Clinical phenotypes, health history key to determining youth suicide risk

Analyzing clinical phenotypes of race, ethnicity and sex, as well as history of concussions and depression, were crucial in determining risk for suicide attempts among youth in the United States, a study showed in JAMA Network Open.

“Understanding the role race and ethnicity plays in recovery from concussion is in its infancy. As a result, most of the existing studies on the topic either compare one minority group to white patients with a concussion, or they group all minorities together and compare with white patients with a concussion,” Shawn R. Eagle, PhD, a research assistant professor at the University of Pittsburgh, told Healio.

Eagle and fellow researchers aimed to examine the associations of concussion history, — along with race, ethnicity and sex — with reported suicide attempts among adolescents.

The population-based cross-sectional cohort study included data from 28,442 individuals up to 18 years of age (50.7% female; mean age, 14.6 years) who responded to the U.S. Youth Risk Behavior Surveillance System survey between 2017 and 2019.

Respondents reported yes or no on whether they sustained a sport- or recreation-related concussion, had depression or engaged in a suicide attempt over the previous 12 months, along with identifying their race and ethnicity, and sex.

For data analysis, two Chi-Square Automatic Interaction Detection (CHAID) decision tree models were built — suicide attempt with depression history (SA-DEP) and suicide attempt without depression history (SA–NO DEP). CHAID utilized risk factors (e.g., number of concussions, race and ethnicity, sex) to divide the study sample into a series of subgroups that are nested within each other. Risk ratios (RRs) and confidence intervals were calculated for each subgroup to provide effect estimates.

Results showed that CHAID revealed a complex interaction between race, sex and concussion history for attempting suicide, which differed by depression history.

Researchers discovered that depression history was the variable most strongly associated with suicide attempt (adjusted odds ratio = 11.24; 95% CI, 10.27-12.29). Concussion was the variable most strongly associated with SA-DEP (RR = 1.31; 95% CI, 1.2-1.51). Black, Hispanic/Latino or multiracial race and ethnicity were associated with increased risk for SA-DEP compared with others (RR = 1.59; 95% CI, 1.38-1.84), while American Indian or Alaska native, Black, and Hispanic/Latino race and ethnicity were associated with increased risk for SA–NO DEP (RR = 1.89; 95% CI, 1.54-2.32) compared with the remaining population.

“Clinicians should be aware that depression and concussion in the past year may impact certain racial/ethnic and biological sex phenotypes differently from others,” Eagle told Healio.