Concussion linked to doubled risk of suicide

(Reuters Health) – Survivors of traumatic brain injury may be more than twice as likely to die from suicide as individuals without a history of injuries such as concussions or skull fractures, a study suggests.

The findings come from six studies involving a total of more than 700,000 people who had concussions or other traumatic brain injuries and more than 6.2 million people who did not have these diagnoses. Half of the participants stayed in the studies for two to twelve years or longer.

The absolute risk of suicide was low. Less than 1 percent of people died in this way during the studies, the analysis found.

"The message is that 99 percent of people with a concussion will not have a suicide-related outcome," said lead author. Michael Fralick from the University of Toronto in Canada.

"There is a very small group of people with an increased risk of suicidal thoughts, suicide attempts or suicide," Fralick said by e-mail. "For anyone who has suicidal thoughts, it is incredibly important that they urgently seek medical attention."

Although in recent years there have been a number of high-profile suicides after concussions and traumatic brain injuries among professional athletes and soldiers, researchers have no clear picture of the connection between these injuries and suicide, Fralick and colleagues in JAMA Neurology report.

For about 80 percent of people with concussions, clear up neurological symptoms within a week, the study authors note. But in some patients, neurological symptoms, including anxiety and depression, can last for years.

Serious brain damage has long been associated with an increased risk of permanent neurological symptoms and suicide, researchers observe.

However, concussions and mild brain injuries are much more common and less is known about the direct link between these events and suicide.

Current analysis focused on concussion and mild traumatic brain injury and found these events associated with an increased risk of suicidal thoughts and suicide attempts in addition to suicide mortality.

Although the exact reason for this connection is not clear, it is possible that concussions and mild traumatic brain damage lead to lasting changes in brain regions that are associated with regulating mood and decision-making, the researchers note.

The smaller studies in the analysis were not controlled experiments to prove whether and how brain injury could directly cause suicide. These smaller studies also varied in length, and it is possible that long-term data may be needed to get a clearer picture of the lasting impact of brain injury on mental health.

Nevertheless, the results provide new evidence for the need for concussion and long-term follow-up of physical and mental health after brain injury, Dr. Donald Redelmeier, author of an accompanying editorial article.

"This study underscores the need for more concussions for everyday people every day, such as wearing seat belts, using helmets and avoiding reckless stunts," said Redelmeier, of the University of Toronto and Sunnybrook Hospital, via email.

"In addition, the study challenges popular stereotypes of masculinity to ward off head injuries and encourage psychiatrists to consider a history of past trauma when assessing a patient's suicide risk," added Redelmeier. "Suicide can be prevented."

SOURCE: JAMA Neurology, online 12 November 2018.

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