Study shows rise in suicide rate among NFL players
For more than a decade, the Football Players Health Study at Harvard University (FPHS) has been conducting research on how a career in football impacts the long-term health and wellbeing of players and their families. The latest FPHS study, published Jan. 12 in the Journal of Neurotrauma, is on suicidality among National Football League (NFL) players, especially in the context of growing awareness of and attention on neurodegenerative disease and chronic traumatic encephalopathy (CTE). The study found that NFL players faced increased risk of suicide compared to their basketball and baseball counterparts, likely due to multiple factors including “copycat” effects from high-profile suicides, increased fears around CTE, and high rates of medical conditions whose symptoms can mimic those of CTE.
Below, the study’s lead authors—Rachel Grashow, senior research scientist at Harvard T.H. Chan School of Public Health and director of epidemiological research initiatives for the FPHS, and Marc Weisskopf, Cecil K. and Philip Drinker Professor of Environmental Epidemiology and Physiology and director of epidemiological studies for the FPHS—talk about their findings and why they instill senses of both caution and hope.
Q: What did you examine in this study?
Weisskopf: Recent high-profile suicides among NFL players have raised serious concerns about player health, wellbeing, and safety. Our study asks whether professional football players are different from other professional athletes when it comes to suicide. We’ve known for some time that suicide rates among male professional athletes, including NFL players, are lower than that of the general male population—but since these groups differ in many ways, we decided to focus exclusively on elite athletes and compare NFL players to their Major League Baseball (MLB) and National Basketball Association (NBA) counterparts.
Grashow: We were also interested in how suicide rates among NFL players may have changed over time. In recent years, conversations around head injury and neurodegenerative disease have shaped a collective narrative around football and health. We believe 2011 was a pivotal year for that conversation, when the publication of scientific studies on brain injury, neurodegenerative disease, and football accelerated. In particular, CTE—a neuropathological condition that is determined only through autopsy, and that cannot yet be diagnosed or treated in living patients—gained attention in a series of highly publicized research articles. There were also a number of high-profile deaths by suicide among some NFL players after 2010 that were discussed publicly.
This study asked whether NFL suicide was more likely from 2011 onwards, since CTE wasn’t as widely discussed prior to that, and we know from our previous research that there is a link between CTE concerns and suicidality. One of our previous FPHS studies, which used data from our cohort of nearly 5,000 former NFL players, showed that players with CTE concerns were more likely to report frequent thoughts of self-harm or killing themselves.
Q: How did you conduct this study and what did it find?
Weisskopf: We used publicly available playing data on all professional baseball, basketball, and football players going back to 1920 that included their names and dates of birth. That information was submitted to the U.S. National Death Index, who returned a list of deceased players along with their date and cause of death. We flagged the deaths by suicide in this list to determine the suicide rate across all the years studied—1979, when the U.S. started maintaining electronic death records, through 2019—as well as broken into two eras: 1979-2010 and 2011-2019.
Grashow: Similar to other studies of suicide among professional athletes, when we pooled all the data from 1979 to 2019, we saw a comparable rate of death by suicide among NFL, MLB, and NBA players.
When we split the data at 2011, we found that prior to 2011, NFL, MLB, and NBA players also had the same rate of death by suicide. From 2011 to 2019, however, we saw an almost threefold increase in suicide among NFL players when compared to these other professional athletes.
Q: What might account for this increase?
Weisskopf: We can’t say for sure from this study, but there are many possible contributing factors. While we did not find any rule-, policy-, or equipment-based changes that could account for the increase, these and other biological or exposure-based causes can’t be ruled out. It’s also possible that deaths among NFL players that would not have been classified as suicides by medical examiners prior to 2011 may have been labeled a suicide after 2010, as a result of greater awareness of issues related to head trauma. Additionally, high profile suicides have been known to cause a “copycat” or contagion effect called the Werther effect. More research is needed to determine the individual contributions of each of these factors.
Grashow: Previous research may lend additional relevant context. Similar to prior FPHS findings linking CTE concerns with thoughts of self-harm or suicide, studies have shown that individuals who have been diagnosed or believe themselves to be at risk for neurodegenerative disease such as Alzheimer’s disease, ALS, or Parkinson’s disease are at greater risk of suicide. Descriptions of these conditions as neurodegenerative diseases without cure—and, in the case of CTE, treatment—may be contributing to increased suicide rates, although, again, we cannot say for certain based on this study.
On a hopeful note, however, while some former players may indeed have the underlying brain changes associated with CTE, there are also other conditions commonly found in former NFL players that may result in symptoms frequently attributed to CTE, but that are treatable. A previous FPHS study showed that members of our cohort disproportionately report living with conditions that can cause cognitive symptoms—issues with memory, concentration, and impulsivity, for example—including sleep apnea, high blood pressure, low testosterone, chronic pain, depression, and opiate use. Players with these conditions and symptoms were more likely to think they had CTE. While these players may have the underlying brain pathology that characterizes CTE, some may not. We believe encouraging players to be proactive about their treatable conditions is worth emphasizing.
Q: What are the study’s key takeaways—for players, their families, and the institutions responsible for their health and safety?
Grashow: We hope our findings motivate collective action among players, families, the NFL, and other organizations who support current and former players to address what may be preventable deaths. First and foremost, the sudden onset of increased suicide risk among NFL players should motivate increased screening, surveillance, and programming for former players related to depression, thoughts of self-harm, and suicide. Further, it may be beneficial for players, families, PCPs and sports medicine physicians, and other organizations that support former players to increase screening for conditions that may mimic symptoms attributed to CTE. Treatments are available for many of these conditions, with the potential to improve quality and length of life and, in so doing, reduce feelings of despair. These investments are important and warranted regardless of whether or not the increased attention and concern about head injury and brain effects are among the contributors to the higher NFL suicide rate.
Weisskopf: There’s still a lot we don’t know about CTE, and specifically how it may relate to enhanced suicide risk. Research to identify treatments and diagnostics should be prioritized. And while this research is ongoing, we really want to emphasize that cognitive symptoms don’t automatically indicate neurodegenerative disease. Rather, cognitive symptoms should motivate thorough screenings for all treatable conditions known to commonly occur in football players, as well as, it’s worth noting, anyone at risk of repetitive head injury, including military service people and players of other contact sports. We encourage these individuals, their families, and their physicians to prioritize treating what’s treatable, and to have open conversations about risks for self-harm and suicidal ideation.
