Fralick M, et al. - Researchers conducted this systematic review and meta-analysis to evaluate suicide risk following concussion. According to findings, experiencing concussion and/or mild traumatic brain injury (TBI) was linked to a higher risk of subsequent suicide.

Methods

• Researchers identified relevant studies via a systematic search of Medline (PubMed), Embase, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS) databases (date range for search: 1963 to May 1, 2017).
• They also contacted field experts and searched Google Scholar and conference proceedings for relevant studies.
• Eligible studies quantified the risk of suicide, suicide attempt, or suicidal ideation after a concussion and/or mild TBI, and involved children and adults, as well as military and nonmilitary personnel.
• To determine study eligibility, two authors independently reviewed all titles and abstracts, and study characteristics were extracted independently by two trained investigators.
• Using the Newcastle-Ottawa Scale, they evaluated study quality.
• Upon random-effects meta-analysis, study data were pooled.
• Concussion and/or mild TBI was the primary exposure, and the primary outcome was suicide.
• Suicide attempt and suicidal ideation were secondary outcomes.

Results

• Data from 10 cohort studies (n=713,706 individuals with and 6,236,010 without concussion and/or mild TBI), 5 cross-sectional studies (n=4,420 individuals with and 11,275 without concussion and/or mild TBI), and 2 case-control studies (n=446 individuals with and 8,267 individuals without concussion and/or mild TBI) were extracted.
• Experiencing concussion and/or mild TBI was related to a two-fold higher risk of suicide.
• In 2 studies that provided estimates with a median follow-up of ~4 years, suicide-related death was reported in 1,664 of 333,118 individuals and 750 of 126,114 individuals with concussion and/or mild TBI.
• In addition, concussion was linked to a higher risk of suicide attempt and suicide ideation.
• The investigators also noted an increased risk of suicide outcomes following concussion in studies with and without military personnel.