Perceived Chronic Traumatic Encephalopathy and Suicidality in Former Professional Football Players.

IF 3.5 3区医学 Q2 CHEMISTRY, MEDICINAL

ACS Medicinal Chemistry Letters Pub Date : 2024-09-23 DOI:10.1001/jamaneurol.2024.3083

Rachel Grashow, Douglas P Terry, Grant L Iverson, Heather DiGregorio, Inana Dairi, Cheyenne Brown, Paula S Atkeson, Alicia J Whittington, LeRoy Reese, Jonathan H Kim, Niki Konstantinides, Herman A Taylor, Frank E Speizer, Daniel H Daneshvar, Ross D Zafonte, Marc G Weisskopf, Aaron L Baggish

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引用次数: 0

Abstract

Importance: Participation 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.

Objective: To determine the proportion, clinical correlates, and suicidality of living former professional ASF players with perceived CTE.

Design, setting, and participants: A 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.

Exposures: Data 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 measures: The proportion of participants reporting perceived CTE. Univariable and multivariable models were used to determine clinical and suicidality correlates of perceived CTE.

Results: Among 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 relevance: This 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.

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退役职业足球运动员的慢性创伤性脑病认知和自杀倾向。

重要性：参加美式橄榄球（ASF）与慢性创伤性脑病神经病理学改变（CTE-NC）有关，这是一种特殊的神经病理学发现，只有在尸检时才能确定。尽管是死后诊断，但在世的前 ASF 球员可能认为自己患有 CTE-NC。目前，在世的前职业 ASF 运动员中，自认为患有 CTE 并报告有自杀倾向的比例和临床相关性尚不清楚：目的：确定自认为患有 CTE 的在世前职业 ASF 运动员的比例、临床相关性和自杀倾向：2017 年至 2020 年，在哈佛大学足球运动员健康研究范围内开展了一项横断面研究。这项以人群为基础的研究使用电子和纸质调查问卷，研究对象包括 1960 年至 2020 年期间与职业联赛签约并自愿填写基线调查问卷的前 ASF 球员。本研究的数据分析时间为 2023 年 6 月至 2024 年 3 月：数据包括人口统计学、足球相关暴露（如位置、职业生涯持续时间）和当前健康问题（焦虑、注意力缺陷/多动障碍、抑郁、糖尿病、情绪和行为控制障碍症状、头痛、高脂血症、高血压、低睾酮水平、疼痛、睡眠呼吸暂停和主观认知功能）：主要结果和测量指标：报告感知到 CTE 的参与者比例。采用单变量和多变量模型确定感知到的 CTE 的临床和自杀相关性：在 4180 名自愿填写基线调查的前职业 ASF 球员中，1980 人（47.4%）提供了后续数据（平均 [SD] 年龄，57.7 [13.9] 岁）。共有 681 名参与者（34.4%）报告了他们认为的 CTE。主观认知困难、低睾酮水平、头痛、比赛期间出现的脑震荡体征和症状、抑郁/情绪和行为控制障碍症状、疼痛以及年龄较小与认为的 CTE 显著相关。在 681 名自认患有 CTE 的参与者中，有 171 人（25.4%）报告有自杀倾向；在 1299 名未自认患有 CTE 的参与者中，有 64 人（5.0%）报告有自杀倾向。在对已确定的自杀预测因素（如抑郁）进行调整后，认为有 CTE 的男性报告自杀的可能性仍然是未认为有 CTE 的男性的两倍（几率比 2.06；95% CI，1.36-3.12；P）：这项研究发现，约有三分之一在世的前职业 ASF 球员报告了他们认为的 CTE。与未感知到 CTE 的男性相比，感知到 CTE 的男性自杀率更高，更有可能出现与认知障碍相关的健康问题。自认为的 CTE 是一种新的自杀风险因素，如果存在，应促使对可能被误认为是 CTE-NC 的医疗和行为疾病进行诊断评估和治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

ACS Medicinal Chemistry Letters CHEMISTRY, MEDICINAL-

CiteScore

7.30

自引率

2.40%

发文量

328

审稿时长

1 months

期刊介绍： ACS Medicinal Chemistry Letters is interested in receiving manuscripts that discuss various aspects of medicinal chemistry. The journal will publish studies that pertain to a broad range of subject matter, including compound design and optimization, biological evaluation, drug delivery, imaging agents, and pharmacology of both small and large bioactive molecules. Specific areas include but are not limited to: Identification, synthesis, and optimization of lead biologically active molecules and drugs (small molecules and biologics) Biological characterization of new molecular entities in the context of drug discovery Computational, cheminformatics, and structural studies for the identification or SAR analysis of bioactive molecules, ligands and their targets, etc. Novel and improved methodologies, including radiation biochemistry, with broad application to medicinal chemistry Discovery technologies for biologically active molecules from both synthetic and natural (plant and other) sources Pharmacokinetic/pharmacodynamic studies that address mechanisms underlying drug disposition and response Pharmacogenetic and pharmacogenomic studies used to enhance drug design and the translation of medicinal chemistry into the clinic Mechanistic drug metabolism and regulation of metabolic enzyme gene expression Chemistry patents relevant to the medicinal chemistry field.