Study: Suicide Risk Increases Following a Concussion

Adults with a diagnosis of concussion have an increased long-term risk of suicide, according to a new study.

“Greater attention to the long-term health of patients after a concussion could save lives because deaths from suicide can be prevented,” said study author Donald A. Redelmeier, MD, MS(HSR), senior scientist at the Sunnybrook Health Sciences Center in Toronto.

The researchers performed a longitudinal cohort analysis of adults with diagnosis of a concussion over a 20-year period, excluding severe cases that resulted in hospital admission. The primary outcome was the long-term risk of suicide after a weekend or weekday concussion.

They identified 235110 patients with a concussion (mean age 41 years, 52% men). Over a median follow-up of 9.3 years, 667 subsequent suicides occurred. “This absolute risk was about 32 per 100000 patients annually, which is 3 times the population norm,” explained Redelmeier, noting the median delay was about 6 years.

In a finding that surprised him, weekend concussions (from recreation) were associated with a one-third further increased risk of suicide compared with weekday concussions (from employment), relative risk 1.36, 95% confidence interval 1.14-1.64.

Overall, they found the increased risk of suicide applied regardless of patients’ demographic characteristics and was independent of past psychiatric conditions. It also became accentuated with time and exceeded the risk among military personnel.

Concussions can be 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,” concluded the researchers, who also said psychiatrists or other physicians rarely deem concussions relevant when eliciting a patient’s history.

“Our findings suggest that the association between concussion and suicide is not limited to military veterans and professional athletes,” Redelmeier added. “The work also highlights the need for prevention and long-term follow-up.”

-Mike Bederka

Reference:

Fralick M, Thiruchelvam D, Tien HC, Redelmeier DA. Risk of suicide after a concussion. Canadian Medical Association Journal. 2016; doi:10.1503/cmaj.150790.