Depression and Pain in Retired Professional Football Players

Thomas L. Schwenk; Daniel W. Gorenflo; Richard R. Dopp; Eric Hipple

Disclosures

Med Sci Sports Exerc. 2007;39(4):599-605. 

In This Article

Results

Usable responses were received from 1617 members (crude response rate, 47.9%), with a functional response rate of 48.6% when accounting for surveys returned undelivered (N = 36) or unable to be completed because of death (N = 10) or mental incompetence (N = 16). The mean age of all respondents was 53.4 yr (± 14.5), and 80%were married. Roughly 30% (N = 483) of respondents reported current involvement in football, most commonly through coaching at the high school or college level. The mean number of years for which respondents played professional football was 7.1 (± 3.6), and they had played for a mean of 2.3 teams (± 1.3) per respondent. The median time since retirement was 25 yr. Roughly a third each of respondents reported having been "cut" (N = 557) (meaning that they had ended their career not because of injury and not of their own choosing), "retired of my own choice" (N = 559), or retired because of a career-ending injury (N = 470).

The most common retirement problems reported by respondents were (in descending order of frequency as quite or very common): difficulty with pain (48%), loss of fitness and lack of exercise (29%), weight gain (28%), trouble sleeping (28%), difficulty with aging (27%), and trouble with transition to life after professional football (27%). The most commonly reported barriers to seeking help for these problems (reported as important or very important) were a preference to use spiritual means to deal with these issues (36%), preference to deal with these issues with family and friends (33%), lack of insurance coverage (33%), and lack of recognition that these problems were important (33%).

The mean PHQ-9 score for all respondents was 4.5 (out of a maximum total score of 27 ± 5.3). The proportion of respondents responding in the no-to-mild category of depression (PHQ-9 score 0-9) was 84.5% (N = 1366) and, in the moderate-to-severe category (PHQ-9 score 10-27), 14.7% (N = 237; there was no response by 14 respondents). Roughly 7% (N = 117) rated the impact of depressive symptoms as making work or home life very or extremely difficult.

The odds ratios for respondents reporting various transition and retirement problems if they reported moderate to severe depression versus no to mild depression are shown in Table 1 . For example, respondents scoring as moderately to severely depressed were 11.2 times more likely to report trouble sleeping than those rated as not or mildly depressed, 7.8 times more likely to report a loss of fitness and lack of exercise, and 7.1 times more likely to report financial difficulties. Other problems reported significantly more commonly in respondents rated as moderately to severely depressed were lack of social support or friendships, the use of prescribed medication, alcohol, or other drugs, and trouble with the transition to life after professional football.

Similar to the analysis above, odds ratios for respondents reporting various barriers to seeking help if they reported moderate to severe depression versus no to mild depression are shown in Table 2 . Respondents reporting moderate to severe depression were most likely to report that "I feel I would be weak if I got help," "I would be embarrassed by what friends or family would think," "help is too far away," and "I didn't recognize issues as important" compared with those with no to mild depression.

Difficulty with pain was reported as very common by 404 respondents (25.2%), quite common by 365 respondents (22.7%), and not or somewhat common by 837 respondents (52.1%). The odds ratios for respondents reporting various transition and retirement problems are shown in Table 3 , comparing those responding that difficulty with pain is quite common or very common versus those reporting it as not common or somewhat common. The most common transition problems for respondents for whom pain was common versus those for whom pain was uncommon were difficulty with aging; the use of prescribed medication, alcohol, or other drugs; trouble sleeping; and loss of fitness and lack of exercise. The survey did not allow further analysis regarding specific types of injuries or sources of pain.

Because of the common cooccurrence of pain with depression in the general population,[2,6,12] the life experiences of respondents who had quite or very common difficulty with pain as well as moderate to severe depression scores (high depression/high pain) were compared with those having low scores in both pain and depression ( Table 4 ). Of the total of 1594 respondents, 173 (10.9%) had high scores in both areas, 593 (37.2%) had high pain scores and low depression scores, 63 (4.0%) had low pain scores and high depression scores, and 765 (48%) had low scores in both. High depression/high pain respondents were 32 times more likely to report trouble sleeping compared with those with low depression/low pain, with high odds ratios for difficulty with aging; loss of fitness and lack of exercise; the use of prescribed medication, alcohol, or other drugs; and financial difficulties.

The comparable analysis for the barriers experienced by respondents, according to having either both high or both low scores in pain and depression, are shown in Table 5 . The barriers reported as most common by those with high depression/high pain scores compared with those with low depression/low pain were "I feel I would be weak if I got help," "help is too far away," and "I didn't recognize these issues as important; thought they were a part of life".

Programs to help with the following problems were most commonly requested by respondents (percentage rated as very or quite helpful): programs to help with fitness and exercise (48%), nutrition (46%), financial assistance (46%), pain management (43%), relaxation (42%), distress or depression, (42%), and spirituality (41%).

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