The concept of chronic traumatic encephalopathy (CTE) gained traction following the suicide by a gunshot wound to the head by the NFL Hall-of-Famer “Junior” Seau on May 29, 2012. But is the risk of suicide following concussions truly increased and is it limited to elite professional athletes and to military personnel?

A new study tries to answer these questions. Researchers in the US and Canada did a meta-analysis of 17 publications which compared over 700,000 people who suffered concussions to those who did not and found that the risk of suicide was 2-3 times greater. The risk extended to civilians and to amateur athletes.

Despite these findings, the absolute risk is very small and the vast majority of those with concussions do not die from suicide. There are other caveats. Alcohol use was not controlled. People with latent psychiatric illness may be more prone to injury. Concussions are under-reported and “sub-concussive” blows may be important. Thus, correlation alone does not prove causality.

Other than trying to prevent concussions, the take-away message is to screen patients with concussion for substance abuse, mood disorders, and, especially, past suicide attempts.

See Fralick et al, JAMA Neurology, November 12, 2018.

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