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Mental health and suicide in former professional soccer players
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  • Published on:
    Reply to: Mental health and suicide in former professional soccer players
    • Emma R Russell, Postgraduate Student University of Glasgow
    • Other Contributors:
      • Thomas McCabe, Specialty Trainee in Psychiatry
      • Daniel F Mackay, Professor of Public Health Informatics
      • Katy Stewart, Sports Scientist
      • John A MacLean, Medical Director
      • Jill P Pell, Director of Institute of Health and Wellbeing
      • William Stewart, Consultant Neuropathologist

    We thank White and colleagues for their correspondence on our article(1) and note many of the observations raised are already addressed by our robust study design and discussed in the original manuscript text. Importantly, we are quite clear throughout that this is a study designed to investigate whether there is higher risk of common mental health disorder in former professional soccer players than anticipated from general population controls.

    Undoubtedly, there will be physically active individuals in our general population control group, including a number who might have participated in some form of contact sport. However, we would suggest this does not define our over 23,000 matched general population controls as a cohort of ‘non-elite’ athletes, as proposed by White et al. Instead, we would assert this merely underlines their legitimacy as a general population control cohort for comparison with our cohort of almost 8000 former professional soccer players.

    Potential study limitations regarding healthy worker effect, illness behavior in former professional soccer players and use of hospitalization datasets are addressed in detail in our manuscript text. Regarding data on duration of hospital stay and therapy, while these might indeed be of interest in follow-on studies regarding illness severity, we would suggest that they are not immediately relevant to a study designed to address risk of common mental health disorder.

    As White et al observe, wh...

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    Conflict of Interest:
    None declared.
  • Published on:
    Response to: Mental health and suicide in former professional soccer players
    • Adam J White, Lecturer Oxford Brookes University
    • Other Contributors:
      • Alan Pearce, Associate Professor
      • Jo Batey, Senior Fellow
      • Keith D Parry, Senior Lecturer
      • Gary Turner, PhD Student
      • Eric Anderson, Professor

    Russell et al. (1) published a retrospective cohort study with a population of former professional soccer players with known high neurodegenerative mortality. Findings showed that they are at lower risk of common mental health disorders and have lower rates of suicide than a matched general population. These findings are surprising and different from previous studies, which have used first-hand clinical accounts of ex-athletes who have lived with neurodegeneration (1). We suggest there may be reasons for this disparity and welcome critical dialogue with the authors of this research.

    Cohort Comparison
    Russell et al. has compared their soccer cohort with a matched population cohort. However, the matched cohort may also include those who have experienced repetitive head impacts, such as amateur soccer players, rugby players or boxers. Therefore, the study represents differences of elite versus non-elite rather than sport versus non-sport. While Russell recognises the healthy worker effect (2), it may have a greater influence in this study than presented.

    Soccer Stoicism
    Men’s engagement in health-seeking behaviours has been a long-standing concern in health care and is often attributed to factors such as stigma, hypermasculinity and stoicism (3). Furthermore, working-class sports such as soccer, require the acceptance of pain, suffering, and physical risk, so these players are more likely to ‘suffer in silence’ than the general population (4). Give...

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    Conflict of Interest:
    None declared.