/physical symptoms, there was virtually no relationship between the number concussions that an individual sustained while playing contact sports and depression symptoms later in life. The more bodily/physical symptoms were endorsed, the stronger the association between self-reported concussion history and depression symptoms.”

Still, there are questions as to whether results from analyzing NFL players can carry over to concussion related issues with athletes below the professional level. The more important public health questions are if these results apply to college, high school, or youth football players. We cannot answer those questions from this paper,” Zuckerman and Brett explained.

Want to learn more about efforts being made to keep high school students safe from concussions? Read our article, “High Tech for Brain Health: Concussion Baseline Testing.”

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