Eric Hipple, formerly a quarterback for the Detroit Lions, has an article in Medicine & Science in Sports & Exercise. Granted, he is the fourth or four authors, but it is still impressive.
Depression and Pain in Retired Professional Football Players.
Medicine & Science in Sports & Exercise. 39(4):599-605, April 2007.
SCHWENK, THOMAS L; GORENFLO, DANIEL W; DOPP, RICHARD R; HIPPLE, ERIC
Abstract:
Purpose: To assess the prevalence of depressive symptoms and difficulty with pain in retired professional football players, difficulties with the transition from active athletic competition to retirement, perceptions of barriers to receiving assistance for those difficulties, and recommended programs to provide such assistance.
Methods: Survey sent to 3377 retired members of the National Football League Players Association (NFLPA), with usable responses received from 1617 members (functional response rate, 48.6%).
Results: Respondents were categorized as experiencing no to mild depression (N = 1366; 84.5%) or moderate to severe depression (N = 237; 14.7%). Respondents were also categorized according to whether they reported difficulty with pain as not or somewhat common (N = 837; 51.8%) versus quite or very common (N = 769; 47.6%). Respondents most frequently reported trouble sleeping, financial difficulties, marital or relationship problems, and problems with fitness, exercise, and aging, all of which were strongly correlated with the presence of moderate to severe depression and with quite or very common difficulty with pain. The same difficulties were even more commonly experienced by respondents who reported both moderate to severe depression and quite or very common difficulty with pain, compared with those who reported low scores in both domains.
Conclusion: Retired professional football players experience levels of depressive symptoms similar to those of the general population, but the impact of these symptoms is compounded by high levels of difficulty with pain. The combination of depression and pain is strongly predictive of significant difficulties with sleep, social relationships, financial difficulties, and problems with exercise and fitness. A hypothesis explaining this association is that significant musculoskeletal disability and chronic pain interferes with physical activity and fitness during retirement and increases the risk of depression.
(C)2007The American College of Sports Medicine
Mr. Hipple is involved because he is on the board of directors of the University of Michigan Depression Center. Hipple's interest comes from two sources: he had depression himself, as early as age 13; and his son committed suicide at age 15. Now he tours schools giving talks on depression.
Anyway, back to the study. One of the interesting findings was that retired professional (American) football players have depression at about the same rate as the general population. (As I say often, it can happen to anybody.)
Another finding: stigma is a problem that prevents people from seeking treatment.
Retired professional football players bear the same stigma as does the general population with regard to barriers to seeking helping for their difficulties with depression and pain, including not recognizing the issues as important, not knowing where to seek help, feeling they would be weak if they sought help, and being embarrassed by what family members and friends would think.
But the central finding is that there is a lot of overlap between depression and pain.
For example, of 236 subjects in this study with high depression scores, 173 (73%) had high pain scores.
Also significant was the association between concurrent pain and depression, with problems later in life.
It is the cooccurrence of depressive symptoms and pain that puts retired players at the highest risk of significant difficulties in retirement.
In a way, this is not surprising; the association between pain and depression is well established. Also, it is well known that depression and pain together create a problem that is far worse than either one alone. What is notable is that these things are true even in a population of remarkably determined, highly-motivated people.
In other words, sheer force of will does not protect a person from depression or disability.
Comments
I'm puzzled by so-called "barriers to seeking help..." The paper must be making reference to some form of therapy or counseling, but the most common treatment for pain and depression and unhappiness is medication. What's the most effective treatment for depression? Nobody knows--everything works for some people. The first author, Thomas L. Schwenk is quoted in a 1995 Science News:: "There's a huge reservoir of mildly depressed patients for whom appropriate treatment is not clear."
It's wellknown that antidepressants and pain medication are among the most abundantly prescribed drugs. I find it odd that anyone would find a barrier to depression and pain relief in getting a prescription--even from a GP.
I see nothing in the abstract that tells me whether respondents were using medication. Might have been useful, too, if there were other kinds of lifestyle data such as alcohol, tobacco use, weight/height. (I suspect that former athletes frequently find their depression and pain exacerbated by alcohol and weight gain. Certainly Hipple's own depression appears to have been linked to something resembling alcoholism.)
I'm always suspicious of survey data, and I'm not sure how the comparison to the general population was made -- speaking in terms of controls (nonathletes in retirement?).
Posted by: degustibus | April 30, 2007 3:55 AM
One of the problems with these kinds of analyses is that if you look at the features of questionnaires for depression and those for pain you will see a lot of overlap. Many items in depression scales have to do with somatic complaints. Many items in pain scales have to do with the emotional effects, and guess what, pain is depressing!
So am I surprised that people that score high on one likely score high on the other? No.
Posted by: Greg P | April 30, 2007 9:26 AM