Is CTE really the main reason behind the rise in NFL player suicides? | NFL

WWhen an NFL player commits suicide, we often wonder why. Injuries and unemployment – ​​common in a violent sport where players are frequently traded and cut – have been linked to increased risks of suicidal ideation. Alongside these factors, however, there is chronic traumatic encephalopathy (CTE). A degenerative brain disease caused by repeated trauma to the head, CTE’s links to football are established and almost impossible to ignore. Players ranging from highly admired Pro Bowlers such as Junior Seau and Dave Duerson to those infamous for more notorious reasons, such as Aaron Hernandez and Phillip Adams, have all been confirmed to have CTE through autopsies. (This illness can only be diagnosed posthumously.) All four players committed suicide.

Such anecdotal observations imply a certain coherent logic that links football to suicide. Contact football, by its nature, increases the risk of head injury for participants. Head injuries increase the likelihood that an affected person will attempt suicide. CTE is often the cumulative consequence of years of head injuries and, indeed, many high-profile NFL players who have committed suicide have been confirmed to have CTE. So it’s easy to think that football and/or CTE, by their very nature, leads to an increased risk of suicide.

That makes sense. But a new study finds that other factors come into play. To put it more precisely: The study says that the data does not support the idea that CTE is the sole cause of NFL players’ increased risk of suicide.

The findings were released in January by members of Harvard’s Football Player Health Study (FPHS), a diverse group of neuroscientists, former NFL players and others who have been examining the health and well-being of professional football players since 2014.

“As someone raised in a basketball family, I started this research with a lot of assumptions,” Dr. Rachel Grashow, one of the lead authors of the FPHS study, told the Guardian. “I learned pretty quickly that the public discourse around CTE didn’t actually reflect the scientific nuance and lived experience of many stakeholders.”

The group’s researchers used the National Death Index to collect information on the causes of death of approximately 34,000 NFL, NBA and MLB players over a 40-year period between 1979 and 2019. When examined across all four decades, NFL players were 20% more likely than their fellow basketball and baseball players to commit suicide. Perhaps this is about what the average fan would expect when comparing football to less contact-intensive sports. However, a more careful examination of the data reveals a more shocking, but ultimately actionable, truth.

If the analysis is limited to the period from 1979 to 2009, NFL players represented approximately 10% less more likely than their NBA and MLB counterparts to commit suicide. Only since 2009 have NFL players become more likely to commit suicide compared to their peers, and the change has been significant. Over the 10-year period from 2009 to 2019, NFL players became 260% more likely than NBA and MLB players to commit suicide. This is a stunning change that raises the question: what could explain such a change?

At first glance, CTE seems like the most obvious explanation. But the picture is a little murkier. Although the first NFL-adjacent case of CTE was not diagnosed until 2002, it is almost certain that undiagnosed cases of CTE were at least as prevalent in 20th century football as they are today. Indeed, given improvements in helmet design, cases of CTE were likely even more common in the past. And yet, suicide rates among NFL players increased in the 2010s. What happened?

Suicide contagion – or an increase in copycat attempts following a high-profile suicide, is a very real and scientifically well-established phenomenon – and may explain some of this increase. The 2010s saw several events at the intersection of the NFL, mental health and suicide, which were widely covered by the media. Seau, a beloved Hall of Famer, committed suicide in 2012. Concussion, a Will Smith film chronicling Dr. Bennet Omalu’s efforts to convince the NFL of the risks of CTE, was released in 2015. Partly due to public pressure following increased media coverage of the issue, the NFL acknowledged a connection between football and CTE during a congressional hearing on the subject in 2016. public CTE has only increased since then.

One aspect of CTE may also make it particularly potent when it comes to suicide contagion: CTE cannot be diagnosed with certainty until after death. With no way to confirm whether they’ve developed CTE, potentially affected gamers find themselves in a perpetual state of uncertainty, wondering whether every headache or misplaced house key is a momentary mental lapse or a symptom of something more worrisome. Generally speaking, professional diagnosis of a chronic illness is already associated with an increased risk of suicide, and many actors essentially self-diagnose CTE.

To clarify, the Harvard study’s findings do not imply that CTE is blameless when it comes to suicide among NFL players. Instead, the study reaffirms that CTE is only one of many possible factors. Imagine simultaneously pouring two full pints of juice – orange and apple – at the same rate into a third empty pint glass. Sure, juice would soon leak from the third glass, but was it the orange juice or the apple juice that caused the spill?

Mental health crises are rarely the result of a single contribution, even among NFL players potentially affected by CTE. It is therefore important for players and their doctors to consider other explanations for CTE-like symptoms. Indeed, many of the symptoms most associated with CTE (memory loss, brain fog, aggression, depression, etc.) are also symptoms linked to other conditions like sleep apnea, low testosterone, and high blood pressure. Adding to the confusion, each of these individual symptoms can also be caused or exacerbated by head trauma, with or without the presence of CTE.

It’s also possible that part of this increase has to do with how player deaths are classified. “Deaths among NFL players that would not have been classified as suicides by medical examiners before 2011 may have been classified as suicides after 2010, due to greater awareness of issues related to head injuries,” study co-author Marc Weisskopf told the Daily Mail.

Perhaps more importantly, once the specter of CTE is removed from the debate (or, at least, properly framed), treatment options become available, even though CTE remains a real risk factor. Hall of Fame running back Tony Dorsett was diagnosed with CTE-like symptoms in 2013 (again, definitive diagnosis of CTE is only possible after death and Dorsett is still alive). The symptoms that led him to get tested are familiar: memory loss, depression and suicidal thoughts. Thirteen years later, Dorsett has even become an advocate for sleep apnea treatments. Even more relevant, recently retired tight end Hayden Hurst, who was diagnosed with a non-CTE neurological condition after a 2023 NFL concussion, spoke about experiencing (and overcoming) a suicide attempt earlier in his career.

Simply put, when an NFL player commits suicide, multiple questions arise around the complicated relationship between professional football, mental health and suicide. Given the simultaneous increase in CTE awareness and suicides in the NFL over the past 15 years, a tendency to conflate the two emerges. But, according to the Harvard study, that’s not the right way to look at things and Weisskopf says “more research is needed to determine the individual contributions” of the factors that lead to suicide in former NFL players.

When the question is “should people at risk of suicide talk to their doctor or loved ones about CTE, sleep apnea, high blood pressure, or something else?” » the only correct answer is “Yes”.