Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review

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Abstract

Background

Elite athletes can experience a diverse range of symptoms following post-concussive injury. The impact of sport-related concussion on specific mental health outcomes is unclear in this population.

Objective

The aim was to appraise the evidence base regarding the association between sport-related concussion and mental health outcomes in athletes competing at elite and professional levels.

Methods

A systematic search of PubMed, EMBASE, SPORTDiscus, PsycINFO, Cochrane, and Cinahl databases was conducted.

Results

A total of 27 studies met inclusion criteria for review. Most of the included studies (67%, n = 18) were published in 2014 or later. Study methodology and reporting varied markedly. The extant research has been conducted predominantly in North America (USA, n = 23 studies; Canada, n = 3), often in male only (44.4%, n = 12) and college (70.4%, n = 19) samples. Depression is the most commonly studied mental health outcome (70.4%, n = 19 studies). Cross-sectional retrospective studies and studies including a control comparison tend to support an association between concussion exposure and depression symptoms, although several studies report that these symptoms resolved in the medium term (i.e. 1 month) post-concussion. Evidence for anxiety is mixed. There are insufficient studies to draw conclusions for other mental health domains.

Conclusion

Consistent with current recommendations to assess mood disturbance in post-concussive examinations, current evidence suggests a link between sports-related concussion and depression symptoms in elite athletes. Causation cannot be determined at this stage of enquiry because of the lack of well-designed, prospective studies. More research is required that considers a range of mental health outcomes in diverse samples of elite athletes/sports.

Electronic supplementary material

The online version of this article (10.1007/s40279-017-0810-3) contains supplementary material, which is available to authorized users.

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Most cited references 65

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Recurrent concussion and risk of depression in retired professional football players.

Kevin M. Guskiewicz, Stephen Marshall, Julian Edwin Bailes … (2007)

The purpose of our study was to investigate the association between prior head injury and the likelihood of being diagnosed with clinical depression among retired professional football players with prior head injury exposure. A general health questionnaire, including information about prior injuries, the SF-36 (Short Form 36), and other markers for depression, was completed by 2552 retired professional football players with an average age of 53.8 (+/-13.4) yr and an average professional football-playing career of 6.6 (+/-3.6) yr. A second questionnaire focusing on mild cognitive impairment (MCI)-related issues was completed by a subset of 758 retired professional football players (50 yr and older). Two hundred sixty-nine (11.1%) of all respondents reported having prior or current diagnosis of clinical depression. There was an association between recurrent concussion and diagnosis of lifetime depression (chi2=71.21, df=2, P<0.005), suggesting that the prevalence increases with increasing concussion history. Compared with retired players with no history of concussion, retired players reporting three or more previous concussions (24.4%) were three times more likely to be diagnosed with depression; those with a history of one or two previous concussions (36.3%) were 1.5 times more likely to be diagnosed with depression. The analyses controlled for age, number of years since retirement, number of years played, physical component score on the SF-36, and diagnosed comorbidities such as osteoarthritis, coronary heart disease, stroke, cancer, and diabetes. Our findings suggest a possible link between recurrent sport-related concussion and increased risk of clinical depression. The findings emphasize the importance of understanding potential neurological consequences of recurrent concussion.

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Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players

Philip H Montenigro, Michael L Alosco, Brett M Martin … (2017)

The term "repetitive head impacts" (RHI) refers to the cumulative exposure to concussive and subconcussive events. Although RHI are believed to increase risk for later-life neurological consequences (including chronic traumatic encephalopathy), quantitative analysis of this relationship has not yet been examined because of the lack of validated tools to quantify lifetime RHI exposure. The objectives of this study were: 1) to develop a metric to quantify cumulative RHI exposure from football, which we term the "cumulative head impact index" (CHII); 2) to use the CHII to examine the association between RHI exposure and long-term clinical outcomes; and 3) to evaluate its predictive properties relative to other exposure metrics (i.e., duration of play, age of first exposure, concussion history). Participants included 93 former high school and collegiate football players who completed objective cognitive and self-reported behavioral/mood tests as part of a larger ongoing longitudinal study. Using established cutoff scores, we transformed continuous outcomes into dichotomous variables (normal vs. impaired). The CHII was computed for each participant and derived from a combination of self-reported athletic history (i.e., number of seasons, position[s], levels played), and impact frequencies reported in helmet accelerometer studies. A bivariate probit, instrumental variable model revealed a threshold dose-response relationship between the CHII and risk for later-life cognitive impairment (p < 0.0001), self-reported executive dysfunction (p < 0.0001), depression (p < 0.0001), apathy (p = 0.0161), and behavioral dysregulation (p < 0.0001). Ultimately, the CHII demonstrated greater predictive validity than other individual exposure metrics.

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Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

Karine Schaal, Muriel Tafflet, Hala Nassif … (2011)

Objectives Few epidemiological studies have focused on the psychological health of high level athletes. This study aimed to identify the principal psychological problems encountered within French high level athletes, and the variations in their prevalence based on sex and the sport practiced. Methods Multivariate analyses were conducted on nationwide data obtained from the athletes' yearly psychological evaluations. Results A representative sample of 13% of the French athlete population was obtained. 17% of athletes have at least one ongoing or recent disorder, generalized anxiety disorder (GAD) being the most prevalent (6%), followed by non-specific eating disorders (4.2%). Overall, 20.2% of women had at least one psychopathology, against 15.1% in men. This female predominance applied to anxiety and eating disorders, depression, sleep problems and self-harming behaviors. The highest rates of GAD appeared in aesthetic sports (16.7% vs. 6.8% in other sports for men and 38.9% vs. 10.3% for women); the lowest prevalence was found in high risk sports athletes (3.0% vs. 3.5%). Eating disorders are most common among women in racing sports (14% vs. 9%), but for men were found mostly in combat sports (7% vs. 4.8%). Discussion This study highlights important differences in psychopathology between male and female athletes, demonstrating that the many sex-based differences reported in the general population apply to elite athletes. While the prevalence of psychological problems is no higher than in the general population, the variations in psychopathology in different sports suggest that specific constraints could influence the development of some disorders.

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Author and article information

Contributors

Simon M. Rice: +61 3 1300 679 436 , simon.rice@orygen.org.au

Journal

Journal ID (nlm-ta): Sports Med

Journal ID (iso-abbrev): Sports Med

Title: Sports Medicine (Auckland, N.z.)

Publisher: Springer International Publishing (Cham )

ISSN (Print): 0112-1642

ISSN (Electronic): 1179-2035

Publication date (Electronic): 20 November 2017

Publication date PMC-release: 20 November 2017

Publication date (Print): 2018

Volume: 48

Issue: 2

Pages: 447-465

Affiliations

[1 ]GRID grid.488501.0, Orygen, The National Centre of Excellence in Youth Mental Health, ; 35 Poplar Road, Parkville, Melbourne, VIC 3052 Australia

[2 ]ISNI 0000 0001 2179 088X, GRID grid.1008.9, Centre for Youth Mental Health, , The University of Melbourne, ; Melbourne, VIC Australia

[3 ]ISNI 0000 0004 0408 1792, GRID grid.488596.e, Youth Mood Clinic, , Orygen Youth Health, ; Melbourne, VIC Australia

[4 ]ISNI 0000 0001 0396 9544, GRID grid.1019.9, Institute of Sport, Exercise and Active Living, , Victoria University, ; Melbourne, VIC Australia

[5 ]ISNI 0000 0004 4902 0432, GRID grid.1005.4, School of Psychiatry, , University of New South Wales, ; Sydney, NSW Australia

[6 ]GRID grid.415193.b, Black Dog Institute, Prince of Wales Hospital, ; Sydney, NSW Australia

Article

Publisher ID: 810

DOI: 10.1007/s40279-017-0810-3

PMC ID: 5775382

PubMed ID: 29159546

SO-VID: 0184d659-64ab-42ba-b3d1-c4e8bb69db04

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Sport-Related Concussion and Mental Health Outcomes in Elite Athletes: A Systematic Review

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Objective

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Results

Conclusion

Electronic supplementary material

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Most cited references 65

Recurrent concussion and risk of depression in retired professional football players.

Cumulative Head Impact Exposure Predicts Later-Life Depression, Apathy, Executive Dysfunction, and Cognitive Impairment in Former High School and College Football Players

Psychological Balance in High Level Athletes: Gender-Based Differences and Sport-Specific Patterns

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