Long-Term Brain Health Outcomes in Females With a History of Contact Sports: A Cross-Sectional Survey Analysis.

Abstract

Objective: To assess whether female sex is associated with higher lifetime concussion risk and if years of contact sport participation and/or concussion history are associated with negative long-term cognitive and psychiatric difficulties in females compared with males.

Design: Cross-sectional survey.

Setting: ResearchMatch, a national health-based volunteer registry.

Participants: A total of 330 participants (111 females) with contact sport exposure.

Interventions: Participants reported lifetime concussion history, age of first exposure, and duration of contact sport exposure.

Main outcome measures: Lifetime concussion history, depressive symptoms (PHQ-9), anxiety symptoms (GAD-7), and cognitive symptoms (BC-CCI).

Results: Of 330 participants (N = 111 females), 57.1% of females reported at least one concussion. Females had fewer years of contact sport exposure than males (6.0 ± 4.5 vs 8.5 ± 8.9 years; P < 0.001). Age of first exposure was similar between sexes (females: 11.7 ± 8.9 years; males: 11.5 ± 5.3 years; P = 0.779). Female sex was not associated with a positive lifetime concussion history (OR = 1.13; 95% CI, 0.66-1.93; P = 0.662). Total years of contact sport exposure did not predict lifetime concussion history in females (OR = 1.02; 95% CI, 0.94-1.11; P = 0.667) but did in males (OR = 1.05; 95% CI, 1.01-1.10; P = 0.020). Increased lifetime concussions predicted increased late-life depressive, anxiety, and cognitive symptoms in both sexes.

Conclusions: Female sex was not associated with a higher likelihood of having a lifetime concussion history. Total years of contact sport exposure did not predict lifetime concussion risk in females but did in males. Increased lifetime concussions were associated with higher late-life depressive, anxiety, and cognitive symptoms in both sexes.

Clinical relevance: These findings highlight the importance of considering sex-specific differences in assessing long-term cognitive and psychiatric risks in former athletes.