Despite strong associations established between head injury and mental health, studies of professional athletes exposed to head injury show reduced risk of suicide compared with general populations. We compared the risk of suicide among National Football League (NFL) players to Major League Baseball (MLB) and National Basketball Association (NBA) players. Death data from 1979 to 2019 were obtained from the National Death Index for 20,765 NFL, 9,684 MLB, and 3,564 NBA players whose careers began after 1919. We calculated hazard ratios (HRs) and 95% confidence intervals (CIs) for suicide for NFL players compared with a combined MLB + NBA reference group, adjusted for age at career end, race, and career body mass index. We additionally stratified follow-up time at 2011, when attention on the long-term effects of head injury and chronic traumatic encephalopathy increased. Between 1979 and 2019, 101 suicides occurred among 34,013 participants with mean ± standard deviation (SD) age at career end of 28.3 ± 4.2, and among whom 13,677 (40.2%) were Black. Overall, the NFL suicide rate was similar to the MLB + NBA (HR = 1.20, 95% CI = 0.71–2.01, p = 0.50). When stratified at 2011, no difference was found through 2010 (HR = 0.91, 95% CI = 0.49–1.71, p = 0.78), while the suicide rate post-2010 was higher among NFL players (HR = 2.64, 95% CI = 1.04–6.84, p = 0.04). We have identified a twofold higher incidence of recent suicide within the at-risk group of former NFL players. These findings underscore the need for more intensive post-career guidance pathways and enhanced, proactive screening measures.
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