Batty G David, Frank Philipp, Kujala Urho M, Sarna Seppo J, Kaprio Jaakko
Department of Epidemiology and Public Health, University College London, London, UK.
Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland.
EClinicalMedicine. 2023 Jun 8;60:102026. doi: 10.1016/j.eclinm.2023.102026. eCollection 2023 Jun.
Former participants in sports characterised by low intensity repetitive head impact appear to have elevated rates of later dementia, but links with other psychological health outcomes such as depression and suicide are uncertain. We quantified the occurrence of these endpoints in former contact sports athletes against general population controls using new data from a cohort study and a meta-analysis.
The cohort study comprised 2004 retired male athletes, who had competed internationally as amateurs for Finland across a range of sports, and 1385 general population controls. All study members were linked to mortality and hospitalisation registries. In the PROSPERO-registered systematic review (CRD42022352780), we searched PubMed and Embase to October 31 2022 for cohort studies that reported standard estimates of association and precision. Study-specific estimates were aggregated in a random-effect meta-analysis. The Newcastle-Ottawa Scale was used to appraise the quality of each study.
In survival analyses of the Finnish cohort data, former boxers (depression: hazard ratio 1.43 [95% CI 0.73, 2.78]; suicide: 1.75 [0.64, 4.38]), Olympic-style wrestlers (depression: 0.94 [0.44, 2.00]; suicide: 1.60 [0.64, 3.99]), and soccer players (depression: 0.62 [0.26, 1.48]; suicide: 0.50 [0.11, 2.16]) did not have statistically higher rates of major depressive disorder or suicide at follow-up relative to controls. In the systematic review, 7 cohort studies met inclusion criteria. After aggregating results with the Finnish cohort, retired soccer players appeared to have a lower risk of depression (summary risk ratio: 0.71 [0.54, 0.93]) relative to general population controls, while the rate of suicide was statistically the same across groups (0.70 [0.40, 1.23]). Past participation in American football seemed to be associated with some protection against suicide (0.58 [0.43, 0.80]) but there were insufficient studies of depression in this sport to facilitate aggregation. The aggregation of results from the soccer and American football studies showed directionally consistent relationships and there was no indication of inter-study heterogeneity (I = 0%).
Based on a small cluster of studies exclusively comprising men, retired soccer players had a lower rate of later depression and former American football players had a lower risk of suicide relative to comparator groups. Whether these findings are generalisable to women requires testing.
The preparation of this manuscript was unfunded.
曾参与以低强度重复性头部撞击为特征的运动项目的运动员，后期患痴呆症的几率似乎有所升高，但与抑郁症和自杀等其他心理健康结果之间的联系尚不确定。我们利用一项队列研究和一项荟萃分析的新数据，对前接触性运动项目运动员与普通人群对照组中这些终点事件的发生率进行了量化。
队列研究包括2004名退休男性运动员，他们曾作为业余选手代表芬兰参加一系列国际体育赛事，以及1385名普通人群对照组。所有研究对象都与死亡率和住院登记系统相链接。在PROSPERO注册的系统评价（CRD42022352780）中，我们检索了截至2022年10月31日的PubMed和Embase，查找报告关联标准估计值和精密度的队列研究。将各研究的特定估计值汇总进行随机效应荟萃分析。采用纽卡斯尔-渥太华量表评估每项研究的质量。
在芬兰队列数据的生存分析中，前拳击运动员（抑郁症：风险比1.43[95%CI0.73，2.78]；自杀：1.75[0.64，4.38]）、奥运式摔跤运动员（抑郁症：0.94[0.44，2.00]；自杀：1.60[0.64，3.99]）和足球运动员（抑郁症：0.62[0.26，1.48]；自杀：0.50[0.11，2.16]）在随访时患重度抑郁症或自杀的发生率相对于对照组在统计学上没有更高。在系统评价中，7项队列研究符合纳入标准。将这些结果与芬兰队列的结果汇总后，相对于普通人群对照组，退休足球运动员患抑郁症的风险似乎较低（汇总风险比：0.71[0.54，0.93]），而各组自杀率在统计学上相同（0.70[0.40，1.23]）。过去参与美式橄榄球运动似乎与预防自杀有一定关联（0.58[0.43，0.80]），但该运动中关于抑郁症的研究不足，无法进行汇总分析。足球和美式橄榄球研究结果的汇总显示出方向一致的关系，且没有研究间异质性的迹象（I²=0%）。
基于仅包含男性的一小批研究，相对于比较组，退休足球运动员后期患抑郁症的几率较低，前美式橄榄球运动员自杀风险较低。这些发现是否适用于女性需要进行检验。
本稿件的撰写未获得资金支持。
