ImportanceParticipation in American-style football (ASF) has been linked to chronic traumatic encephalopathy neuropathological change (CTE-NC), a specific neuropathologic finding that can only be established at autopsy. Despite being a postmortem diagnosis, living former ASF players may perceive themselves to have CTE-NC. At present, the proportion and clinical correlates of living former professional ASF athletes with perceived CTE who report suicidality are unknown.ObjectiveTo determine the proportion, clinical correlates, and suicidality of living former professional ASF players with perceived CTE.Design, Setting, and ParticipantsA cross-sectional study within the Football Players Health Study at Harvard University was conducted from 2017 to 2020. Using electronic and paper surveys, this population-based study included former ASF players who contracted with a professional league from 1960 to 2020 and volunteered to fill out a baseline survey. Data for this study were analyzed from June 2023 through March 2024.ExposuresData included demographics, football-related exposures (eg, position, career duration), and current health problems (anxiety, attention-deficit/hyperactivity disorder, depression, diabetes, emotional and behavioral dyscontrol symptoms, headache, hyperlipidemia, hypertension, low testosterone level, pain, sleep apnea, and subjective cognitive function).Main Outcomes and MeasuresThe proportion of participants reporting perceived CTE. Univariable and multivariable models were used to determine clinical and suicidality correlates of perceived CTE.ResultsAmong 4180 former professional ASF players who volunteered to fill out a baseline survey, 1980 (47.4%) provided follow-up data (mean [SD] age, 57.7 [13.9] years). A total of 681 participants (34.4%) reported perceived CTE. Subjective cognitive difficulties, low testosterone level, headache, concussion signs and symptoms accrued during playing years, depressive/emotional and behavioral dyscontrol symptoms, pain, and younger age were significantly associated with perceived CTE. Suicidality was reported by 171 of 681 participants with perceived CTE (25.4%) and 64 of 1299 without perceived CTE (5.0%). After adjusting for established suicidality predictors (eg, depression), men with perceived CTE remained twice as likely to report suicidality (odds ratio, 2.06; 95% CI, 1.36-3.12; P < .001).Conclusions and RelevanceThis study found that approximately one-third of living former professional ASF players reported perceived CTE. Men with perceived CTE had an increased prevalence of suicidality and were more likely to have health problems associated with cognitive impairment compared with men without perceived CTE. Perceived CTE represents a novel risk factor for suicidality and, if present, should motivate the diagnostic assessment and treatment of medical and behavioral conditions that may be misattributed to CTE-NC.

中文翻译：

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前职业橄榄球运动员的感知慢性创伤性脑病和自杀倾向


重要性参与美式橄榄球 （ASF） 与慢性创伤性脑病神经病理学变化 （CTE-NC） 有关，这是一种只能在尸检时确定的特异性神经病理学发现。尽管是尸检诊断，但在世的前 ASF 球员可能会认为自己患有 CTE-NC。目前，报告自杀倾向的在世前职业 ASF 运动员与感知到 CTE 的比例和临床相关性尚不清楚。目的确定在世的前职业 ASF 球员与感知 CTE.Design、环境和参与者的比例、临床相关性和自杀率 2017 年至 2020 年在哈佛大学足球运动员健康研究中进行了一项横断面研究。这项基于人群的研究使用电子和纸质调查，包括 1960 年至 2020 年与职业联盟签约并自愿填写基线调查的前 ASF 球员。本研究的数据是从 2023 年 6 月到 2024 年 3 月分析的。主要结局和措施报告感知到 CTE 的参与者比例。单变量和多变量模型用于确定感知 CTE 的临床和自杀相关性。结果在 4180 名自愿填写基线调查的前职业 ASF 球员中，1980 名 （47.4%） 提供了随访数据 （平均 [SD] 年龄，57.7 [13.9] 岁）。共有 681 名参与者 （34.4%） 报告了感知到 CTE。主观认知困难、低睾酮水平、头痛、球员时代积累的脑震荡体征和症状、抑郁/情绪和行为失控症状、疼痛和年轻与感知到 CTE 显着相关。681 名感知到 CTE 的参与者中有 171 名 （25.4%） 报告了自杀倾向，1299 名没有感知到 CTE 的参与者中有 64 名 （5.0%） 报告了自杀倾向。在调整了已确定的自杀倾向预测因子（例如，抑郁症）后，感知到 CTE 的男性报告自杀倾向的可能性仍然是其两倍（比值比，2.06;95% CI，1.36-3.12;P < .001）。结论和相关性本研究发现，大约三分之一的在世前职业 ASF 球员报告了感知到 CTE。与没有感知到 CTE 的男性相比，感知到 CTE 的男性自杀倾向增加，并且更有可能出现与认知障碍相关的健康问题。感知到 CTE 代表了自杀倾向的新风险因素，如果存在，则应激励对可能被误认为是 CTE-NC 的医疗和行为状况进行诊断评估和治疗。