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Original Investigation
August 2017

Association of Playing High School Football With Cognition and Mental Health Later in Life

Author Affiliations
  • 1Department of Statistics, The Wharton School, University of Pennsylvania, Philadelphia
  • 2Brain Injury Neuropsychology Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
  • 3TBI Rehabilitation Research Laboratory, Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania
  • 4Center for Demography and Ecology, University of Wisconsin–Madison
  • 5New York University, New York, New York
  • 6Standard Prevention Research Center, Stanford School of Medicine, Stanford University, Palo Alto, California
  • 7Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 8Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 9Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia
  • 10Sports Medicine and Performance Center, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 11Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
JAMA Neurol. 2017;74(8):909-918. doi:10.1001/jamaneurol.2017.1317
Key Points

Question  Does playing high school football have a statistically and clinically significant adverse association with cognitive impairment and depression at 65 years of age?

Findings  In this cohort study using data from the Wisconsin Longitudinal Study among men graduating high school in Wisconsin in 1957, there was no statistically or clinically significant harmful association between playing football in high school and increased cognitive impairment or depression later in life, on average.

Meaning  For men who attended high school in the late 1950s, playing high school football did not appear to be a major risk factor for later-life cognitive impairment or depression; for current athletes, this study provides information on the risk of playing sports today that have a similar head trauma exposure risk as high school football played in the 1950s.

Abstract

Importance  American football is the largest participation sport in US high schools and is a leading cause of concussion among adolescents. Little is known about the long-term cognitive and mental health consequences of exposure to football-related head trauma at the high school level.

Objective  To estimate the association of playing high school football with cognitive impairment and depression at 65 years of age.

Design, Setting, and Participants  A representative sample of male high school students who graduated from high school in Wisconsin in 1957 was studied. In this cohort study using data from the Wisconsin Longitudinal Study, football players were matched between March 1 and July 1, 2017, with controls along several baseline covariates such as adolescent IQ, family background, and educational level. For robustness, 3 versions of the control condition were considered: all controls, those who played a noncollision sport, and those who did not play any sport.

Exposures  Athletic participation in high school football.

Main Outcomes and Measures  A composite cognition measure of verbal fluency and memory and attention constructed from results of cognitive assessments administered at 65 years of age. A modified Center for Epidemiological Studies’ Depression Scale score was used to measure depression. Secondary outcomes include results of individual cognitive tests, anger, anxiety, hostility, and heavy use of alcohol.

Results  Among the 3904 men (mean [SD] age, 64.4 [0.8] years at time of primary outcome measurement) in the study, after matching and model-based covariate adjustment, compared with each control condition, there was no statistically significant harmful association of playing football with a reduced composite cognition score (–0.04 reduction in cognition vs all controls; 97.5% CI, –0.14 to 0.05) or an increased modified Center for Epidemiological Studies’ Depression Scale depression score (–1.75 reduction vs all controls; 97.5% CI, –3.24 to –0.26). After adjustment for multiple testing, playing football did not have a significant adverse association with any of the secondary outcomes, such as the likelihood of heavy alcohol use at 65 years of age (odds ratio, 0.68; 95% CI, 0.32-1.43).

Conclusions and Relevance  Cognitive and depression outcomes later in life were found to be similar for high school football players and their nonplaying counterparts from mid-1950s in Wisconsin. The risks of playing football today might be different than in the 1950s, but for current athletes, this study provides information on the risk of playing sports today that have a similar risk of head trauma as high school football played in the 1950s.

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