University of North Carolina at Chapel Hill, CB #8700, Chapel Hill, NC 27599-8700, USA.
Am J Sports Med. 2012 Oct;40(10):2206-12. doi: 10.1177/0363546512456193. Epub 2012 Aug 24.
Concussions may accelerate the progression to long-term mental health outcomes such as depression in athletes.
To prospectively determine the effects of recurrent concussions on the clinical diagnosis of depression in a group of retired football players.
Cohort study; Level of evidence, 2.
Members of the National Football League Retired Players Association responded to a baseline General Health Survey (GHS) in 2001. They also completed a follow-up survey in 2010. Both surveys asked about demographic information, number of concussions sustained during their professional football career, physical/mental health, and prevalence of diagnosed medical conditions. A physical component summary (Short Form 36 Measurement Model for Functional Assessment of Health and Well-Being [SF-36 PCS]) was calculated from responses for physical health. The main exposure, the history of concussions during the professional playing career (self-report recalled in 2010), was stratified into 5 categories: 0 (referent), 1 to 2, 3 to 4, 5 to 9, and 10+ concussions. The main outcome was a clinical diagnosis of depression between the baseline and follow-up GHS. Classic tabular methods computed crude risk ratios. Binomial regression with a Poisson residual and robust variance estimation to stabilize the fitting algorithm estimated adjusted risk ratios. χ(2) analyses identified associations and trends between concussion history and the 9-year risk of a depression diagnosis.
Of the 1044 respondents with complete data from the baseline and follow-up GHS, 106 (10.2%) reported being clinically diagnosed as depressed between the baseline and follow-up GHS. Approximately 65% of all respondents self-reported sustaining at least 1 concussion during their professional careers. The 9-year risk of a depression diagnosis increased with an increasing number of self-reported concussions, ranging from 3.0% in the "no concussions" group to 26.8% in the "10+" group (linear trend: P < .001). A strong dose-response relationship was observed even after controlling for confounders (years retired from professional football and 2001 SF-36 PCS). Retired athletes with a depression diagnosis also had a lower SF-36 PCS before diagnosis. The association between concussions and depression was independent of the relationship between decreased physical health and depression.
Professional football players self-reporting concussions are at greater risk for having depressive episodes later in life compared with those retired players self-reporting no concussions.
脑震荡可能会加速运动员出现长期心理健康问题，如抑郁。
前瞻性地确定在一组退役足球运动员中，反复脑震荡对临床抑郁症诊断的影响。
队列研究；证据水平，2 级。
国家橄榄球联盟退役球员协会的成员在 2001 年对一般健康调查（GHS）进行了基线调查。他们还在 2010 年完成了后续调查。这两项调查都询问了人口统计学信息、在职业足球生涯中遭受的脑震荡次数、身体/心理健康以及诊断疾病的流行情况。从对身体状况的回复中计算出物理成分摘要（用于健康和幸福感功能评估的短表单 36 测量模型 [SF-36 PCS]）。主要暴露因素是职业比赛期间的脑震荡史（2010 年回忆），分为 5 个类别：0（参照）、1-2、3-4、5-9 和 10+次脑震荡。主要结局是在基线和随访 GHS 之间的临床抑郁症诊断。经典表格方法计算了粗风险比。使用具有泊松残差和稳健方差估计的二项式回归来稳定拟合算法，以估计调整后的风险比。卡方分析确定了脑震荡史与 9 年抑郁诊断风险之间的关联和趋势。
在基线和随访 GHS 完整数据的 1044 名受访者中，有 106 名（10.2%）报告在基线和随访 GHS 之间被临床诊断为抑郁症。大约 65%的受访者报告在职业生涯中至少遭受过 1 次脑震荡。9 年抑郁诊断风险随着自我报告的脑震荡次数增加而增加，从“无脑震荡”组的 3.0%到“10+”组的 26.8%（线性趋势：P<.001）。即使在控制了职业足球退役年限和 2001 年 SF-36 PCS 等混杂因素后，仍观察到了强烈的剂量反应关系。有抑郁诊断的退役运动员在诊断前的 SF-36 PCS 也较低。脑震荡与抑郁之间的关联独立于身体健康下降与抑郁之间的关系。
与报告无脑震荡的退役球员相比，报告脑震荡的职业足球运动员在以后的生活中出现抑郁发作的风险更高。
