New research from Lund University in Sweden has revealed alarming connections between repeated concussions and mental health outcomes in professional hockey players, with implications that extend across both genders and potentially to other contact sports.
The comprehensive study surveyed nearly 650 active hockey players in Sweden's top divisions, finding that players who had suffered three or more concussions faced significantly elevated risks of both depression and burnout compared to their non-concussed peers.
Concussion's Mental Health Impact
According to the research published in BMC Sports Science, Medicine and Rehabilitation, hockey players with three or more concussions had twice the risk of developing depression symptoms compared to those who had never experienced a concussion. Even more concerning, these same athletes faced 3.5 times the risk of experiencing burnout symptoms compared to concussion-free players.
"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," said lead researcher Mitchell Andersson, a doctoral student in psychiatry at Lund University.
The prevalence of multiple concussions was startlingly high among the elite players surveyed, with more than one in four male players (25%) and nearly one in five female players (20%) reporting having suffered three or more concussions during their careers.
Burnout Symptoms and Contributing Factors
The research team identified a constellation of burnout symptoms that were significantly more common in concussed players, including:
- Exhaustion
- Stress
- Difficulty concentrating
- Irritability
- Problems performing under pressure
- Sleep disturbances
Interestingly, the study found that female players reported higher rates of burnout symptoms even without concussion history, which researchers suggest may be related to the financial realities of women's hockey. Female players typically earn less and must often balance their athletic careers with day jobs, potentially creating additional stressors.
Hockey Culture and Mental Health
The study also highlighted concerning aspects of hockey culture that may exacerbate mental health challenges. Researchers found that players of both genders reported drinking alcohol at hazardous levels, which Andersson attributes partly to the sport's subculture.
"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," Andersson explained. "There can be a sense of pride in being part of such a subculture. Romanticizing alcohol can be a part of it, for both men and women."
This same tough-guy image might contribute to male players underreporting mental health concerns, potentially masking the true prevalence of depression and anxiety in the sport.
Compounding Effects of Concussion and Depression
This research aligns with a separate study from Penn State University published in Brain Research, which found that depression and concussion can create a negative feedback loop, with each condition worsening the other.
The Penn State study demonstrated that athletes with both concussion and depression reported nearly twice as many depression symptoms as those with either condition alone. Additionally, EEG brain scans showed that people had significantly less coherent brain wave patterns if they suffered from both conditions simultaneously.
"We wanted to measure—both subjectively and objectively—whether these two neurological conditions also have a compounding effect on each other, and our study demonstrated that they do," said Owen Griffith, a doctoral candidate in kinesiology at Penn State who led the research.
Clinical Implications
These findings have significant implications for how sports medicine professionals should approach concussion management, particularly for athletes with pre-existing mental health conditions.
"Historically, the clinical standard was to approach concussion as a problem with a one-size-fits-all solution," noted Semyon Slobounov, a professor of kinesiology at Penn State. "This study demonstrated that people with pre-existing mental health conditions may require more care in recovery from a concussion."
For hockey players specifically, Andersson emphasized the importance of accessible mental health resources: "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."
He added, "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."
Future Directions
As research continues to illuminate the complex relationship between brain injury and mental health, sports organizations face increasing pressure to implement more sophisticated concussion protocols and mental health support systems.
The findings suggest that return-to-play decisions may need to be more individualized, with longer recovery timelines potentially necessary for athletes with depression or other mental health conditions.
With mounting evidence of the long-term neuropsychiatric effects of concussions, these studies underscore the importance of both prevention strategies and comprehensive support systems that address the full spectrum of an athlete's health—both physical and mental.
