Perceived Chronic Traumatic Encephalopathy And Suicidality In Former Professional American-style Football Players

PURPOSE: American-style football (ASF) has been linked to chronic traumatic encephalopathy neuropathological change (CTE-NC), a condition only established at autopsy. Despite being a post-mortem diagnosis, former living ASF players may perceive themselves to have CTE-NC. At present, the prevalence and clinical correlates of living former professional ASF athletes with perceptions of CTE (CTEperceived) is unknown. METHODS: The Football Players Health Study at Harvard University conducted a cross-sectional study of men who played professional ASF between 1960-2020 and completed surveys during 2015 to 2020. We calculated the prevalence of CTEperceived, and used multivariable regression models to determine clinical and suicidality correlates of CTEperceived. Models were adjusted for age, race, career duration, position, professional career body mass index, age of first football, concussion symptom burden, performance enhancing drugs, and current health (hypertension, hypercholesterolemia, attention deficit hyperactivity disorder, depression, anxiety, pain, sleep apnea, subjective cognitive function, low testosterone, headache, diabetes, and behavioral dyscontrol symptoms). RESULTS: Among 1980 former professional ASF players (mean[SD] age: 57.7[13.9]; 30.1% Black), 681 (34.4%) reported CTEperceived. Subjective cognitive difficulties, low testosterone, headache, prior concussion symptom burden, depressive and behavioral dyscontrol symptoms, pain, and younger age were significantly associated with CTEperceived (p-value range: 0.03- > 0.001). Suicidality prevalence in those with and without CTEperceived was 25.4% and 5.0%, respectively. After adjusting for established suicidality predictors (e.g., depression), men with CTEperceived remained twice as likely to report suicidality (OR = 2.06, 95%CI = 1.36,3.12, p < 0.001). CONCLUSION: Among living former ASF players, one-third have CTEperceived. Men with CTEperceived report increased prevalence of suicidality and are more likely to have alternative conditions associated with cognitive impairment compared to men without CTEperceived. CTEperceived represents a novel risk factor for suicidality and should motivate the diagnostic assessment and treatment of medical conditions that may be misattributed to CTE-NC.