title: Risk of suicide after a concussion.
abstract: BACKGROUND
  Head injuries have been associated with subsequent suicide among military personnel, but outcomes after a concussion in the community are uncertain. We assessed the long-term risk of suicide after concussions occurring on weekends or weekdays in the community.
  
  
  METHODS
  We performed a longitudinal cohort analysis of adults with diagnosis of a concussion in Ontario, Canada, from Apr. 1, 1992, to Mar. 31, 2012 (a 20-yr period), excluding severe cases that resulted in hospital admission. The primary outcome was the long-term risk of suicide after a weekend or weekday concussion.
  
  
  RESULTS
  We identified 235,110 patients with a concussion. Their mean age was 41 years, 52% were men, and most (86%) lived in an urban location. A total of 667 subsequent suicides occurred over a median follow-up of 9.3 years, equivalent to 31 deaths per 100,000 patients annually or 3 times the population norm. Weekend concussions were associated with a one-third further increased risk of suicide compared with weekday concussions (relative risk 1.36, 95% confidence interval 1.14-1.64). The increased risk applied regardless of patients' demographic characteristics, was independent of past psychiatric conditions, became accentuated with time and exceeded the risk among military personnel. Half of these patients had visited a physician in the last week of life.
  
  
  CONCLUSIONS
  Adults with a diagnosis of concussion had an increased long-term risk of suicide, particularly after concussions on weekends. Greater attention to the long-term care of patients after a concussion in the community might save lives because deaths from suicide can be prevented.
authors: Department of Medicine (Fralick, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Fralick, Thiruchelvam, Tien, Redelmeier), Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences (Thiruchelvam); Canadian Forces Health Services (Tien), Toronto, Ont.
authors: Michael
authors: M
authors: Fralick
authors: Department of Medicine (Fralick, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Fralick, Thiruchelvam, Tien, Redelmeier), Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences (Thiruchelvam); Canadian Forces Health Services (Tien), Toronto, Ont.
authors: Deva
authors: D
authors: Thiruchelvam
authors: Department of Medicine (Fralick, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Fralick, Thiruchelvam, Tien, Redelmeier), Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences (Thiruchelvam); Canadian Forces Health Services (Tien), Toronto, Ont.
authors: Homer C
authors: HC
authors: Tien
authors: Department of Medicine (Fralick, Redelmeier), University of Toronto; Evaluative Clinical Sciences (Fralick, Thiruchelvam, Tien, Redelmeier), Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences (Thiruchelvam); Canadian Forces Health Services (Tien), Toronto, Ont. dar@ices.on.ca.
authors: Donald A
authors: DA
authors: Redelmeier
mesh_terms: D000328:Adult; D001924:Brain Concussion / Q000150:complications*; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D009864:Ontario; D012307:Risk Factors; D013405:Suicide / Q000706:statistics & numerical data*