@article {Fralick497, author = {Michael Fralick and Deva Thiruchelvam and Homer C. Tien and Donald A. Redelmeier}, title = {Risk of suicide after a concussion}, volume = {188}, number = {7}, pages = {497--504}, year = {2016}, doi = {10.1503/cmaj.150790}, publisher = {CMAJ}, 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{\textendash}1.64). The increased risk applied regardless of patients{\textquoteright} 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.Interpretation: 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.}, issn = {0820-3946}, URL = {https://www.cmaj.ca/content/188/7/497}, eprint = {https://www.cmaj.ca/content/188/7/497.full.pdf}, journal = {CMAJ} }