PITTSBURGH — Adolescents with a history of depression have a higher chance of attempting suicide if they’ve had a concussion, a new study led by University of Pittsburgh School of Medicine researchers finds.
The study, which was published July 1 in JAMA Network Open, analyzed survey responses from more than 28,000 high school students between 2017 and 2019 and found that in those who had a history of depression, concussions were the strongest predictor of also attempting suicide.
Researchers found among the same group, being Black, Latino or multiracial and having past-year concussion history increased the odds of a suicide attempt by 59%. Within that cohort, the study found that people born female had a 33% higher attempted suicide risk than their male counterparts.
The study found that race seemed to be the primary factor in suicide attempts among American Indian or Alaska Native, Black and Native Hawaiian or Pacific Islander youth who reported no history of depression. Adolescents in those groups had an 89% higher chance of attempting suicide when compared to other races and ethnicities.
The study used survey data from the Youth Risk Behavior Surveillance System, a national survey measuring health-related behaviors contributing to death and disability among Americans.
In addition, the study’s researchers used Chi-Square Automatic Interaction Detection tree models, a type of statistical analysis, to discover the relationship between history of depression, concussion, race, ethnicity and sex variables.
“We were able to parse out some of the nuances in what it means to be a certain race and ethnicity in this country, as a kid, and how it relates to concussion and mental health,” said Shawn Eagle, the lead author of the study and a research assistant professor at the University of Pittsburgh’s department of neurological surgery.
Adolescents are most likely to be concussed from playing sports, assaults, motor vehicle accidents, falls or accidentally being struck by or against an obstacle, according to a Centers for Disease Control and Prevention concussion facts guide.
Other researchers have previously found that, as they age, youth with a history of concussions were about 40% more likely to be diagnosed with a mental health condition and are at greater risk for committing self-harm than their concussion-free counterparts.
Additional research has found that each time someone gets a concussion they are at an increased risk for suicide.
Researchers said that in some minority communities, there tend to be less accessible health care and suicide-prevention screening mechanisms in place, so suicide attempts as a result of depression are further exacerbated in communities of color. Eagle explained that quantifying those inequalities was a driving factor behind the study.
The study found that most concussion diagnoses are not correlated to attempted suicide. Eagle said that adolescents should continue to participate in sports because the benefits of physical activity and sports still outweigh the dangers of a possible concussion.
But, Eagle emphasized that because the study analyzed survey responses, researchers could not distinguish between the timing of the concussion and the suicide attempt. They were unable to determine the causality between variables.
“But based off what the literature tells us, there’s a clear mental health crisis in the United States in American youth, and that is magnified in certain minority groups,” Eagle said.
Jessica Wallace, one of the study’s co-authors and an assistant professor of health science athletic training at the University of Alabama, said most concussion, depression and anxiety-related studies focus predominantly on homogenous, white groups.
“It helps us to take a step back and understand that we do have to look at different social things that people of other races and ethnicities might go through, we need to look at resources for mental health, (and) we need to look at resources for concussions,” she said. “My big takeaway is that we can’t keep applying a one-size-fits-all when people have different resources to use in different communities.”
Experts said the new research supports previous findings on the connection between concussion and suicide and helps quantify the need for improved concussion screening and support infrastructure in historically underrepresented communities.
“If we can stop teens from engaging in an impulsive act, we can save their life and get them to the other side."
Sara Chrisman, an associate professor of adolescent medicine at Seattle Children’s who also studies concussions and was not involved in the research, said the stressors that come along with concussion diagnosis and treatment might lead to worsening mental health in adolescents.
“I think some of it is the stress around the injury, like not doing well in school or being taken out of your sport. Those stressors cause an increased risk of things like suicide and self-harm,” she said.
Concussion treatment culture, Chrisman explained, also needs to be altered to educate and support youth who have to temporarily sit out of their normal activities like sports and academics. She added that if there isn’t an accessible diagnosis system, adolescents may face further barriers to preventing concussion-related harm.
“If we can stop teens from engaging in an impulsive act, we can save their life and get them to the other side,” she said.
Researchers have found that health screening and treatment care options are significantly less accessible for minority patients and people living in low-income communities. Studies have shown that high costs and a lack of consistent primary care have led to U.S. minorities forgoing treatment.
“It’s very hard to find mental health therapists and workers who look like the minority community. So it’s hard to find people of color to serve the population,” said Elizabeth Errickson, the director of family based mental health services at Allegheny Children’s Initiative, a social services agency on the South Side of Pittsburgh.
“There just aren’t as many (resources) as there are in white communities,” she said.
Anthony Kontos, a co-author of the study and the director of research for the UPMC Sports Medicine Concussion Program, said researchers should now focus on studying the qualitative life events that may lead to higher suicide attempts in certain minority adolescents with concussion history.
“What we need to do is more prospective and longitudinal work, where we look at kids when they get a concussion and follow them over time and learn how does that interact with all of these other factors that were included in this study?” he said.
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