Protocol for an observational study on the effects of playing football in adolescence on mental health in early adulthood

TL;DR

This observational study investigates the long-term effects of adolescent football participation on mental health in early adulthood, addressing concerns about neurological risks associated with modern playing styles.

Contribution

It replicates a previous study using recent data to assess whether modern football safety measures impact mental health outcomes in young adults.

Findings

No significant harmful effects on mental health found

Provides insights into long-term neurological risks

Highlights importance of updated safety protocols

Abstract

More than 1 million students play high school American football annually, but many health professionals have recently questioned its safety or called for its ban. These concerns have been partially driven by reports of chronic traumatic encephalopathy (CTE), increased risks of neurodegenerative disease, and associations between concussion history and later-life cognitive impairment and depression among retired professional football players. A recent observational study of a cohort of men who graduated from a Wisconsin high school in 1957 found no statistically significant harmful effects of playing high school football on a range of cognitive, psychological, and socio-economic outcomes measured at ages 35, 54, 65, and 72. Unfortunately, these findings may not generalize to younger populations, thanks to changes and improvements in football helmet technology and training techniques. In particular, these changes may have led to increased perceptions of safety but ultimately more dangerous styles of play, characterized by the frequent sub-concussive impacts thought to be associated with later-life neurological decline. In this work, we replicate the methodology of that earlier matched observational study using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). These include adolescent and family co-morbidities, academic experience, self-reported levels of general health and physical activity, and the score on the Add Health Picture Vocabulary Test. Our primary outcome is the CES-D score measured in 2008 when subjects were aged 24 -- 34 and settling into early adulthood. We also examine several secondary outcomes related to physical and psychological health, including suicidality. Our results can provide insight into the natural history of potential football-related decline and dysfunction.