Former professional footballers have lower risk of mental health disorders

New findings from the FIELD study announced today, show that former professional football players have lower risk of hospitalization for the most common mental health disorders, including anxiety and depression, and are at no greater risk of suicide.

The results follow the publication of landmark research last year, which found that former professional footballers had an approximately three and a half times higher rate of death due to neurodegenerative disease than expected.

Led by consultant neuropathologist Dr Willie Stewart, honorary clinical associate Professor at the University of Glasgow, this latest research looking at mental health outcomes in over 7,500 former professional footballers and approximately 23,000 general population controls and is published in the Journal of Neurology, Neurosurgery and Psychiatry.

Recent concerns over the risk of mental health disorder and suicide in former athletes have been driven, in part, by post-mortem studies reporting a specific degenerative brain pathology linked to exposure to brain injury. Known as chronic traumatic encephalopathy (CTE), this pathology has been described in a high proportion of former contact sports athletes, including former footballers and has been linked to psychiatric presentations including depression and suicidality.

Nevertheless, despite former professional footballers in the FIELD study having high rates of dementia, they were at lower risk of hospital admission for the most common mental health disorders, when compared to matched counterparts in the general population. Specifically, former footballer players were approximately half as likely to be admitted for anxiety and stress related disorders, depressive disorder, alcohol use disorders, drug use disorders, and bipolar and affective mood disorders.

Further analysis showed no significant difference in deaths due to suicide between footballers and their matched population controls.

Dr Willie Stewart said: "This is the first and largest study to date to investigate the association between elite level contact sport and risk of common mental health disorders after retirement in this way.

"Our findings show that, despite former professional footballers having higher death from neurodegenerative disease, they are in fact approximately half as likely to be admitted to hospital with common mental health disorders."

"This is important, because in recent decades there have been suggestions that common mental health disorders and suicide are features of neurodegenerative disease in contact sports athletes. The results from FIELD would suggest this is not the case after all.

The FIELD study is currently funded by the Football Association (FA) and the Professional Footballers’ Association (PFA) to the end of February 2021.

Data on mental health outcomes were obtained by individual-level record linkage to national electronic records of hospital admissions and death certification.

Study inclusion was restricted to individuals born prior to 1st January 1977, with study follow-up commencing from age 40. All former football players were male.

The Community Health Index database was used to randomly identify a general population comparison group, individually matched by sex, year of birth and social deprivation status to former soccer players on a 3:1 basis i.e. for each former soccer player 3 matched population controls were identified.

Among former professional soccer players neurodegenerative disease mortality is approximately three-and-a-half-fold higher than anticipated, with this risk ranging from an approximately doubling of deaths with Parkinson’s disease to a 5-fold increase in deaths with Alzheimer’s disease. Further, CTE neuropathologic change is present in the majority of former soccer players dying with dementia.

The FIELD study is an acronym for ’Football’s InfluencE on Lifelong health and Dementia risk.’ The FIELD study began in March 2018 and runs to February 2021.

The landmark FIELD study on former professional footballers neurodegenerative disease risk, published in the New England Journal of Medicine­0.1056/NEJ­Moa1908483

A manuscript detailing brain pathology in former footballers and rugby players with dementia in Acta Neuropatholgica­19-02030-y