The Association Between Sports- or Physical Activity-Related Concussions and Suicidality Among US High School Students, 2017

Miller GF, DePadilla L, Everett Jones S, Bartholow BN, Sarmiento K, Breiding MJ. Sports Health. 2020 August 26th.

Take-Home Message

Sports- or physical activity-related concussions are associated with suicidality in high school students. Persistent feelings of sadness or hopelessness, current alcohol use, or current marijuana use may influence the relationship between a concussion and suicidality.


People with traumatic brain injuries may have an increased risk of suicidal ideation and suicide. However, we know little about factors that influence the relationship between a concussion and suicidal planning or attempts among children. Thus, the authors evaluated the relationship between sports- or physical activity-related concussions and suicidality (seriously considered attempting suicide, making a suicide plan, or attempted suicide) among high school students. They also examined which factors (e.g., sleep, academic grades, alcohol use) may relate to concussions and suicidality. The authors used data from the 2017 national Youth Risk Behavior Survey to assess concussions and suicidality during the one year before the survey. The authors also considered several factors that may influence the relationship between concussions and suicidality: physical activity levels, playing on a sports team, persistent feelings of sadness or hopelessness, academic grades, hours of sleep, current alcohol use, and current marijuana use.

Among 14,765 high school students, 17% strongly considered attempting suicide, 14% created a suicide plan, and 7% attempted suicide. A student was more likely to report suicidality if they 1) had a concussion, 2) did not play sports, 3) expressed persistent feelings of sadness/helplessness, 4) had lower academic grades, 5) slept less than 7 hours/day, 6) used alcohol or marijuana, or 7) were female or physically inactive. The relationship between concussions and suicidality was weaker when the authors adjusted for persistent feelings of sadness or hopelessness, current alcohol use, or current marijuana use. Though causality cannot be determined, two scenarios may explain this finding. First, these three factors may clarify why a concussion could lead to increased suicidality. For example, a concussion could contribute to depressive symptoms that lead to an increased risk of suicidality. Alternatively, these 3 factors could explain why someone might experience a concussion (e.g., increased risk taking, poor focus) and suicidality. No other factor influenced the strength of the relationship between a concussion and suicidality.


The authors found that sports- or physical activity-related concussions were associated with suicidality. However, we should consider that overall ~1 in 6 high school students strongly considered attempting suicide (17% without a concussion, 22% with a concussion). It may be beneficial if preseason assessments and post-concussion assessments include questions about suicidality, depressive symptoms, sleep, academic performance, and alcohol/marijuana use. Clinicians should also educate parents on how to do monitor and report changes in a student’s depressive symptoms. Educators can also assist by providing school accommodations such as shorter assignments and rest breaks. By doing so, children will be able to spend more time with family and friends, which may alleviate depression symptoms. Finally, clinicians may implement suicide prevention strategies provided by the CDC, which “includes strategies that can be used to identify and support people at risk, create protective environments, promote connectedness, and teach coping and problem-solving skills”. A clinician that identifies a child at risk for suicide can refer them to a mental health provider for evaluation.

Questions for Discussion

How may clinicians best monitor risk factors for suicidality in children after a concussion? How can we teach parents to identify changes in their children after a concussion?

Written by: Ryan Paul
Reviewed by: Jeffrey Driban

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