They may leave you with a sore head for a few days, but for most people who have suffered a concussion, the symptoms resolve themselves pretty quickly. But is that the end of the story? Perhaps not, as a new study has highlighted that there could be lasting and sinister effects on the brain that might normally go unnoticed. According to the results, those who have had a concussion face a significantly increased risk of suicide in the long term.
Perhaps most strikingly, the risk was greatest if the injury was sustained on a weekend, in comparison to during the week. And the more concussions a person had, the more the risk was raised. While such a link has previously been identified in athletes and military veterans who have sustained serious head trauma, this study is important because it tells us that even mild injuries can carry with them long-term risks that shouldn’t be overlooked.
“Even though things might be invisible after concussion, and patients spontaneously improve, there may be some lingering issues with damage to neurons,” lead researcher Donald Redelmeier of the Institute for Clinical Evaluative Sciences in Canada told IFLScience. “This could subsequently contribute to depression, impulsivity, insomnia, and self-harm behaviors. We know that’s the case with major brain injuries, so the same sorts of issues might apply, albeit to a lesser degree, for patients with less obvious forms of head trauma.”
For the investigation, published in the Canadian Medical Association Journal, the researchers examined 20 years’ worth of medical records for more than 235,000 patients who had sustained a concussion in Ontario. They wanted to compare occupational and recreational concussions, so they separated out weekday events from weekend injuries as workplace accidents are more likely to occur during the week, and vice versa.
Looking at the data, the average age was 41 years, slightly over half were men, and the majority had no prior psychiatric diagnoses, hospital visits, or suicide attempts. All of the concussions were mild, with no patients requiring overnight hospitalization.
A concussion could leave lasting effects on the brain, possibly leading to depression. Sander van der Werf/Shutterstock
During follow-up investigations, which were over a median of 9.3 years, 667 suicides occurred. This is equivalent to 31 deaths per 100,000 annually, or three times greater than the population norm. Of these, 148 occurred on weekends, representing an absolute suicide risk of 39 per 100,000 annually, or four times the population norm. Compared with weekday concussions, those taking place on the weekend were associated with a one-third increased risk of suicide. And this increased risk still stood even when past psychiatric conditions were taken into account, and was greater with additional concussions.
Importantly, virtually none of the deaths occurred immediately after the injury: The average time between concussion and suicide was almost six years. In addition, roughly half the individuals had seen a doctor during their last week of life. This is important, because it suggests that greater awareness could help prevent these deaths. “Doctors may not be able to restore a patient to normality, but they can prevent a bad situation from becoming worse,” said Redelmeier.
While the researchers cannot be certain as to why weekend concussions carried a greater risk of suicide, the authors suggest that reduced hospital staff on weekends could play a role, leading to limited medical care. Alternatively, people who are injured at work are more likely to be wearing safety equipment like helmets, which lessen the impact.
The take-home message here is that attention needs to be paid to these patients not only immediately afterward, but also in the long term – a step that could save lives.