The long-term risk of suicide for adults who have had a concussion is three times higher than the population norm, and the risk increases further if the concussion occurred on a weekend, found a new study published in CMAJ (Canadian Medical Association Journal).
“Given the quick usual resolution of symptoms, physicians may underestimate the adverse effects of concussion and its relevance in a patient’s history,” states Dr. Donald Redelmeier, senior core scientist at the Institute for Clinical Evaluative Sciences (ICES) and a physician at Sunnybrook Health Sciences Centre, Toronto, Ontario. “Greater attention to the long-term implications of a concussion might save lives because deaths from suicide can be prevented.”
Suicide is a major cause of death in the community. In 2010, there were 3951 deaths from suicide in Canada and 38 364 in the United States. Concussion is the most common brain injury in adults. Each year in Canada, there are about 400 000 cases of concussion and about 4 million in the United States. “The link between concussion and suicide is not confined to professional athletes or military veterans,” states Michael Fralick, a coauthor and medical trainee at the University of Toronto.
In this large study, researchers examined anonymized records for 235 110 patients with concussion over a 20-year period in Ontario, Canada, using diagnostic codes from the health insurance database. The study specifically compared concussions that occurred on a weekend or a weekday to distinguish between recreational and occupational injuries. The mean age of the patients was 41 years, about half were men, and the majority lived in cities. Most had no prior suicide attempt, hospitalization or past psychiatric disorder.
During follow-up (9.3 years), there were 667 suicides. Patients diagnosed with a concussion on weekdays accounted for 519 suicides and an absolute suicide risk three times the population norm (29 suicides per 100 000 people a year). Patients diagnosed with a concussion on weekends accounted for 148 suicides and an absolute suicide risk four times that of the population norm (39 per 100 000 a year).
The mean time from concussion to subsequent suicide was 5.7 years. Additional concussions were associated with a further increased risk of suicide. The majority of patients had visited their family physician in the month before suicide. The most common mechanism was a drug overdose, and the average age at death was 44 years.
Other studies have shown a link between concussion and suicide. However, “no past study, to our knowledge, has focused on concussions and tested the potential difference between weekends and weekdays,” write the authors. “The increased long-term risk of suicide observed in this study persisted among those who had no psychiatric risk factors and was distinctly larger than among patients after an ankle sprain.”
The authors hope the study will help doctors and patients better understand the risks of concussion and prevent possible suicides.
The study was conducted by researchers from ICES, Sunnybrook Research Institute, the University of Toronto and the Canadian Armed Forces.
Source: Kim Barnhardt – CMAJ
Image Source: The image is in the public domain
Original Research: Abstract for “Risk of suicide after a concussion” by Michael Fralick, Deva Thiruchelvam, Homer C. Tien, and Donald A. Redelmeier in Canadian Medical Association Journal. Published online February 8 2016 doi:10.1503/cmaj.150790
Abstract
Risk of suicide after a concussion
Background: Head injuries have been associated with subsequent suicide among military personnel, but outcomes after a concussion in the community are uncertain. We assessed the long-term risk of suicide after concussions occurring on weekends or weekdays in the community.
Methods: We performed a longitudinal cohort analysis of adults with diagnosis of a concussion in Ontario, Canada, from Apr. 1, 1992, to Mar. 31, 2012 (a 20-yr period), excluding severe cases that resulted in hospital admission. The primary outcome was the long-term risk of suicide after a weekend or weekday concussion.
Results: We identified 235 110 patients with a concussion. Their mean age was 41 years, 52% were men, and most (86%) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100 000 patients annually or 3 times the population norm. Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions (relative risk 1.36, 95% confidence interval 1.14–1.64). The increased risk applied regardless of patients’ demographic characteristics, was independent of past psychiatric conditions, became accentuated with time and exceeded the risk among military personnel. Half of these patients had visited a physician in the last week of life.
Interpretation: Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented.
“Risk of suicide after a concussion” by Michael Fralick, Deva Thiruchelvam, Homer C. Tien, and Donald A. Redelmeier in Canadian Medical Association Journal. Published online February 8 2016 doi:10.1503/cmaj.150790
