Benevolent Childhood Experiences (BCEs) and Neuropsychological Outcomes in Former Professional American-style Football Players

Abstract

Research indicates that childhood experiences significantly shape neuropsychological function, impacting mood and cognitive function (e.g., deficits in memory, executive function, and mood regulation) in adulthood. Benevolent childhood experiences (BCEs) such as emotional support, stable caregiving, and safe, nurturing environments are shown to be associated with better mental health outcomes in general population studies. Mood and cognition have been shown to be affected by previous exposure to repetitive head impacts, often experienced by contact sport athletes and military personnel. While previous research has shown that former American-style football (ASF) players experiencing many Adverse Childhood Experiences (ACEs) have reported worse neuropsychological outcomes, the relationship between BCEs and neuropsychological outcomes in populations exposed to repeated traumatic brain injuries, such as former professional ASF players, remains largely unexplored. This study utilized data from the Football Players’ Health Study at Harvard University (FPHS) to examine BCEs among former professional ASF players, and how BCEs are associated with neuropsychological function. This data set included self-reported measures of BCEs, ACEs, and neuropsychological outcomes in former professional ASF players, in addition to demographic and football-related data. Specifically, this study evaluated the extent to which BCEs are associated with mood and cognition, and how these associations may change after adjusting for ACEs. BCEs and ACEs were assessed using the Adverse Childhood Experiences Questionnaire and the Benevolent Childhood Experiences Questionnaire, and neuropsychological outcomes including depression, anxiety, and self-reported cognition were measured using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and the Neuro-Quality of Life in Neurological Disorders (Neuro-QoL), respectively. Multivariable generalized estimating equation models were used to examine associations between BCEs and neuropsychological outcomes, with sequential adjustment for demographic characteristics, football-related exposures, and ACEs. I hypothesized that BCEs would provide a protective mechanism against neuropsychological health in former professional ASF players. The principal finding of this thesis was that BCEs were highly prevalent in this population and were associated with more favorable neuropsychological outcomes in minimally adjusted models, but these associations were attenuated after adjustment for ACE burden and adult health-related covariates. This suggests that, in this cohort, BCEs did not demonstrate strong independent protective associations in fully adjusted models. Furthermore, the persistence of ACE associations for depression and anxiety was consistent with prior literature in former ASF players. Understanding these associations could provide insights into protective factors that enhance resilience within this high-risk group.