Frequency of Concussions Increases US High School Athletes’ Reporting of Suicidal Attempts

Utilizing nationally representative data from the Youth Behavior Risk Surveillance System (YBRSS), a new study¹ examined the association between self-reported concussion frequency and non-fatal suicidal behaviors among U.S. high school students. The study appeared in a special mental health issue of the Journal of Athletic Training, the scientific journal of the National Athletic Trainers’ Association.

“We found that students who reported 2 or more concussions in 1 year were at 2-fold greater odds of reporting suicide attempts when compared to students reporting a single concussive event during that same time,” said lead author Jacob Kay, PhD, MSc, rehabilitation scientist, Prisma Health Children’s Hospital, Pediatric Concussion Clinic, Columbia, South Carolina in a press release. “We also found that male and female youth may be impacted differently – when biological sex was factored in our analyses, results indicated that this finding may have been driven by males; the strength of association did not increase from single to multiple concussions among females.”

“Ensuring a young athlete has appropriate mental health support is vital to their overall sports participation and as critical as physical preparation,” said NATA President Kathy Dieringer, EdD, LAT,ATC. “This study sheds significant light on the role that concussion can have on mental health and provides a roadmap to establishing the right school and medical professional protocols. Athletic trainers play an integral role in working with students to ensure their overall health and welfare.”

Key Statistics

• It has been estimated that roughly 1.9 million adolescents sustain sport- and recreation-related concussions (SRRCs) annually in the United States.²
• In 2020, suicide was the second leading cause of death among individuals between the ages of 10-14 and 25-34 , and the third leading cause of death among individuals between the ages of 15-24.³
• In 2020, roughly 100,000 adolescents (aged 10 to 19 years) were hospitalized for intentional self-harm (latest available data).⁴
• What The Study Authors Did
• The YBRSS is a school-based survey administered biennially in both private and public high schools across the U.S. The YBRSS provides valid measures of health risk behaviors among this cohort. Data from the 2017 and 2019 YBRSS were combined and cross-sectionally analyzed.
• A total of 28,442 respondent questionnaires were available for analysis. After adjusting for missing data (independent and dependent variables of interest, as well as covariates), researchers were left with a final sample of 17,397 students, or 61.16% of the total sample.
• Statistics were calculated to evaluate the association between concussion history and (1) sadness or hopelessness, (2) suicidal ideation, (3) suicidal planning, (4) suicidal attempts, and (5) injurious suicidal attempts.
• All statistical models were adjusted for the covariates of age, sex, race and ethnicity, bully victimization, sexual orientation, and physical activity.
• For each model, an interaction term between concussion exposure and sex was included to explore possible differences between males and females.

Topline Results

• Students who reported two or more concussions in a year were at significantly greater odds of reporting suicidal attempts than students reporting a single concussion.
• Among respondents, 15.0% noted at least one SRRC during the past 12 months, with 5.6%reporting two or more SRRCs.
• A greater proportion of male students (16.7%) versus female (13.2%) students experienced 1 or more concussions during the past year.
• A greater proportion of female students reported feeling sad or hopeless (44.3% vs 23.6%)