Three or more college concussions linked to worse mental health five years later

American Academy of Neurology

How much does a concussion in college cost you five years later? For most athletes, the answer appears to be: not much, at least by clinical standards. But for those who rack up three or more, the toll, while small, is measurable and consistent across multiple dimensions of mental and cognitive health.

A study of 3,910 former college athletes, published March 11, 2026, in Neurology, tracked participants from the start of their college sports careers through the first five years after graduation. Those with three or more concussions showed slightly worse scores on tests of anxiety, depression, psychological distress, sleep quality, and concussion-related symptoms compared to athletes with no concussion history.

The study design

Participants came from 20 sports, including football, soccer, volleyball, lacrosse, rowing, swimming, tennis, and golf. Nearly half were female. Seventy-three percent competed at NCAA Division 1 schools. All received baseline concussion evaluations at enrollment, typically before starting their college sport, with 77% reporting no prior concussion diagnosis.

Athletes were evaluated again within five years of graduation using 11 tests covering physical, mental, behavioral, and cognitive health. Researchers grouped participants by concussion history: 2,494 reported zero concussions, 1,203 reported one or two, and 213 reported three or more.

Small effects, consistent pattern

On a symptom checklist covering 22 concussion-related symptoms, athletes with three or more concussions reported an average of five symptoms, compared to three for those with no concussions. After adjusting for confounding factors including pain interference scores, the three-plus group showed worse performance on seven of the 11 tests.

Athletes with one or two concussions also fared slightly worse than the zero-concussion group on measures of psychological distress, quality of life, anxiety, depression, sleep quality, and concussion symptoms.

The critical nuance: the effect sizes were small. Study author Steven Broglio of the University of Michigan Concussion Center emphasized that the vast majority of athletes, even those with multiple concussions, remained within normal clinical ranges for brain health. These are statistical differences between groups, not individual diagnoses.

The age problem

The participants are still in their twenties. That is both reassuring and concerning. Reassuring because most are functioning normally. Concerning because neurodegenerative processes associated with repeated head trauma, if they occur, typically manifest decades later. Small differences at age 25 could widen at 45 or remain stable. We don't yet know.

Broglio noted that continuing to follow these athletes over time will be essential to determine whether the associations become more or less apparent and clinically meaningful as participants age.

What the study does not tell us

Concussion counts were self-reported, which introduces recall bias. Athletes may underreport concussions, particularly in sports cultures that discourage acknowledging injury. Conversely, athletes who are generally more health-anxious might both report more concussions and score worse on mental health measures.

The study population was 76% White, limiting generalizability to other racial and ethnic groups. Athletes from different backgrounds may have different exposure patterns, different access to post-concussion care, and different baseline rates of the mental health outcomes measured.

This is an observational study. It cannot establish that concussions caused the worse outcomes. Other factors correlated with concussion risk, such as playing more aggressive positions, more years of contact sport participation, or personality traits associated with risk-taking, could contribute to both concussion frequency and mental health scores.

The study also cannot distinguish between the effects of diagnosed concussions and the cumulative effects of subconcussive hits, the routine impacts that occur in contact sports without producing a diagnosable concussion. Athletes in high-contact sports accumulate thousands of subconcussive impacts that may contribute to brain health independently of diagnosed concussions.

A five-year snapshot, not a final answer

The study fills a gap between two well-studied time points: the immediate aftermath of concussion and the long-term outcomes seen in retired professional athletes decades later. What happens in the early post-career years has been less examined, and this study provides a first look.

For current college athletes, the data reinforce what concussion protocols already aim to achieve: minimizing repeated concussions matters. For clinicians following former athletes, the results suggest that mental health screening in early adulthood could be valuable, particularly for those with histories of multiple concussions. The differences are small now. Whether they stay that way is the question that only time can answer.