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Context There is growing interest in the relation between repetitive concussions and mental health; however, studies on the relation between concussion frequency and adverse mental health outcomes among female and male youth are lacking. Objective To examine the association between self-reported concussion frequency and non-fatal suicidal behaviors among youth and to explore the potential interaction of biological sex. Design Retrospective cross-sectional survey. Setting National Youth Risk Behavior Surveillance System. Participants 28,442 United States secondary school students. Main Outcome Measure(s) Exposure variables included frequency of self-reported sport/recreation-related concussion within the previous 12-months (0, 1, ≥2). Outcome variables included feelings of self-reported sadness/hopelessness, suicidal ideation, planning, and attempts. Covariates included age, sex, race/ethnicity, bullying victimization, sexual orientation, and physical activity. Results Students that reported ≥2 concussions were at significantly greater odds of reporting suicidal attempts (AOR = 2.03 [95% CI = 1.43, 2.88]) when compared to students reporting a single concussive event during the past 12-months. However, sex interactions revealed that this finding may be driven by males; the strength of associations did not increase from single to multiple concussions among females. Conclusions Findings from the present study suggest that adolescents who self-reported concussion were at increased odds of reporting poor mental health and suicidal behaviors. Moreover, increased number of concussive events may be associated with significantly greater odds of reporting suicidal attempts, particularly among males. Irrespective of sex, health care professionals should closely monitor mental health behaviors in adolescents with repetitive concussions, especially those that occur in close temporal proximity. |
