Risk of suicidal behaviors following sport-related and non-sport-related concussion: a systematic review and meta-analysis.

Abstract

<h4>Objective</h4>This systematic review and meta-analysis aimed to quantify the strength of association between a history of concussion and the spectrum of suicidal behaviors, including Suicidal Ideation, Made a Suicide Plan, Attempted Suicide, and Death by Suicide. It also sought to provide the first direct comparison of suicide risk associated with sport-related concussion (SRC) versus non-sport-related concussion (non-SRC) and to examine the moderating role of sex.<h4>Methods</h4>Following the PRISMA guidelines, this study was prospectively registered with PROSPERO (CRD420251074749). A systematic search of PubMed, Embase, Cochrane Library, Web of Science, and EBSCO databases was conducted through August 2025. Observational studies reporting on the association between a history of concussion and at least one suicidal behavior outcome were included. A random-effects model was used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Subgroup analyses were performed based on the context of injury (SRC vs. non-SRC) and sex.<h4>Results</h4>A total of 18 studies, comprising 13,483,226 participants (of whom 650,465 had a history of concussion), were included. The meta-analysis revealed that a history of concussion was significantly associated with an increased risk for all suicidal behavior outcomes: Suicidal Ideation (OR = 1.35, 95% CI: 1.20-1.52), Made a Suicide Plan (OR = 1.35, 95% CI: 1.20-1.51), Attempted Suicide (OR = 1.66, 95% CI: 1.43-1.94), and Death by Suicide (OR = 1.90, 95% CI: 1.59-2.27). The strength of this association increased in a graded manner corresponding to the severity of the suicidal behavior. Subgroup analysis stratified by sex revealed that for Attempted Suicide, the risk was significantly higher in males with a history of concussion (OR = 2.03) compared to females (OR = 1.41). Furthermore, the degree of risk increase for suicidal behaviors brought by sport-related and non-sport-related concussion was comparable and both were statistically significant (p < 0.05).<h4>Conclusion</h4>Concussion, whether sport-related or non-sport-related, is a risk factor for suicidal behaviors, including Suicidal Ideation, Made a Suicide Plan, and Attempted Suicide, with comparable levels of risk for both contexts. Given the elevated risk for Attempted Suicide observed among males following a concussion, the integration of suicide risk screening and sex-specific intervention strategies into the standard of care for all patients with concussion is warranted.