Research Reports - Repetitive traumatic brain injury, psychological symptoms, and suicide risk

JAMA Psychiatry. 2013 May 15:1-6

Bryan CJ, Clemans TA

IMPORTANCE Traumatic brain injury (TBI) is believed to be one factor contributing
to rising suicide rates among military personnel and veterans. This study
investigated the association of cumulative TBIs with suicide risk in a clinical
sample of deployed military personnel referred for a TBI evaluation. OBJECTIVE To
determine whether suicide risk is more frequent and heightened among military
personnel with multiple lifetime TBIs than among those with no TBIs or a single
TBI. DESIGN Patients completed standardized self-report measures of depression,
posttraumatic stress disorder (PTSD), and suicidal thoughts and behaviors;
clinical interview; and physical examination. Group comparisons of symptom scores
according to number of lifetime TBIs were made, and generalized regression
analyses were used to determine the association of cumulative TBIs with suicide
risk. PARTICIPANTS Patients included 161 military personnel referred for
evaluation and treatment of suspected head injury at a military hospital's TBI
clinic in Iraq. MAIN OUTCOMES AND MEASURES Behavioral Health Measure depression
subscale, PTSD Checklist-Military Version, concussion symptoms, and Suicide
Behaviors Questionnaire-Revised. RESULTS Depression, PTSD, and TBI symptom
severity significantly increased with the number of TBIs. An increased incidence
of lifetime suicidal thoughts or behaviors was associated with the number of TBIs
(no TBIs, 0%; single TBI, 6.9%; and multiple TBIs, 21.7%; P = .009), as was
suicidal ideation within the past year (0%, 3.4%, and 12.0%, respectively;
P = .04). The number of TBIs was associated with greater suicide risk (β
[SE] = .214 [.098]; P = .03) when the effects of depression, PTSD, and TBI
symptom severity were controlled for. A significant interaction between
depression and cumulative TBIs was also found (β = .580 [.283]; P = .04).
CONCLUSIONS AND RELEVANCE Suicide risk is higher among military personnel with
more lifetime TBIs, even after controlling for clinical symptom severity. Results
suggest that multiple TBIs, which are common among military personnel, may
contribute to increased risk for suicide.

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