Introduction There is growing recognition of an association between contact sports participation and increased risk of neurodegenerative disease, including Alzheimer’s disease and chronic traumatic encephalopathy. In addition to cognitive impairment, a range of mental health disorders and suicidality are proposed as diagnostic features of traumatic encephalopathy syndrome, the putative clinical syndrome associated with chronic traumatic encephalopathy. However, to date, epidemiological data on contact sport participation and mental health outcomes are limited.
Methods For a cohort of former professional soccer players (n=7676) with known high neurodegenerative mortality and their matched general population controls (n=23 028), data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification.
Results Compared with matched population controls, former professional soccer players showed lower risk of hospital admission for anxiety and stress related disorders, depression, drug use disorders, alcohol use disorders and bipolar and affective mood disorders. Among soccer players, there was no significant difference in risk of hospitalisation for mental health disorders between outfield players and goalkeepers. There was no significant difference in rate of death by suicide between soccer players and controls.
Conclusions Among a population of former professional soccer players with known high neurodegenerative disease mortality, hospital admissions for common mental health disorders were lower than population controls, with no difference in suicide. Our data provide support for the reappraisal of currently proposed diagnostic clinical criteria for traumatic encephalopathy syndrome, in particular the inclusion of mental health outcomes.
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Contributors ERR and DFM collated the former soccer player and matched population control datasets. ERR completed all the primary data analyses. ERR and TM provided a first draft of the analyses and manuscript. ERR, TM, DFM, KS, JAM, JPP and WS edited manuscript drafts and WS collated all author comments to the final submitted version. ERR, TM, DFM, KS, JAM, JPP and WS contributed to discussions on data analysis and interpretation, commented on manuscript drafts and approved the final version. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication.
Funding This work was supported by funding from: The Football Association and Professional Footballers Association and an NHS Research Scotland Career Researcher Fellowship (WS).
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Approval for this study was provided by the University of Glasgow College of Medical, Veterinary and Life Sciences Ethics Committee (Project Number 200160147), with protocol and data governance procedures reviewed and approved by National Health Service Scotland’s Public Benefit and Privacy Panel for Health and Social Care (reference 1718–0120).
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available on reasonable request. Per Public Benefits and Privacy Panel (PBPP) authorisations, electronic health records data are stored on secure server with access granted only to specified investigators after approval. Subject to approvals from PBPP datasets should be accessible.