Fralick M, et al. – In this systematic review and meta-analyses, experts evaluated suicide risk following concussion and/or mild traumatic brain injury (TBI). According to findings, experiencing concussion and/or mild TBI was correlated with an increased risk of suicide

Methods

• Experts conducted a systematic search of Medline (PubMed), Embase, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS) from 1963 to May 1, 2017 for relevant studies.
• They also searched Google Scholar and conference proceedings, and contacted experts in the field to seek additional studies.
• They included studies that quantified the risk of suicide, suicide attempt, or suicidal ideation after a concussion and/or mild TBI among children and adults—as well as military and nonmilitary personnel.
• All titles and abstracts were independently reviewed by two authors to determine study eligibility.
• The two trained investigators independently extracted study characteristics.
• The researchers evaluated study quality using the Newcastle-Ottawa Scale and pooled study data using random-effects meta-analysis.
• Concussion and/or mild TBI was the primary exposure, and suicide was the primary outcome.
• Suicide attempt and suicidal ideation were the secondary outcomes.

Results

• Data were extracted from 10 cohort studies (concussion/TBI, n=7,13,706; no concussion/TBI, n=6,236,010), 5 cross-sectional studies (concussion/TBI, n=4,420; no concussion/TBI, n=11,275), and 2 case-control studies (concussion/TBI, n=446; no concussion/TBI, n=8,267).
• They investigators noted an association of experiencing concussion and/or mild TBI with a two-fold higher risk of suicide.
• According to results of two studies that provided estimates with a median follow-up of ~4 years, 1,664 of 3,33,118 individuals (0.50%) and 750 of 126,114 individuals (0.59%) with concussion and/or mild TBI died by suicide.
• They noted an association of concussion with a higher risk of suicide attempt and suicide ideation also.
• In studies with and without military personnel, heightened risk of suicide outcomes after concussion was also evident.