Literature Review: What is post-athlete depression?

Let’s redefine mental toughness together.

Timeout

Published in

The Huddle

5 min readApr 29, 2022

**Image Description:** Light blue background with indigo words that read, “Reimagining science.”

By: Mikaela Brewer | Head of Content & Research

The athlete ecosystem is one of the most vibrant, inspiring, and soulful communities. It is also submerged in an expectation that these things can only be maintained by a standard of mental toughness that deeply embeds mental health stigma. At Timeout, we’re deconstructing this barrier by painting the full picture — bringing you the humans beneath athletes, coaches, care providers, and anyone else immersed in this world. We’re exploring mental health research in a fresh and approachable way — by welcoming our entire community into the conversation and asking questions that will prompt change. Let’s redefine mental toughness together.

In this literature review series called “Reimagining Science,” we are exploring research in a fresh way, by unpacking some of the literature around specific topics. Our goal is for these literature reviews to be accessible to the entire athletic community — coaches, athletes, care providers, etc. We’re beginning with grief, loss, and heaviness, as we navigate the uncertainty of our world.

Venturing into athletic retirement isn’t as easy as hanging up our gear for the last time. Each of us has a different story to unpack, which may include many different chapters: nearing the end, the moment we realize we won’t compete again, career-ending injuries, a difficult choice to retire, and perhaps especially, the days, weeks, months, and years afterward where we carry not only our foggy retirement experience, but our entire career. Carrying these doesn’t necessarily mean they’re neatly packaged, tied, and stored.

There are many ways in which athletic retirement prompts unique mental, emotional, physical, social, and spiritual health risks, and thankfully, the research has explored them. In this article, we’ll focus on how clinical depression and depressive symptoms can find their way into the mix.

The following research is largely focused on football, and though the field is working on more generalizable data for all athletes, there is much we can learn from these findings. Many of these results may resonate, and like any story — research or other — I hope you feel seen in these narratives.

How to engage with research

First, you’ll see the title of the research paper, followed by its citation (if you’d like to read the full article, head to scholar.google.com and copy-paste this citation)! Beneath the citation are the critical points from the research, framed in an easy-to-understand way. There may be further citations beneath each “main citation” which can be used as further reading if you’re interested. Enjoy!

Self-reported depressive symptoms in active and retired professional hockey players

Aston, P., Filippou-Frye, M., Blasey, C., Johannes van Roessel, P., & Rodriguez, C. I. (2020). Self-reported depressive symptoms in active and retired professional hockey players. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement.

Moderate to very severe levels of depressive symptoms were reported at nearly 2x the rate of current players (and higher than the general population), in a group of 409 active and retired professional hockey players.
Both groups of players experienced higher levels of normative male alexithymia (NMA), which was related to greater depressive symptoms.
Retired athletes expressed lower perceived social support (family and friends) than those who were still competing. Lower social support (across both groups) was associated with greater depressive symptoms.

Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players

Kerr ZY, Marshall SW, Harding HP, et al. Nine-year risk of depression diagnosis increases with increasing self-reported concussions in retired professional football players. Am J Sports Med 2012;40:2206–12.

Professional football players: With an increasing number of concussions (self-reported), the risk of a diagnosis of depression and depressive episodes — within 9 years post-retirement — increased.
The relationship between depression and a decline in physical health did not impact the relationship between depression and concussions.

Depression and pain in retired professional football players.

Schwenk TL, Gorenflo DW, Dopp RR, et al. Depression and pain in retired professional football players. Med Sci Sports Exerc 2007;39:599–605.

In this study, 84.5% of respondents (1366) experienced no to mild depression, and 14.7% (237) experienced moderate to severe depression.
These individuals were also grouped based on their experiences with pain. 51.8% (837) reported not/somewhat often difficulty with pain, and 47.6% (769) said that their difficulty with pain was quite/very common.
Notes about difficulties with marriage, relationships, sleep, finance, aging, and exercise were strongly correlated with quite/very common pain difficulty and moderate/severe depression. These specific struggles were more common among retired athletes who experienced both quite/very common pain difficulty and moderate/severe depression.
The general consensus is that pain, specifically if lingering into retirement, can compound depressive symptoms and increase the risk of severe depression.

Associations between retirement reasons, chronic pain, athletic identity, and depressive symptoms among former professional footballers.

Sanders G, Stevinson C. Associations between retirement reasons, chronic pain, athletic identity, and depressive symptoms among former professional footballers. Eur J Sport Sci 2017;17:1311–8.

16% of participants in this study met criteria for a possible case of clinical depression. These individuals held a stronger athletic identity and retired more recently.
This group reported injury as their most frequent retirement reason. They also experience high levels of continuing pain related to their injury.
The statistics show us that depressive symptoms are individually associated with 1) chronic pain, 2) stronger athletic identity, and 3) career-ending injury.
During retirement, these are the potential contributors for depressive symptoms, with the strongest being retirement due to injury.

Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players.

Hart J, Kraut MA, Womack KB, et al. Neuroimaging of cognitive dysfunction and depression in aging retired National Football League players. JAMA Neurol 2013;70:326–35.

This study looked at cognition and depression in 34 former NFL players (average age ~62)
Through neuroimaging of a few players, there were white matter* abnormalities and cerebral blood flow* differences in both cognitively impaired and depressed players.
*White matter — the brain tissue where most messages are passed (between cells in the grey matter)
*Cerebral blood flow — the rate at which blood (and the oxygen in it) is delivered from the heart to the brain
Alongside cognitive deficits and impairment, depression seems to be more common in older former NFL players.

Thank you for reading. More to come!

Resources to check out (because we’re human first):