Adverse childhood experiences (ACES) may be linked with dementia symptoms, poor neuropsychiatric health, and a higher risk of concussion symptoms among former professional US football players, according study findings in JAMA Network Open.

Concussion experience and psychological trauma are linked with poorer cognitive function. Prior studies have indicated the effects of adverse childhood experiences (ACEs) may persist into adulthood. Adults who experienced childhood neglect and abuse have a greater likelihood of low self-esteem, partaking in risk-taking behaviors, aggression, and self-harm compared with those who have not, the researchers explained. “Thus, men who have been exposed to ACEs may be more likely than nonexposed men to play football with more aggression and disregard for their own safety, resulting in a higher risk of concussion,” they stated.

The objective of the current study was to determine whether concussions and a history of playing football influenced a possible association between ACEs and poor neuropsychiatric health.


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The researchers analyzed data of 1755 former National Football League (NFL) players (aged 57.2±13.5 years 66.1% White 29.6% Black) who participated in the Football Player’s Health Study at Harvard University longitudinal study. Twelve percent of the players had experienced at least 4 ACEs while 43.7% had no ACEs.

Divorce (30%), living with a family member with alcohol use or substance use problem (23.1%), and physical abuse (20.7%) were the most commonly reported ACEs. ACEs were linked with childhood socioeconomic status (SES). Black players more frequently had experienced more ACEs compared with White individuals (Black no ACES 17.9% at least 4 ACEs 51.4%, White no ACES 78.0% at least 4 ACEs 42.8%). Individuals who had not experienced ACEs were more likely to be quarterback, kicker, or punter.

Concussion symptoms were linked in dose-dependent fashion with ACEs.

The researchers found that 42.8% of the players had positive dementia screening results and 37.4% had poor cognition-related quality of life.

Compared with those who did not experience ACEs, individuals who experienced at least 4 ACEs had a 48% higher chance of positive dementia screening and a higher risk (RR range 1.62 to 1.74) of all neuropsychiatric outcomes except anxiety.

Individuals with at least 4 ACEs had a 60% higher risk of being in the top quartile of concussion symptoms compared with their peers who did not have ACEs.

Study limitations included possibility of participation bias, recall bias, residual confounding, and comorbidities.

The researchers said an association they found between ACEs and concussion symptoms during professional football careers could stem from a hypothetical tie between exposure to ACEs and a riskier approach to football, experience of worse symptoms following concussion, or biased recall.

“These findings further suggest that treatment of psychological trauma in addition to treatment of physical injury may improve neuropsychiatric health in former NFL players,” they concluded.

Disclosure: Some study authors declared affiliations with the National Football League Players Association. One study author reported affiliations with Myomo Inc and onecare.ai Inc.

Reference

Roberts AL, Zafonte R, Chibnik LB, et al. Association of adverse childhood experiences with poor neuropsychiatric health and dementia among former professional US football players. JAMA Network Open. Published online March 22, 2022. doi:10.1001/jamanetworkopen.2022.3299