Chronic traumatic encephalopathy and suicide: A systematic review
Open accessAbstract
Traumatic brain injury (TBI) is a global health concern, and the recent literature reports that a single mild TBI can result in chronic traumatic encephalopathy (CTE). It has been suggested that CTE may lead to death by suicide, raising important prevention, treatment, and policy implications. Thus, we conducted a systematic review of the medical literature to answer the key question: What is the existing evidence in support of a relationship between CTE and suicide? Systematic searches of CTE and suicide yielded 85 unique abstracts. Seven articles were identified for full text review. Only two case series met inclusion criteria and included autopsies from 17 unique cases, 5 of whom died by suicide. Neither studies used blinding, control cases, or systematic data collection regarding TBI exposure and/or medical/neuropsychiatric history. The identified CTE literature revealed divergent opinions regarding neuropathological elements of CTE and heterogeneity regarding clinical manifestations. Overall quality of evidence regarding a relationship between CTE and suicide was rated as very low using Grading of Recommendations Assessment, Development and Evaluation Working Group (GRADE) criteria. Further studies of higher quality and methodological rigor are needed to determine the existence and nature of any relationship between CTE and suicide.
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Cites
(2014) · Medical Entomology and Zoology · Cited by 17,633 · see citing works
GRADE guidelines: 3. Rating the quality of evidence
Balshem, H., Helfand, M., Schünemann, H. J., Oxman, A. D., Kunz, R., Brozek, J., Vist, G. E., Falck-Ytter, Y., Meerpohl, J., & Norris, S. (2011) · Journal of Clinical Epidemiology · doi:10.1016/j.jclinepi.2010.07.015 · Cited by 8,285 · see citing works
Chronic traumatic encephalopathy in athletes: Progressive tauopathy after repetitive head injury
McKee, A. C., Cantu, R. C., Nowinski, C. J., Hedley-Whyte, E. T., Gavett, B. E., Budson, A. E., Santini, V. E., Lee, H.-S., Kubilus, C. A., & Stern, R. A. (2009) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0b013e3181a9d503 · Cited by 2,295 · see citing works
The spectrum of disease in chronic traumatic encephalopathy
McKee, A. C., Stein, T. D., Nowinski, C. J., Stern, R. A., Daneshvar, D. H., Alvarez, V. E., Lee, H.-S., Hall, G., Wojtowicz, S. M., Baugh, C. M., et al. (2013) · Brain · doi:10.1093/brain/aws307 · Cited by 2,098 · see citing works
Goldstein, L. E., Fisher, A. M., Tagge, C. A., Zhang, X.-L., Velisek, L., Sullivan, J. A., Upreti, C., Kracht, J. M., Ericsson, M., Wojnarowicz, M. W., et al. (2012) · Science Translational Medicine · doi:10.1126/scitranslmed.3003716 · Cited by 958 · see citing works
Chronic Traumatic Encephalopathy in a National Football League Player
Omalu, B. I., DeKosky, S. T., Minster, R. L., Kamboh, M. I., Hamilton, R. L., & Wecht, C. H. (2005) · Neurosurgery · doi:10.1227/01.neu.0000163407.92769.ed · Cited by 894 · see citing works
MARTLAND, H. S. (1928) · Journal of the American Medical Association · doi:10.1001/jama.1928.02700150029009 · Cited by 774 · see citing works
CHRONIC TRAUMATIC ENCEPHALOPATHY IN A NATIONAL FOOTBALL LEAGUE PLAYER: PART II
Omalu, B. I., DeKosky, S. T., Hamilton, R. L., Minster, R. L., Kamboh, M. I., Shakir, A. M., & Wecht, C. H. (2006) · Neurosurgery · doi:10.1227/01.neu.0000245601.69451.27 · Cited by 694 · see citing works
Chronic Traumatic Encephalopathy in a National Football League Player
Kelly, D. F. (2006) · Neurosurgery · doi:10.1097/00006123-200605000-00037 · Cited by 694 · see citing works
Silver, J., KRAMER, R. A., Greenwald, S., & Weissman, M. M. (2001) · Brain Injury · doi:10.1080/02699050110065295 · Cited by 396 · see citing works
Emerging histomorphologic phenotypes of chronic traumatic encephalopathy in American athletes
Omalu, B., Bailes, J., Hamilton, R. L., Kamboh, M. I., Hammers, J., Case, M., & Fitzsimmons, R. (2011) · Neurosurgery · doi:10.1227/neu.0b013e318212bc7b · Cited by 381 · see citing works
Chronic traumatic encephalopathy (CTE) in a National Football League Player
Omalu, B. I., Hamilton, R. L., Kamboh, M. I., DeKosky, S. T., & Bailes, J. E. (2010) · Journal of Forensic Nursing · doi:10.1111/j.1939-3938.2009.01064.x · Cited by 260 · see citing works
Omalu, B. I., Hammers, J., Bailes, J. E., Hamilton, R. L., Kamboh, M. I., Webster, G., & Fitzsimmons, R. P. (2011) · Neurosurgical FOCUS · doi:10.3171/2011.9.focus11178 · Cited by 235 · see citing works
Chronic Traumatic Encephalopathy, Suicides and Parasuicides in Professional American Athletes
Omalu, B. I., Bailes, J. E., Hammers, J., & Fitzsimmons, R. P. (2010) · American Journal of Forensic Medicine & Pathology · doi:10.1097/paf.0b013e3181ca7f35 · Cited by 213 · see citing works
Suicide and Traumatic Brain Injury Among Individuals Seeking Veterans Health Administration Services
Brenner, L. A., Ignacio, R. V., & Blow, F. C. (2011) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0b013e31821fdb6e · Cited by 187 · see citing works
Self-citationBaron, S., Hein, M. J., Lehman, E. J., & Gersic, C. M. (2012) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2011.10.050 · Cited by 185 · see citing works
Simpson, G. K., & Tate, R. L. (2007) · Brain Injury · doi:10.1080/02699050701785542 · Cited by 174 · see citing works
Chronic traumatic encephalopathy in a professional American wrestler
Omalu, B. I., Fitzsimmons, R. P., Hammers, J., & Bailes, J. (2010) · Journal of Forensic Nursing · doi:10.1111/j.1939-3938.2010.01078.x · Cited by 155 · see citing works
Chronic Traumatic Encephalopathy
Omalu, B. I. (2014) · Progress in neurological surgery · doi:10.1159/000358761 · Cited by 123 · see citing works
Implementation of a Suicide Nomenclature within Two VA Healthcare Settings
Brenner, L. A., Breshears, R. E., Betthauser, L. M., Bellon, K. K., Holman, E. G., Harwood, J. E. F., Silverman, M. M., Huggins, J., & Nagamoto, H. T. (2011) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-011-9240-9 · Cited by 62 · see citing works
Self-citationA forensic neuropsychiatric approach to traumatic brain injury, aggression, and suicide.
Wortzel, H. S., & Arciniegas, D. B. (2013) · PubMed · Cited by 40 · see citing works
Self-citationTraumatic Brain Injury and Chronic Traumatic Encephalopathy: A Forensic Neuropsychiatric Perspective
Wortzel, H. S., Brenner, L. A., & Arciniegas, D. B. (2013) · Behavioral Sciences & the Law · doi:10.1002/bsl.2079 · Cited by 35 · see citing works
Self-citation(2010) · Journal of Clinical Epidemiology · Cited by 34 · see citing works
Granier, J. P., McNamee, S., Cifu, D. X., & Goldberg, G. (2011) · AJOB Neuroscience · doi:10.1080/21507740.2011.620071 · Cited by 3 · see citing works
Kristof, N. D. (2012) · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- [1]Martland HS Punch Drunk The Journal of the American Medical Association 1928 91 1103 1107
Cited by
Sorted by citations
Suicide mortality among retired National Football League players who played 5 or more seasons
Lehman, E. J., Hein, M. J., & Gersic, C. M. (2016) · The American Journal of Sports Medicine · doi:10.1177/0363546516645093 · Cited by 112 · see citing works
A critical review of chronic traumatic encephalopathy
Iverson, G. L., Gardner, A. J., McCrory, P., Zafonte, R., & Castellani, R. J. (2015) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2015.05.008 · Cited by 103 · see citing works
The Need to Separate Chronic Traumatic Encephalopathy Neuropathology from Clinical Features
Iverson, G. L., Keene, C. D., Perry, G., & Castellani, R. J. (2017) · Journal of Alzheimer's Disease · doi:10.3233/jad-170654 · Cited by 72 · see citing works
Suicide and chronic traumatic encephalopathy
Iverson, G. L. (2016) · The Journal of Neuropsychiatry and Clinical Neurosciences · doi:10.1176/appi.neuropsych.15070172 · Cited by 66 · see citing works
Suicide in professional American football players in the past 95 years
Webner, D., & Iverson, G. L. (2016) · Brain Injury · doi:10.1080/02699052.2016.1202451 · Cited by 60 · see citing works
Chronic Effects of Mild Neurotrauma: Putting the Cart Before the Horse?
Castellani, R. J., Perry, G., & Iverson, G. L. (2015) · Journal of Neuropathology & Experimental Neurology · doi:10.1097/nen.0000000000000193 · Cited by 40 · see citing works
- Authors
- Wortzel, H. S., Shura, R. D., & Brenner, L. A.
- Affiliations
- Denver VA Medical Center (US)
- Corresponding author
- Wortzel, Hal S.
- Venue
- BioMed Research International
- Publisher
- Hindawi Limited
- Published
- 2013
- Volume
- 2013
- Pages
- 1-6
- ISSN
- 1110-7243 (ISSN-L)
- 2314-6133
- 2314-6141
- PMC
- PMC3847964
- OpenAlex
- W2054726280
- Cited by
- 47
- References
- 25
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 2 · 2022: 3 · 2021: 7 · 2020: 2 · 2019: 4 · 2018: 4 · 2017: 4 · 2016: 6 · 2015: 7 · 2014: 2
- FWCI
- 0.59
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- BioMed Research International (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- chronic traumatic encephalopathy, suicide, traumatic brain injury, mild traumatic brain injury, neuropathology, clinical features, autopsy findings, quality of evidence
- MeSH terms
- Humans, Suicide, Brain Injury, Chronic
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