Multiple concussions linked to poorer mental health after college football

Former collegiate football players who reported three or more concussions during their lifetimes had poorer self-reported cognitive and mental health than players with no concussion history, according to an observational study of 627 athletes in the NCAA–Department of Defense Concussion Assessment, Research, and Education Consortium. The clearest association after statistical adjustment was with depressive symptoms. The research focused on the relatively understudied interval between leaving college and the decades-long period of retirement, when former athletes begin transitioning from structured athletics to professional and personal life.

In unadjusted analyses, the three-or-more-concussion group had worse average scores on all four health measures: subjective cognitive quality of life, depressive symptoms, general mental health and life satisfaction. These players were also more likely than athletes with no concussions or one to two concussions to exceed clinical screening thresholds for adverse cognitive quality of life, depressive symptoms and general mental health. Life satisfaction did not differ significantly by concussion group.

Years of football participation were not associated with any of the four outcomes in the study. The researchers analyzed post-graduation questionnaires completed between 2018 and 2021 by former varsity football players recruited from 26 United States universities between 2014 and 2020. Participants were surveyed within five years of leaving their institutions.

Their mean age at follow-up was 25.0 years, with a standard deviation of 1.7, and they had accumulated an average of 11.4 years of football experience. Overall, 56.9% reported at least one lifetime concussion. The sample was 60.6% White, and 62.7% competed in Division I; the remainder represented Division II or III programs.

Four validated questionnaires assessed different aspects of psychosocial health. The Quality of Life in Neurological Disorders cognitive domain, or Neuro-QoL, measured self-reported cognitive quality of life, with higher scores indicating better functioning. The Mental Component Summary of the 12-item Short Form Health Survey, or SF-12 MCS, assessed general mental health, while the Satisfaction with Life Scale, or SWLS, measured life satisfaction.

Clinically adverse thresholds were defined as a Neuro-QoL or SF-12 MCS t-score below 40, a PHQ-9 score of at least 10, or an SWLS score below 20. Ordinary least-squares regression models estimated the relationships between football exposure and questionnaire scores while accounting for alcohol use, athletic identity, resilience, sleep quality, race, salary, athletic division, graduate degree status, bodily pain and physical functioning. Missing covariate information was handled through multiple imputation, with estimates pooled using Rubin’s rules.

Interaction terms tested whether the relationship between concussion history and an outcome differed according to playing position. The researchers applied Benjamini–Hochberg procedures to control the false discovery rate across multiple tests, while separate analyses compared the proportions of participants exceeding clinical thresholds. After adjustment for the prespecified covariates, athletes with three or more concussions had significantly higher PHQ-9 scores than those with none.

The estimated difference was 1.53 points, with a standard error of 0.52 and a p-value of 0.014, which the authors classified as a medium-to-large effect. Their SF-12 MCS scores were also an estimated 2.32 points lower than those of players with no concussions, with a standard error of 1.01 and a p-value of 0.022, although that association was no longer statistically significant after false-discovery-rate correction. A Type III test for concussion history as a variable in the PHQ-9 model returned p = 0.003.

Playing position produced less consistent results. In unadjusted analyses, line players reported more depressive symptoms than special-teams players, while line and hybrid players had lower general mental-health scores than special-teams players. A total of 17.8% of line players crossed the PHQ-9 threshold, compared with 8.6% of hybrid players and 2.3% of special-teams players.

A position-by-concussion interaction appeared for Neuro-QoL scores: the change from zero to one or two concussions differed between hybrid and agility players, with an estimated coefficient of 4.57, a standard error of 1.60 and a p-value of 0.018. The effect was small, however, and the researchers said its clinical significance was likely limited. Clinical-threshold results provided additional context.

Overall, 11.8% of the sample had a PHQ-9 score of at least 10, compared with 14.3% in a cited reference sample of American men aged 20 to 39; 12.6% scored below the Neuro-QoL threshold, and 17.6% fell below the SF-12 MCS threshold, broadly near the approximately 16% expected from normative scoring. Just over 10% of participants crossed at least one adverse threshold. The group-level figures therefore appeared broadly similar to the available population references, even though the three-or-more-concussion subgroup consistently showed more adverse outcomes on three of the four measures.

The authors cautioned that the normative references were not stratified by age or sex, which may limit the comparison. These results do not establish that concussions caused the reported symptoms. The study used self-reported concussion counts and self-reported health outcomes, and its post-graduation analysis was cross-sectional, with exposure and health status assessed at the same time.

Recall bias was possible, including the possibility that athletes experiencing more symptoms were more likely to report additional concussions. Players with poorer health may also have been more likely to participate in follow-up, while some instruments used relatively short recall periods and may not have captured longer-term well-being. Other unmeasured injuries, changes in athletic identity after leaving college, possible professional participation, and concussions occurring after college could also have influenced the findings.

The researchers lacked comprehensive helmet-sensor measurements across participants’ careers, so playing position and years of participation served as proxies for head-impact exposure. The study’s practical implication is that a history of three or more concussions may help identify former collegiate football players who warrant attention as they leave organized sport, the authors said. Screening was proposed as a way to detect problems during the transition, not because the study demonstrated that screening improves health outcomes.

The findings apply specifically to recently retired collegiate football players and may not extend to professional players, high-school athletes or participants in other sports. Within those limits, the study identifies a group with measurably poorer self-reported psychosocial health at a consequential career transition and supports targeted monitoring and support for athletes with substantial concussion burden.

Subject of Research: Associations between lifetime concussion history and self-reported mental and cognitive health among recently retired collegiate football players

Article Title: Cognitive and Mental Health in Recently Retired Collegiate Football Players: Findings from the CARE Consortium

Article References: Syrydiuk, R. A., Brett, B. L., Varangis, E. M. L., Wiebe, D. J., Pasquina, P. F., McCrea, M. A., McAllister, T. W., Broglio, S. P., CARE Consortium Investigators, Hoy, A., Kelly, L., Ortega, J., McDevitt, J., D’Lauro, C., Cameron, K., Susmarski, A., Benjamin, H., Kamisnki, T., Buckley, T., … Morath, B. (2026). Cognitive and Mental Health in Recently Retired Collegiate Football Players: Findings from the CARE Consortium. Sports Medicine – Open, 12(1), Article 157. https://doi.org/10.1186/s40798-026-01126-6

Image Credits: AI Generated

DOI: 10.1186/s40798-026-01126-6

Keywords: collegiate football, concussion history, mental health, depressive symptoms, cognitive health, athletic retirement, CARE Consortium, self-reported health, Cognitive, Mental, Health, Recently