AUTHOR=Iverson Grant L. , Karr Justin E. 

TITLE=Association Between Concussions and Suicidality in High School Students in the United States

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.810361

DOI=10.3389/fneur.2022.810361

ISSN=1664-2295

ABSTRACT=Importance: Prior research has shown a statistically significant association between sustaining a concussion and suicidality in adolescents, but this prior research controlled for relatively few variables predictive of suicidality.

Objective: To examine whether sustaining a concussion remained a significant predictor of suicidality after controlling for relevant covariates (e.g., sexual abuse/assault, bullying, substance use, depression), hypothesizing that the relationship between concussion and suicidality would become nonsignificant after controlling for these variables.

Design: This study involved secondary data analysis of the 2019 Youth Risk Behavior Surveillance (YRBS) System, a national cross-sectional study of adolescents. Analyses were stratified by gender.

Setting: A national sampling of U.S. high school students.

Participants: 11,262 students in the YRBS database, including 5,483 boys and 5,779 girls.

Exposure(s): Participants included in the analyses reported whether, in the last year, they experienced a concussion and/or suicidality.

Main Outcomes and Measures: The main outcome was suicidality (i.e., ideation, planning, attempt), which was predicted by concussion in an unadjusted analysis and by concussion along with other risk factors in a multivariable analysis.

Results: The final sample included 11,262 participants with available data on concussion and suicidality in the last year (14-18 years-old; 51.3% girls; 49.0% White). Per unadjusted odds ratios with 95% confidence intervals, there was a relationship between concussion and suicidal ideation (girls: OR=1.46 [1.24, 1.73]; boys: OR=1.69 [1.41, 2.03]), planning (girls: OR=1.39 [1.16, 1.66]; boys: OR=1.76 [1.44, 2.14]), and attempt (girls: OR=1.70 [1.32, 2.19]; boys: OR=3.13, [2.37, 4.15]). These relationships became mostly nonsignificant after controlling for relevant risk factors for suicidality. The adjusted odds ratios showed no relationship between concussion and suicidal ideation (girls: OR=1.11 [0.86, 1.44]; boys: OR=1.24 [0.92, 1.69]) or planning (girls: OR=1.07 [0.82, 1.40]; boys: OR=1.12 [0.82, 1.55]); but a small relationship with suicide attempts in boys (OR=1.98 [1.28, 3.04]), but not girls (OR=1.05 [0.74, 1.49]).

Conclusions and Relevance: There was an association between concussion and suicidality in U.S. high school students; however, after controlling for other important variables (e.g., depression, sexual abuse/assault, illicit drug use), there was no association between concussion and suicidality aside from a small relationship between concussion and attempts in boys.