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Risk for suicide threefold among adults with concussion

Long-term risk for suicide was significantly higher among adults who experienced concussions, particularly those that occurred on weekends.

“Concussion is the most common brain injury in young adults and is defined as a transient disturbance of mental function caused by acute trauma,” Michael Fralick MD, BScH, of the University of Toronto, and colleagues wrote. “The majority lead to self-limited symptoms, and only a small proportion have a protracted course. However, the frequency of depression after concussion can be high, and traumatic brain injury in the military has been associated with subsequent suicide. Severe head trauma resulting in admission to hospital has also been associated with an increased risk of suicide, whereas mild concussion in ambulatory adults is an uncertain risk factor.”

To assess long-term risk for suicide after concussions occurring on weekdays or weekends, researchers conducted longitudinal analysis of adults diagnosed with concussion in Ontario, Canada, from April 1992 through March 2012, excluding severe cases that resulted in hospital admission. The study cohort included 235,110 patients with a mean age of 41 years. The majority of study participants lived in an urban setting.

Over a median follow-up of 9.3 years, 667 suicides occurred among study participants, indicating 31 deaths per 100,000 patients annually — three times the population norm, according to researchers.

Concussions that occurred on the weekend were associated with one-third further increased risk for suicide compared with weekday concussions (RR = 1.36; 95% CI, 1.14-1.64).

Half of individuals who died of suicide visited a physician within the last week of life.

Increased risk for suicide occurred regardless of demographics, was independent of past psychiatric conditions, became attenuated with time, followed a dose-response gradient and was not as high as risk associated with past suicide attempts.

“Concussion differs in three important ways from other risk factors for suicide,” Fralick and colleagues wrote. “First, concussions are sometimes preventable through adequate training, the minimizing of distractions, avoidance of alcohol, use of protective gear and other safety basics. Second, concussions are easily neglected under a popular belief that the neurologic symptoms have an obvious cause, will resolve quickly, leave nothing visible on medical imaging and do not require follow-up. Third, concussions are rarely deemed relevant for consideration by psychiatrists or other physicians when eliciting a patient’s history. Greater attention to the long-term implications of a concussion in community settings might save lives because deaths from suicide can be prevented.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.