Frequency of Concussion Exposure Modulates Suicidal Ideation, Planning, and Attempts Among U.S. High School Students
Kay JJM, Coffman CA, Tavakoli AS, Torres-McGehee TM, Broglio SP, Moore RD. J Athl Training. 2022 doi: 10.10.4085/1062-6050-0117.22. Epub ahead of print.
High school students who reported a sport- and recreation-related concussion in the past 12 months were more likely to report depressive symptoms and suicidal ideation than those who did not. Students who reported multiple concussions in the past 12 months were about twice as likely to report attempting suicide than those who reported a single concussion.
A history of repetitive concussions may increase the risk of adverse mental health outcomes, including suicidal ideation, the second leading cause of death in adolescents in the United States. However, we lack evidence to inform clinical practice about this risk in adolescents and whether the risk differs among males and females.
Kay and colleagues completed a retrospective cross-sectional study to examine the association between concussion frequency and suicidal ideation or behavior among biological males and females.
The researchers used data from the National Youth Risk Behavior Surveillance System to explore this question. The survey was administered in 2017 and 2019 to students in 9th through 12th grade in both private and public schools. The authors summarized the self-reported sports- or recreation-related concussion history responses as 1) no history, 2) a single concussion, or 3) multiple concussions. The survey included five yes/no questions regarding mental health: 1) feeling sadness/hopelessness, 2) suicidal ideation, 3) suicidal planning, 4) suicide attempts, and 5) injurious suicide attempts. The timeframe for all variables was “within the last 12 months.”
Fifteen percent of respondents reported at least one concussion in the last 12 months. A larger proportion of female respondents reported yes to each mental health question. The authors observed an overall relationship between concussion history and the chance of reporting feelings of depression, suicidal ideation, and behaviors. Respondents who reported multiple concussions in the past 12 months were about twice as likely to report attempting suicide than those who reported a single concussion. While this finding occurred among males and females, this association was stronger in males.
Interestingly, the authors found that a high school student who reports a history of concussion in the prior year could be more likely to report adverse mental health outcomes. However, they also observed that when a person sustains multiple concussions, they may be at even greater risk for attempting suicide. However, this data comes from a cross-sectional survey. Hence, it is impossible to know the timing of these adverse mental health outcomes. Could they precede the concussion and cause someone to take more risks and experience more concussions? Is this an acute or chronic outcome that develops after concussions, or a vicious cycle where a concussion causes adverse mental health outcomes that increases their risk for another concussion and worse outcomes that manifest as attempting suicide? This information will be essential to understand to help inform prevention strategies. Hopefully, this study encourages future longitudinal research that can assess the timing of events and the impact of multiple concussions. Future research could also explore the role of concussion severity concerning mental health outcomes.
Clinicians should recognize that even a single concussion could be related to negative mental health outcomes within 12 months. Clinicians should monitor mental health outcomes after a concussion and educate family members about recognizing changes to a patient’s mental health status.
Questions for Discussion
How do you currently discuss or monitor a patient’s mental health following a concussion? Is there anything you would consider changing in your clinical practice considering the findings of this study?
Written by Kyle Harris
Reviewed by Jeffrey Driban
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