Risk of suicidal behaviors following sport-related and non-sport-related concussion: a systematic review and meta-analysis
Abstract
Objective: 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.
Methods: 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.
Results: 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…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 13,483,226 participants or records.
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