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Concussions may increase suicide risk

Sustaining a concussion and/or a mild traumatic brain injury was tied to a higher risk for suicide, according to findings of a systematic review recently published in JAMA Neurology.

“Although there has been anecdotal evidence reported in newspaper reports, movies, and documentaries suggesting a link between concussion and/or mild TBI and subsequent suicide, past studies on the topic have been limited by small sample sizes and conflicting results,” Michael Fralick, MD, SM, of the clinician investigator program at the University of Toronto, and colleagues wrote.

Fralick and colleagues reviewed 17 studies containing more than 718,000 persons affected with concussion and/or mild TBI, comparing the data to more than 6.5 million unaffected persons. Persons were from all age groups, and those with and without a military background were included.

Researchers found sustaining a concussion and/or mild TBI was associated with a twofold higher risk for suicide (RR = 2.03; 95% CI, 1.47-2.8). Two studies with estimates after a median follow-up of about 4 years found 1,664 of 333,118 individuals (0.5%) and 750 of 126,114 individuals (0.59%) diagnosed with concussion and/or mild TBI died from suicide. Concussion was also associated with a higher risk for suicide ideation and suicide attempt. The heightened risk for suicide outcomes after concussion was consistent in studies with and without military personnel.

Sustaining a concussion and/or a mild traumatic brain injury was tied to a higher risk for suicide.

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“Future studies are required to develop strategies to prevent concussions and/or mild TBI and to identify patients at highest risk of suicide after incurring such injuries,” Fralick and colleagues wrote.

In a related editorial, Donald A. Redelmeier, MD, MSHR professor of medicine at the University of Toronto and Junaid A. Bhatti, MBBS, MSc, PhD, assistant professor of general surgery at the University of Toronto wrote that besides establishing an important link between concussions and suicide risk, Fralick and colleagues’ review establishes that patients with concussion do not fit certain criteria.

“This risk is not isolated to elite professional athletes and may extend to ordinary people in everyday activities. The findings also argue that this risk may be even greater for adults in civilian fields than in military occupations,” Redelmeier and Bhatti wrote.

Redelmeier and Bhatti added that clinicians should focus on preventing concussions and not trivializing the adverse events these head injuries cause. – by Janel Miller

Disclosures: Redelmeier reports grant support from the BrightFocus Foundation, the Canada Research Chair in Medical Decision Sciences and the Canadian Institutes of Health Research. Bhatti reports supported from the Sunnybrook Research Institute. None of the other authors reported any relevant financial disclosures.