Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts.
Now with Eliot Phillipson Clinician Scientist Training Program, Department of Medicine, University of Toronto, Ontario, Canada.
JAMA Neurol. 2019 Feb 1;76(2):144-151. doi: 10.1001/jamaneurol.2018.3487.
Concussion is the most common form of traumatic brain injury (TBI). While most patients fully recover within 1 week of injury, a subset of patients might be at a higher risk of suicide.
To assess the risk of suicide after concussion.
We performed a systematic search of Medline (PubMed), Embase, PsycINFO, and Published International Literature on Traumatic Stress (PILOTS) from 1963 to May 1, 2017. We also searched Google Scholar and conference proceedings and contacted experts in the field to seek additional studies.
Studies that quantified the risk of suicide, suicide attempt, or suicidal ideation after a concussion and/or mild TBI were included. Studies that included children and adults, including military and nonmilitary personnel, were included. Two authors independently reviewed all titles and abstracts to determine study eligibility.
Study characteristics were extracted independently by 2 trained investigators. Study quality was assessed using the Newcastle-Ottawa Scale. Study data were pooled using random-effects meta-analysis.
The primary exposure was concussion and/or mild TBI, and the primary outcome was suicide. Secondary outcomes were suicide attempt and suicidal ideation.
Data were extracted from 10 cohort studies (n = 713 706 individuals diagnosed and 6 236 010 individuals not diagnosed with concussion and/or mild TBI), 5 cross-sectional studies (n = 4420 individuals diagnosed and 11 275 individuals not diagnosed with concussion and/or mild TBI), and 2 case-control studies (n = 446 individuals diagnosed and 8267 individuals not diagnosed with concussion and/or mild TBI). Experiencing concussion and/or mild TBI was associated with a 2-fold higher risk of suicide (relative risk, 2.03 [95% CI, 1.47-2.80]; I2 = 96%; P < .001). In 2 studies that provided estimates with a median follow-up of approximately 4 years, 1664 of 333 118 individuals (0.50%) and 750 of 126 114 individuals (0.59%) diagnosed with concussion and/or mild TBI died by suicide. Concussion was also associated with a higher risk of suicide attempt and suicide ideation. The heightened risk of suicide outcomes after concussion was evident in studies with and without military personnel.
Experiencing concussion and/or mild TBI was associated with a higher risk of suicide. Future studies are needed to identify and develop strategies to decrease this risk.
脑震荡是最常见的外伤性脑损伤（TBI）形式。虽然大多数患者在受伤后 1 周内完全康复，但有一部分患者可能有更高的自杀风险。
评估脑震荡后自杀的风险。
我们从 1963 年到 2017 年 5 月 1 日，对 Medline（PubMed）、Embase、PsycINFO 和国际创伤后应激发布文献（PILOTS）进行了系统搜索。我们还在 Google Scholar 和会议论文集中进行了搜索，并联系了该领域的专家以寻求其他研究。
纳入了定量评估脑震荡和/或轻度 TBI 后自杀、自杀未遂或自杀意念风险的研究。纳入了包括军人和非军人在内的儿童和成人的研究。两名作者独立审查了所有标题和摘要，以确定研究的合格性。
两名经过培训的调查员独立提取研究特征。使用纽卡斯尔-渥太华量表评估研究质量。使用随机效应荟萃分析汇总研究数据。
主要暴露是脑震荡和/或轻度 TBI，主要结局是自杀。次要结局是自杀未遂和自杀意念。
从 10 项队列研究（n=713706 例确诊和 6236010 例未确诊脑震荡和/或轻度 TBI 的个体）、5 项横断面研究（n=4420 例确诊和 11275 例未确诊脑震荡和/或轻度 TBI 的个体）和 2 项病例对照研究（n=446 例确诊和 8267 例未确诊脑震荡和/或轻度 TBI 的个体）中提取了数据。经历脑震荡和/或轻度 TBI 与自杀风险增加 2 倍相关（相对风险，2.03 [95%CI，1.47-2.80]；I2=96%；P<.001）。在 2 项提供约 4 年中位随访期估计值的研究中，1664 例 333118 例（0.50%）和 750 例 126114 例（0.59%）确诊患有脑震荡和/或轻度 TBI 的患者自杀死亡。脑震荡也与自杀未遂和自杀意念的风险增加相关。在有和没有军人的研究中，脑震荡后自杀结局的风险增加是明显的。需要进一步的研究来确定和制定降低这种风险的策略。
