Sport-Related Head Exposure Characteristics and Health Outcomes in Former Collegiate Athletes: A CARE Consortium Study

BACKGROUND AND OBJECTIVES: Sport-related head exposure characteristics (i.e., concussion history, sport contact classification, and total years of sport participation) are suggested to be associated with short-term and long-term health outcomes in competitive athletes. However, their relationship with intermediate health outcomes (specifically within 5 years of collegiate sport retirement) remains unknown. Therefore, we examined associations between sport-related head exposure characteristics and physical, mental, cognitive, and behavioral health measures among former collegiate athletes. METHODS: Former collegiate athletes who completed a baseline evaluation between 2018 and 2021 and were evaluated within 5 years of collegiate graduation were included. Primary predictors included lifetime concussion history (0 [referent], 1-2, 3+), sport contact classification (unexposed [ref.], low, high), and total years of sport participation (continuous). Outcome measures collected included the Alcohol Use Disorders Identification Test, Brief Symptom Inventory-18 (BSI-18), Neuro-Quality of Life cognitive domain (Neuro-QoL), Patient Health Questionnaire (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), Sport Concussion Assessment Tool (SCAT) symptom inventory, 12-Item Short Form Survey (SF-12), and Satisfaction with Life Scale. Twelve multivariable linear regression models with bootstrapping were constructed, with adjusted unstandardized beta coefficients (BAdj) and standard errors (SEs) estimated. RESULTS: Overall, 3,910 former collegiate student-athletes were examined; 48.6% were female, 73.0% attended a Division I school, 36.2% self-reported ≥1 lifetime diagnosed concussion, 38.1% participated in a high-exposure sport, and the median years since college graduation to assessment was 5.0. Independently, scores of BSI anxiety (BAdj = 1.24, SE = 0.36), BSI depression (BAdj = 0.88, SE = 0.37), global severity index [GSI] (BAdj = 2.66, SE = 0.91), PHQ-9 (BAdj = 1.34, SE = 0.40), PSQI (BAdj = 0.69, SE = 0.29), SCAT total symptom severity (BAdj = 5.14, SE = 1.31), and SF-12 mental composite score (BAdj = -3.39, SE = 0.83) were worse in athletes with 3+ concussions compared with athletes without a history of concussion. Athletes with 1-2 concussions vs no concussion history similarly had worse scores independently for BSI-18 GSI (BAdj = 0.88, SE = 0.35), anxiety (BAdj = 0.40, SE = 0.15), Neuro-QoL (BAdj = -0.97, SE = 0.36), PHQ-9 (BAdj = 0.77, SE = 0.19), PSQI (BAdj = 0.27, SE = 0.13), SCAT total symptom severity (BAdj = 2.13, SE = 0.55), and SF-12 mental composite score (BAdj = -1.80, SE = 0.41). DISCUSSION: Lifetime concussion history was the most common predictor of adverse self-reported health outcomes compared with other exposure characteristics, within 5 years of collegiate sport retirement. Despite the associations, most former athletes remained within normal clinical levels during this early postretirement period.