Predictors and Correlates of Depression in Retired Elite Level Rugby League Players

Abstract

Background: There is considerable interest in determining whether later-in-life depression is associated with lifetime history of concussions or the duration of a career in professional contact and collision sports. Rugby league is a high-intensity collision sport involving a large number of tackles per game and a high rate of concussions. We examined predictors and correlates of depression in retired elite level rugby league players in Australia.Methods: Retired elite level rugby league players (N = 141, age: M = 52.6, SD = 13.8; Range = 30–89 years) completed the Depression, Anxiety, and Stress Scale (DASS), Brief Pain Inventory, Connor-Davidson Resilience Scale (CD-RISC), and Epworth Sleepiness Scale; they also reported on lifetime history of concussions. The DASS depression score was regressed on age, total number of self-reported concussions, years played professionally, CD-RISC score, BPI pain interference score, and ESS score.Results: The retired players reported a median of 15 total lifetime concussions [interquartile range (IQR) = 6–30], and a median of 8 years playing professional sports (IQR = 3.5–11). The proportion of the sample endorsing at least mild current depression was 29%. The DASS depression score was positively correlated with the DASS anxiety (r = 0.54) and DASS stress scores (r = 0.58). The CD-RISC score was negatively correlated with the depression score (r = −0.53). Depression scores were not significantly correlated with pain severity (r = 0.14), and were weakly correlated with life interference due to pain (r = 0.20) and years playing professional sports (r = −0.17). Depression scores were not significantly correlated with lifetime history of concussions (r = 0.14). A multiple regression model, with age, total number of self-reported concussions, years played professionally, the CD-RISC, Brief Pain Inventory-pain interference score, and Epworth Sleepiness Scale score as predictors was significant, with 35% of the variance in DASS depression accounted for. The two significant independent predictors of depression were lower resilience and greater life interference due to pain.Conclusions: This is the first large study of depression in retired rugby league players. Depression in these retired players was not meaningfully associated with lifetime history of concussions or number of years playing elite level collision sport. Depression was associated with current anxiety, stress, resilience, and life interference due to chronic pain.

A dominance analysis of subjective cognitive complaint comorbidities in former professional football players with and without mild cognitive impairment

“…By examining the increase in variance explained across all possible models, this method allows for comparing the additional contribution of each predictor to equivalent subsets of models (e.g., X 1 added to model X 2 + X 3 , X 2 added to model X 1 + X 3 , X 3 added to X 1 + X 2 ). Given the high correlation between comorbid contributing factors (Brett et al, 2021; Esopenko et al, 2017; Iverson, Van Patten, et al, 2021; Kerr et al, 2012; Schwenk et al, 2007), this method is advantageous in determining unique contribution of these factors to levels of subjectively rated cognition, as one factor’s additional contribution to the outcome could drastically differ depending on which other variables are included in the model; as well as the fact that a one-unit increase in one factor can simultaneously influence the outcome directly and indirectly through an increase in another factor (increase in pain can simultaneously increase depression, both acting on the outcome).…”

“…Higher levels of SCD have been observed among former contact sport athletes (Alosco, M.L., Kasimis, A.B., Stamm, J.M., Chua, A.S., Baugh, C.M., Daneshvar, D.H., Robbins, C.A., Mariani, M., Hayden, J., Conneely, S., Au, R., Torres, A., McClean, M.D., McKee, A.C., Cantu, R.C., Mez, J., Nowinski, C.J., Martin, B.M., Chaisson, C.E., Tripodis, Y., & Stern, R.A. et al, 2017; Esopenko et al, 2017). However, other health, mood, and lifestyle factors are also commonly present, often co-occurring, among former contact sport athletes as well (Brett et al, 2021; Esopenko et al, 2017; Iverson et al, 2021; Kerr et al, 2012; Prien et al, 2020; Schwenk et al, 2007). For example, interrelated relationships between pain, depression, and chronic sleep disturbance, have been observed in former elite-level contact sport athletes (Brett et al, 2021; Iverson, Van Patten, et al, 2021; Schwenk et al, 2007).…”

“…However, other health, mood, and lifestyle factors are also commonly present, often co-occurring, among former contact sport athletes as well (Brett et al, 2021; Esopenko et al, 2017; Iverson et al, 2021; Kerr et al, 2012; Prien et al, 2020; Schwenk et al, 2007). For example, interrelated relationships between pain, depression, and chronic sleep disturbance, have been observed in former elite-level contact sport athletes (Brett et al, 2021; Iverson, Van Patten, et al, 2021; Schwenk et al, 2007). Given the common comorbidity and dynamic relationships (e.g., increased pain can positively influence sleep disturbance and depression symptoms) of these factors, identifying sources of the greatest contribution to difficulties can be challenging, but doing so may improve the efficacy of targeted treatment strategies.…”

“…As such, it is critical to gain a greater understanding of the relative influence of these factors on SCD to optimize treatment and prognosis in older adults. Given the notable prevalence and high comorbidities of these factors with SCD among former contact sport athletes and in the general population, it is critical to differentiate which factors are associated with SCD among those with and without documented cognitive impairment (Brett et al, 2021; Esopenko et al, 2017; Iverson, Van Patten, et al, 2021; Kerr et al, 2012; Schwenk et al, 2007).…”

Ready to Play: A Biopsychosocial Approach to Return-to-Sport in Adults with Prolonged Concussion Symptoms

“…Legend -Green repres ents a l a rge correl a tion (.5-1.0); Yel l ow repres ents a modera te correl a tion (.3-.5) rugby players who had clinically mild stress, anxiety, and depression (Iverson et al, 2021). A recent Canadian study also found non-athletes with persistent symptoms to have clinical levels of anxiety and depression, but they did not calculate the stress subgroup score (Doroszkiewicz et al, 2021).…”