not often that retired NFL players get published in medical journals,
but apparently it does happen.
Hipple, formerly a quarterback for the href="http://en.wikipedia.org/wiki/Detroit_Lions">Detroit
Lions, has an article in Medicine & Science in Sports
& Exercise. Granted, he is the fourth or four
authors, but it is still impressive.
and Pain in Retired Professional Football Players.
& Science in Sports & Exercise. 39(4):599-605, April
THOMAS L; GORENFLO, DANIEL W; DOPP, RICHARD R; HIPPLE, ERIC
face="Helvetica, Arial, sans-serif">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
(C)2007The American College of Sports Medicine
Mr. Hipple is involved because he is on the board of directors of the href="http://www.med.umich.edu/depression/">University of
Michigan Depression Center. Hipple's interest comes
from two sources: he href="http://www.voicenews.com/stories/112906/loc_20061129002.shtml">had
depression himself, as early as age 13; and his href="http://www.stignacenews.com/news/2006/0202/Front_page/046.html">son
committed suicide at age 15. Now he href="http://www.cadillacnews.com/articles/2006/01/23/news/news01.txt">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
face="Helvetica, Arial, sans-serif">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
But the central finding is that there is a lot of overlap between
depression and pain.
face="Helvetica, Arial, sans-serif">For example, of 236
subjects in this study with high depression scores, 173 (73%) had high
Also significant was the association between concurrent pain and
depression, with problems later in life.
face="Helvetica, Arial, sans-serif">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
In other words, sheer force of will does not protect a person from
depression or disability.
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?).
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.