Neurotrauma

Suicidality and Perceived CTE: Is There a Connection in Former Football Players?

Hibah Khaja, PharmD
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Publish Date
An increased prevalence of suicidality was linked to perceived chronic traumatic encephalopathy, which was reported by 34% of former professional football players.

Nearly one-third of living former professional football players reported perceived chronic traumatic encephalopathy (CTE), which was associated with an increased prevalence of suicidality and cognitive impairment, according to study results published in JAMA Neurology.

Researchers conducted a cross-sectional, population-based study between 2017 and 2020 to decipher the percentage and clinical profile of living former football players who participated in a professional league between 1960 and 2020 and reported perceived CTE. The 9-item Patient Health Questionnaire (PHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) Questionnaire were used to assess symptoms of depression and anxiety, respectively, over the previous 2 weeks. Perceived cognitive difficulties were measured using the Quality of Life in Neurological Disorders (Neuro-QoL) Applied Cognition General Concerns scale, while emotional and neurobehavioral dyscontrol was evaluated using the Neuro-QoL Emotional and Behavioral Dyscontrol questionnaire. Lastly, pain intensity was assessed using a single Brief Pain Inventory survey item. The primary outcome was the proportion of participants who reported perceived CTE. Logistic regression models were used in statistical analyses.

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Future work will be required to determine the degree to which perceived CTE aligns with the true presence of this pathology as substantiated by neuropathological evidence or a future antemortem test.

A total of 1980 retired football players (mean age, 57.7; White, 65.8%; mean body mass index [BMI], 30.8 kg/m2; mean professional football career duration, 7 years) were included in the study, of whom 681 reported perceived CTE and 1299 did not report perceived CTE.

According to fully adjusted multivariable logistic regression, significant predictors of perceived CTE included:

  • Subjective cognitive difficulties (odds ratio [OR] per SD unit, 1.91; 95% CI, 1.58-2.31; P <.001);
  • Low testosterone levels (OR, 1.42; 95% CI, 1.04-1.94; P =.03);
  • CSS score (OR per SD unit, 1.34; 95% CI, 1.18-1.53; P <.001);
  • Depressive symptoms (OR per SD unit, 1.33; 95% CI, 1.07-1.65; P =.01)
  • Emotional and behavioral dyscontrol symptoms (OR per SD unit, 1.24; 95% CI, 1.03-1.48; P =.02); and,
  • Pain intensity (OR, 1.11; 95% CI, 1.04-1.19; P =.001).

Older age was related to lower odds of perceived CTE (OR per SD unit, 0.97; 95% CI, 0.96-0.98; P <.001).

Individuals with vs without perceived CTE had significantly higher rates of suicidality (25.4% vs 5.0%, respectively). After adjusting for established predictors of suicidality (ie, depression), former players with vs without perceived CTE remained approximately twofold more likely to report suicidal or self-harm thoughts (OR, 2.06; 95% CI, 1.36-3.12; P <.001).

Study limitations include the cross-sectional design, reliance on self-reported comorbidity data, and potential sample bias and misclassification.

“Future work will be required to determine the degree to which perceived CTE aligns with the true presence of this pathology as substantiated by neuropathological evidence or a future antemortem test,” the study authors concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

References:

 Grashow R, Terry DP, Iverson GL, et al. Perceived chronic traumatic encephalopathy and suicidality in former professional football players. JAMA Neurol. Published online September 23, 2024. doi:10.1001/jamaneurol.2024.3083