Background: While there is increasing evidence on the long-term risks associated with concussions, the association between hopelessness, suicidal ideation, suicidal planning and suicidal attempts in high school aged adolescents has not yet been explored. The current study aims to estimate the association between concussions and suicidal behaviors in Utah high school students.

Methods: We analyzed the 2013 Utah Youth Risk Behavior Survey (YRBS), a state, representative survey of 2,195 9^th through 12^th grade high school students. Bivariate and multivariable logistic regressions controlling for race/ethnicity, sex, grade, and alcohol use were conducted to evaluate the adjusted odds ratio and 95% confidence interval (CI) of suicidal behaviors comparing students exposed to one or more concussions to those unexposed.

Results: Students with self-reported concussion exposure had significantly greater odds of reporting feeling sad of hopeless (OR = 1.7; 95% CI 1.4, 2.2), suicidal ideations (AOR =2.0; 95% CI 1.4, 2.7), suicidal planning (AOR= 2.0; 95% CI 1.4, 2.8) and suicidal attempts (OR=2.3; 95% CI 1.4, 3.7) after controlling for grade, sex, race and alcohol-use.

Discussion: Results from this study suggest that high school students who have suffered from a concussion are more likely to report suicidal behaviors, compared to high school students who did not report a concussion. Given the results, concussion prevention education efforts in high schools are warranted. In addition, it’s imperative to educate parents, teachers, and health professionals how to recognize a concussion and any possible mental health outcomes as a result. Future longitudinal research is needed to better understand temporality of this association.