Association between concussion and risk of suicide among youth and young adults.

Introduction: . Limited data exists on the risk of suicide following diagnosed concussion, particularly among youth. This study addresses that gap by examining the association between concussion and suicide among youth enrolled in Ohio Medicaid.

Methods: . This retrospective longitudinal cohort study used Ohio Medicaid claims linked with death certificate data from January 1, 2011, to December 30, 2020. The sample included 417,512 youth and young adults aged 5-24 years diagnosed with either concussion (n=41,341) or orthopedic injury (OI; n=376,171) and followed for up to 10 years. Cox regression models with inverse probability of treatment weighting (IPTW) estimated the association between injury type and time to suicide death. Additional analyses evaluated the impact of concussions sustained during follow-up. Analyses were conducted between April and August 2024.

Results: There were 42 suicides in the concussion group and 229 in the OI group. Youth with concussion had a higher suicide hazard than those with OI (HR=1.65, 95% CI=1.18-2.30) in IPTW-adjusted models. The 5-year risk difference was 0.034% (95% CI=0.006%-0.061%), equating to 34 additional suicides per 100,000 individuals. Concussions during follow-up were also associated with elevated suicide hazard (HR=1.52 per concussion event, 95% CI=1.12-2.05) after adjusting for demographic and clinical covariates.

Conclusions: Concussions were associated with more than 60% increased suicide hazard relative to orthopedic injuries. Each subsequent concussion further elevated the suicide hazard. Targeted suicide prevention strategies for youth with concussions may help reduce this risk.