Concussion Exposure and Suicidal Ideation, Planning, and Attempts Among US High School Students

Interest is growing in the association between repetitive concussions and mental health. However, studies on the relationship between concussion frequency and adverse mental health outcomes among female and male youth are lacking.

To examine the association between self-reported concussion frequency and nonfatal suicidal behaviors among youth and to explore the possible interaction of biological sex.

Retrospective cross-sectional survey.

National Youth Risk Behavior Surveillance System.

United States secondary school students (N = 28 442).

Exposure variables were the frequency of self-reported sport- or recreation-related concussion in the previous 12 months (0, 1, ≥2). Outcome variables were feelings of self-reported sadness or hopelessness and suicidal ideation, planning, and attempts. Covariates were age, sex, race and ethnicity, bullying victimization, sexual orientation, and physical activity.

Students who reported ≥2 concussions were at significantly greater odds of reporting suicidal attempts (adjusted odds ratio = 2.03; 95% CI = 1.43, 2.88) when compared with students reporting a single concussive event during the past 12 months. However, sex interactions revealed that this finding may have been driven by males; the strength of associations did not increase from single to multiple concussions among females.

Our findings suggest that adolescents who reported concussion were at increased odds of reporting poor mental health and suicidal behaviors. Moreover, an increased number of concussive events may be associated with significantly greater odds of reporting suicidal attempts, particularly among males. Irrespective of sex, health care professionals should closely monitor mental health behaviors in adolescents with repetitive concussions, especially those that occur in close temporal proximity.