Elite ice hockey players with concussion history have heightened mental health symptoms

Elite ice hockey players with a history of concussion report heightened mental health symptoms, according to a new study from Lund University in Sweden. In addition, one in five female hockey players suffered symptoms of burnout, and both sexes reported an alcohol consumption at a risk-level.

The researchers based their study on Sweden's two highest hockey divisions for men - the SHL and Hockeyallsvenskan, and the women's top league, SDHL. A total of 648 players, 180 of them women, completed the researchers' online questionnaire. The focus of the questions was on alcohol consumption, mental health and concussion history.

A lot of research is undertaken in both Europe and the USA into the effects of concussions on mental health and well-being.

However, we want to investigate more long-term consequences for Swedish top players - six months or more after a concussion. The players' responses have provided important insights into the links between concussion and mental health effects."

Mitchell Andersson, doctoral student in psychiatry at Lund University

He is behind the study, which has now been published in the journal BMC Sports Science, Medicine and Rehabilitation, together with Anders Håkansson, consultant physician and professor of addiction medicine at Lund University. When Lund University researchers collated the reported psychiatric symptoms among players, the male players were shown to have significantly fewer symptoms of depression/anxiety and burnout than other men - whether that be elite athletes in other sports or the wider Swedish male workforce. Thirty per cent of male hockey players did, however, report at-risk levels of alcohol consumption - far more than in the comparison groups.

For female hockey players, the picture was slightly different. The prevalence of depression/anxiety symptoms was comparable to that of the average Swedish woman. Burnout, however, was far more common: over 19 per cent of the women reported living with clinical symptoms of burnout - almost double the rate among Swedish women on average. The female hockey players also reported that they drank a lot of alcohol. The percentage of respondents reporting that they reached the level of at-risk consumption was 36.4 per cent - also far above average.

Concerning concussion, both female and male hockey players who reported more concussions were more likely to report elevations in various psychiatric symptoms (e.g., depression and anxiety) . The correlation was clearest in both sexes after three or more concussions: the risk of developing symptoms of depression doubled, and the risk of burnout was three-and-a-half times higher. More than one in four male and almost one in five female players reported having suffered at least three concussions.

"Other studies have shown that women experience more short-term symptoms after a concussion than men, but it was interesting that the link between concussion and heightened prevalence of symptoms of depression, anxiety and burnout was equally strong for both sexes. This might indicate that the long-term neuropsychiatric recovery process is more similar in men and women than the short-term process," says Mitchell Andersson.

To meet the criteria for burnout, the individual is to have lived under stress for a least six months and to have developed a number of physical and psychiatric symptoms. According to Mitchell Andersson, however, it can sometimes be difficult to see what is what - long-term symptoms after a concussion are often similar to those of burnout, such as cognitive impairment, irritability, difficulty concentrating and sleep problems.

The results of the study suggest several lines to follow up, argues Mitchell Andersson. One is to dig into why alcohol consumption among elite players is so high.

"Hockey players are physically slightly larger, and are perhaps able to drink a little more. Their own view of themselves, and that of others, may be that they are a bit tougher than others. There can be a sense of pride in being part of such a subculture. Romanticising alcohol can be a part of it, for both men and women," Mitchell Andersson speculates. He himself played hockey at a non-elite level.

This same self-assumed toughness might contribute to male players actually underreporting possible mental health issues. The fact that such a high proportion of women report burnout symptoms even without concussion might point to a recurring pattern within women's sport at the highest level: Their salaries are lower than the men's. They are more likely to have to combine hockey with another job or academic studies. Juggling their responsibilities with late night matches, often far from home, can be an impossible equation.

"Swedish hockey players at elite level need to know where and how they can get help. There is help available aimed at this target group. Imagine that you are an elite athlete who trains regularly, eats healthily, earns good money from the sport you love - and yet you are still struggling. Can you imagine how frightening and isolating that must feel? Not having to feel alone in your state of mind is important," concludes Mitchell Andersson.