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BioMed Research International
Volume 2013 (2013), Article ID 424280, 6 pages
http://dx.doi.org/10.1155/2013/424280
Review Article

Chronic Traumatic Encephalopathy and Suicide: A Systematic Review

1Departments of Psychiatry, Neurology, and Physical Medicine and Rehabilitation, Veterans Integrated Service Network (VISN) 19 Mental Illness, Research, Education and Clinical Center, Denver Veterans Affairs Medical Center, Denver, CO 80220, USA
2Departments of Psychiatry and Neurology, University of Colorado School of Medicine, Denver, CO 80045, USA
3Department of Psychology, Marshall University, Huntington, WV 25755, USA

Received 28 May 2013; Accepted 6 October 2013

Academic Editor: Lap Ho

Copyright © 2013 Hal S. Wortzel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.