Elite hockey players with a concussion have increased psychological symptoms

Elite hockey players with a history of concussion report increased psychological symptoms, according to a new study from Lund University in Sweden. In addition, one in five female ice hockey players suffered from burnout symptoms and both genders reported high-risk alcohol consumption.

The researchers based their study on Sweden’s two top men’s ice hockey leagues – the SHL and Hockeyallsvenskan – as well as the top women’s league SDHL. A total of 648 players, 180 of whom were women, filled out the researchers’ online questionnaire. Questions focused on alcohol use, mental health and concussion history.

There is a lot of research being done in both Europe and the US on the impact of concussions on mental health and well-being.

However, we want to investigate further long-term effects for top Swedish players – six months or longer after a concussion. Players’ responses provided important insights into the links between concussions and mental health outcomes.”

Mitchell Andersson, doctoral student in psychiatry at Lund University

He is behind the study, now 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 researchers at Lund University compiled reported psychiatric symptoms in players, it was found that the male players had significantly fewer symptoms of depression/anxiety and burnout than other men – be they elite athletes in other sports or the broader Swedish male workforce. However, 30 percent of male ice hockey players reported alcohol consumption as being at risk – significantly more than in the comparison groups.

The picture was somewhat different for the female ice hockey players. The prevalence of depression/anxiety symptoms was comparable to that of an average Swedish woman. However, burnout was far more common: over 19 percent of women reported living with clinical symptoms of burnout – almost twice the average rate for Swedish women. The ice hockey players also said they drank a lot of alcohol. The proportion of respondents who stated that they had reached the level of risky consumption was also well above average at 36.4 percent.

Regarding concussions, both female and male hockey players who reported more concussions were more likely to report increases in various psychiatric symptoms (e.g., depression and anxiety). The connection was clearest in both sexes after three or more concussions: the risk of developing depression symptoms 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 are more likely to experience short-term symptoms after a concussion than men, but it was interesting that the association between concussion and the increased prevalence of depression, anxiety and burnout symptoms was equally strong in both genders. This could be an indication.” “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 person must have lived under stress for at least six months and developed a range of physical and psychiatric symptoms. However, Mitchell Andersson says it can sometimes be difficult to tell which is which – the long-term symptoms after a concussion are often similar to those of burnout, such as cognitive impairment, irritability, difficulty concentrating and sleep problems.

The study’s results suggest several approaches to pursue, argues Mitchell Andersson. One is to find out why alcohol consumption is so high among top players.

“Hockey players are a little bigger physically and can maybe drink a little more. Your own view of yourself and others might be that you are a little tougher than others. There can be a sense of pride in belonging.” “The romanticization of alcohol can be part of it for both men and women,” speculates Mitchell Andersson. He himself played ice hockey at a non-elite level.

This same self-conscious harshness could lead to male players actually under-reporting possible mental health issues. The fact that such a high proportion of women report symptoms of burnout even without a concussion may point to a recurring pattern in women’s sports at the highest levels: their salaries are lower than men’s. It is more likely that they will have to combine hockey with another job or academic study. Juggling your responsibilities with late night games, often far from home, can be an impossible equation.

“Swedish ice hockey players at elite level need to know where and how they can get help. There is help for this target group. “Imagine being an elite athlete who trains regularly, eats healthily, and makes good money doing the sport you love” – and yet you’re still struggling. Can you imagine how scary and isolating it must be to not feel alone in your state of mind?