Exposure to American Football and Neuropsychiatric Health in Former National Football League Players: Findings From the Football Players Health Study

Am J Sports Med. 2019 Oct;47(12):2871-2880. doi: 10.1177/0363546519868989. Epub 2019 Aug 30.


Background: Former American football players have a higher prevalence of cognitive impairment than that of the US general population. It remains unknown what aspects of playing football are associated with neuropsychiatric outcomes.

Hypothesis: It was hypothesized that seasons of professional football, playing position, and experience of concussions were associated with cognition-related quality of life (QOL) and indicators of depression and anxiety.

Study design: Descriptive epidemiology study.

Methods: The authors examined whether seasons of professional football, playing position, and experience of concussions, as measured by self-report of 10 symptoms, were associated with cognition-related QOL and indicators of depression and anxiety in a cross-sectional survey conducted 2015 to 2017. Cognition-related QOL was measured by the short form of the Quality of Life in Neurological Disorders: Applied Cognition-General Concerns. The Patient Health Questionnaire-4 measured depression and anxiety symptoms. Of 13,720 eligible men with apparently valid contact information, 3506 players returned a questionnaire at the time of this analysis (response rate = 25.6%).

Results: Seasons of professional play (risk ratio [RR] per 5 seasons = 1.19, 95% CI = 1.06-1.34) and playing position were associated with cognition-related QOL. Each 5 seasons of play was associated with 9% increased risk of indicators of depression at borderline statistical significance (P = .05). When compared with former kickers, punters, and quarterbacks, men who played any other position had a higher risk of poor cognition-related QOL, depression, and anxiety. Concussion symptoms were strongly associated with poor cognition-related QOL (highest concussion quartile, RR = 22.3, P < .001), depression (highest quartile, RR = 6.0, P < .0001), and anxiety (highest quartile, RR = 6.4, P < .0001), even 20 years after last professional play.

Conclusion: The data suggest that seasons of play and playing position in the NFL are associated with lasting neuropsychiatric health deficits. Additionally, poor cognition-related QOL, depression, and anxiety appear to be associated with concussion in the long term.

Keywords: anxiety; cognitive function; depression; football; postconcussion syndrome; sports injuries.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Anxiety / epidemiology*
  • Brain Concussion / complications*
  • Brain Concussion / epidemiology
  • Cognition Disorders / epidemiology*
  • Cross-Sectional Studies
  • Depression / epidemiology*
  • Football / injuries*
  • Humans
  • Male
  • Middle Aged
  • Post-Concussion Syndrome / epidemiology
  • Prevalence
  • Quality of Life
  • Self Report
  • Surveys and Questionnaires
  • United States / epidemiology