There’s the damage you can see, and the damage you can’t. A new study by the UK rugby health project at Durham University has shown that professional rugby players are more likely to have mental health issues in retirement than athletes in non-contact sports, and that those who suffered multiple concussions during their playing career are at even greater risk of depression, anxiety, sleep and anger issues.
The study suggests a strong association between head trauma and mental health in both codes of rugby, and provides evidence of what many people working in the field already believe to be true: rugby has a mental health crisis.
The study, which is entirely independent of the governing bodies of each code, found that players who reported suffering from three or more concussions during their professional careers scored significantly worse for psychological signs of depression and anxiety and for sleep disruption.
Around half the players who reported suffering five or more concussions were suffering with symptoms of depression, and two-thirds of them with covert anger and irritability. The study found no difference in the levels of alcohol consumption between the retired rugby players and the other athletes, which means that can be discounted as an explanation for these findings.
“We know acute concussion is associated with confusion and depression and irritability and mood changes,” says the study’s lead author, Dr Karen Hind, “and we know post-concussion syndrome, which is three months afterward the event, is the same, but these cases we’re looking at are years after the event.” Hind says the findings are “in line with what we see in head trauma victims in other fields”.
Alarmingly, one in 10 of the 83 elite rugby players who took part in the study said that they often felt “life is hardly worth living”. The researchers allow that their findings could be because many of those elite players were forced into retirement through injury, an outcome that has been associated with depressive symptoms in other studies. But of course that happens in all sports, and they are also clear that they believe another factor among the elite rugby group in particular is the repeated exposure to concussive and subconcussive impacts during their playing career.
More worryingly, those players were also the group least likely to seek help. One in five respondents said they “would not turn to anyone if they had a problem or felt upset about something”. The findings may startle the hundreds of thousands of fans who follow union and league, but they will come as no surprise to the small band of people with first-hand experience in the field. In the last two years the Guardian has run interviews with a handful of retired players who spoke about the effect the sport had on their mental health, but there are hundreds more who haven’t felt able to talk about it publicly.
For Hind, who enjoys playing and watching rugby, the conclusion is clear. “There clearly needs to be better care for players in retirement,” she says. “We had over 100 players come into our clinic. Among the ones I spoke to, the consistent feedback was that they felt very well looked-after when they were playing, because they had access to all the medical support they needed, but once they hit retirement there was nothing there for them.” The reason many of those players signed up for the study in the first place, she explained, was because they felt like it was the best way to “get an MOT” on their bodies.
There are 150 former union players and 75 league players involved in legal actions against the governing bodies, all of them showing symptoms of brain damage, many of them struggling with depression, anxiety and anger. There are many more, some of them currently working in the game, who are suffering symptoms but feel unable to speak openly about them, sometimes because they are worried about their job security. Among this network, there have been instances when former players have had to arrange emergency clinical interventions for others after private cries for help.
This is one reason why Alix Popham, the former Wales international who spoke openly to the Guardian last year about his own diagnosis of early onset dementia and probable CTE, has since set up the Head For Change foundation. It is designed to be a safe space for athletes and families who need support.
As always, the question is why a charity should have to take on the work that ought to fall on sport governing bodies. Hind has offered to share her work with the rugby authorities but so far nobody has taken her up on it. “We have blood samples, cognitive tests all sorts. We’re sitting on a lot of data, and while we’re very well-supported by Durham, we are working on a bit of a shoestring budget,” she says. “I’d be very happy to share our findings with the governing bodies, of course I would, but we have not received any requests, any interest even in what we are doing.”
“We feel we need to get this research out,” Hind says. “I hope this paper will help to open the conversation and get the dialogue going. This is not OK, and people suffering need to know that they’re not alone, and that they can seek help.”