University of Pittsburgh, Pittsburgh, Pennsylvania.
Michigan State University, East Lansing.
JAMA Netw Open. 2022 Jul 1;5(7):e2219934. doi: 10.1001/jamanetworkopen.2022.19934.
Racial, ethnic, and sex disparities for concussion incidence and suicide attempts in youth have been reported, but data on the interaction of these variables in a large national data set are lacking. Understanding how race and ethnicity interact with sex and concussion to influence suicide attempts could yield critical information on the sociocultural impact of brain injury and mental health in US youth.
To examine the associations of concussion history, race and ethnicity, and sex with reported suicide attempts among adolescents.
DESIGN, SETTING, AND PARTICIPANTS: This population-based cross-sectional cohort study used data from US Youth Risk Behavior Surveillance System (YRBSS) survey respondents between 2017 and 2019. Data were analyzed from May 2021 to January 2022.
Respondents reported sport- or recreation-related concussion (yes or no), depression (yes or no), and suicide attempt (yes or no) over the previous 12 months, along with race and ethnicity (categorized as American Indian or Alaska Native, Asian, Black, Hispanic/Latino, multiracial, Native Hawaiian or other Pacific Islander, and White), and sex (male or female).
Two Chi-Square Automatic Interaction Detection (CHAID) decision tree models were built. The first was suicide attempt with depression history (SA-DEP), the second was suicide attempt without depression history (SA-NO DEP). CHAID uses risk factors (eg, number of concussions, race and ethnicity, sex) to divide the study sample into a series of subgroups that are nested within each other. Risk ratios (RRs) and 95% CIs were calculated for each subgroup to provide effect estimates.
A total of 28 442 youths aged up to 18 years (mean [SD] age, 14.6 [3.0] years; 14 411 [50.7%] female) responded to the survey. The CHAID decision trees revealed a complex interaction between race, sex, and concussion history for attempting suicide, which differed by depression history (overall accuracy, 84.4%-97.9%). Overall, depression history was the variable most strongly associated with SA (adjusted odds ratio, 11.24; 95% CI, 10.27-12.29). Concussion was the variable most strongly associated with SA-DEP (RR, 1.31; 95% CI, 1.20-1.51; P < .001). Black, Hispanic/Latino, or multiracial race and ethnicity were associated with increased risk for SA-DEP compared with others (RR, 1.59; 95% CI, 1.38-1.84; P < .001). American Indian or Alaska Native, Black, and Hispanic/Latino race and ethnicity were associated with increased risk for SA-NO DEP (RR, 1.89; 95% CI, 1.54-2.32; P < .001) compared with the remaining population.
These findings suggest that clinicians should consider race, ethnicity, and sex when evaluating the role of sport- or recreation-related concussion on suicide risk among US youth.
已有研究报告了在青少年中，与种族、民族和性别相关的脑震荡发病率和自杀未遂率的差异，但在大型国家数据集缺乏这些变量相互作用的数据。了解种族和民族如何与性别和脑震荡相互作用，以影响自杀未遂，可以为美国青少年脑损伤和心理健康的社会文化影响提供关键信息。
研究脑震荡史、种族和民族以及性别与青少年报告的自杀未遂之间的关联。
设计、地点和参与者：本基于人群的横断面队列研究使用了 2017 年至 2019 年期间美国青少年风险行为监测系统（YRBSS）调查应答者的数据。数据分析于 2021 年 5 月至 2022 年 1 月进行。
应答者报告了过去 12 个月内与运动或娱乐相关的脑震荡（是或否）、抑郁（是或否）和自杀未遂（是或否），以及种族和民族（分为美国印第安人或阿拉斯加原住民、亚洲人、黑人、西班牙裔/拉丁裔、多种族、夏威夷原住民或其他太平洋岛民和白人）和性别（男或女）。
建立了两个 Chi-Square 自动交互检测（CHAID）决策树模型。第一个是有抑郁史的自杀未遂（SA-DEP），第二个是无抑郁史的自杀未遂（SA-NO DEP）。CHAID 使用风险因素（例如，脑震荡次数、种族和民族、性别）将研究样本分为嵌套的一系列子组。为每个子组计算风险比（RR）和 95%置信区间（CI），以提供效应估计。
共有 28442 名年龄在 18 岁以下的青少年（平均[SD]年龄 14.6[3.0]岁；14411 名[50.7%]女性）对调查做出了回应。CHAID 决策树揭示了种族、性别和脑震荡史之间试图自杀的复杂相互作用，这因抑郁史而有所不同（总体准确性，84.4%-97.9%）。总体而言，抑郁史是与 SA 最相关的变量（调整后的优势比，11.24；95%CI，10.27-12.29）。脑震荡是与 SA-DEP 最相关的变量（RR，1.31；95%CI，1.20-1.51；P<0.001）。与其他种族和民族相比，黑种人、西班牙裔/拉丁裔或多种族种与 SA-DEP 的风险增加有关（RR，1.59；95%CI，1.38-1.84；P<0.001）。与其他种族相比，美国印第安人或阿拉斯加原住民、黑人和西班牙裔/拉丁裔与 SA-NO DEP 的风险增加有关（RR，1.89；95%CI，1.54-2.32；P<0.001）。
这些发现表明，临床医生在评估与运动或娱乐相关的脑震荡对美国青少年自杀风险的作用时，应考虑种族、民族和性别。
