Life after pro football: Playing with pain becomes living with pain, depression

Research indicates retired NFL players face depression at rates similar to the general public, but chronic pain compounds their symptoms.

By Stephanie Stapleton — Posted June 11, 2007

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Professional football players exude mystique.

As elite athletes, they are stronger or swifter than others. They make and break tackles, leap in the air to pull down impossible passes, and score thrilling touchdowns. They sign autographs. And once they leave the game, fans assume their celebrity continues and they reap the benefits of product endorsement contracts and broadcasting careers.

Certainly, they aren't depressed.

But a study published in the April Medicine & Science in Sports & Exercise, the journal of the American College of Sports Medicine, suggests that retired National Football League players experience depression at levels at least equal to that of the general public. The impact of these symptoms is compounded by high levels of chronic pain.

The study, which was supported in part by a grant from the NFL Players Assn., was designed to assess the experiences of respondents with a range of life problems following retirement. "It boils down to the concept that retired NFL players are people, too, " said Thomas L. Schwenk, MD, the study's lead author. "They spend their careers playing a brutal sport -- most people don't understand how brutal."

Researchers contacted 3,377 members of the NFLPA, Retired Players Section with a survey that included a structured depression screening tool -- the PHQ-9 questionnaire -- as well as questions about chronic pain and demographics. It also explored postretirement issues, such as employment, marital or financial problems, and the barriers to receiving help.

Among the 1,594 respondents, the prevalence of moderate to severe depression was nearly 15%, similar to that of the general public, according to the study's authors. But the frequency with which retired players reported problems with pain -- nearly half of those who replied -- puts them at significant additional risk for depression and associated difficulties, said Dr. Schwenk, also a professor of family medicine at the University of Michigan Health System and associate director of the U-M Depression Center in Ann Arbor. "The two together are predictive of so much misery."

Overall, more than half of the retired players had high scores in pain, depression or both. Specifically, about 11% had high scores in both areas, 37% had high pain scores and low depression scores, and 4% had low pain scores and high depression scores. The remaining 48% had low scores in both categories.

In addition to the strong link between depression and pain, the relationship between these conditions and other issues also was notable, said co-author Eric Hipple, a retired Detroit Lions quarterback who now is outreach coordinator for the U-M Depression Center.

Retired players who rated as moderately to severely depressed were 11 times more likely to report trouble sleeping; eight times more likely to experience a loss of fitness and lack of exercise; and seven times more likely to face financial difficulties than those who were not depressed or only mildly depressed.

Those in the moderate-to-severe category also were more likely to lack social support or friendships and have problems with the use of alcohol, prescribed medication or other drugs.

Similar patterns existed regarding high scores in pain categories.

Pain was an important factor in the retired players' qualities of life, especially to the extent that it limited mobility and exercise, which seemed to affect self-esteem. However, another theme that emerged was the stress associated with retirement and life after football. The survey shows that "players had a lot of trouble with the transition -- leaving the game, not knowing what to do next," said Hipple. "This is not much different than that of the general public."

Also similar to the broader population, stigma was high on the list of barriers to seeking help. Many said they would feel weak or embarrassed, and most expressed a preference to deal with mental health issues using spiritual means or with the help of family and friends. A lack of health insurance was frequently mentioned.

Dr. Schwenk pointed out that a number of former players do indeed face financial challenges and have insufficient health insurance. "It highlights the fact that the fantasies of what happens to these people's lives are not accurate."

"I might have that"

Lack of recognition among this group that depression is a serious condition also drew researchers' attention.

Hipple, who after a family tragedy, sought help for his own depression, went on to serve as a liaison between the depression center and the NFLPA. At one of his first meetings in this capacity, another retired player turned to him and said, "This depression thing you're working on ... I might have that." The exchange, he said, drove home the importance of fleshing out the symptoms for people who might not even know what is happening to them.

He had a similar experience later, after the study was designed. He and his fellow researchers took the survey to a local meeting of the retired players section to gauge reactions. The players were interested, wanted information and were forthcoming regarding their own situations. Hipple said he "walked away with the idea that there is a huge need for education. ... People don't need to hit rock bottom before they get help."

"It's not just football players," he continued, echoing public health messages encouraging more discussion about depression -- both within the general community and among health professionals. "We all need to ask the right questions about sleep disturbances ... and aches and pains. ... [It] could lead to more screening and get at the depression problem."

"It's a huge issue in this country," Hipple added. "Yes, men do get depressed."

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