This article is more than 5 years old. Information may no longer be current.

TBI may increase suicide risk among veterans

Veterans with a history of traumatic brain injury, or TBI, were twice as likely to die by suicide compared with veterans without history of TBI, findings from a large-scale study revealed.

Prior research has indicated that patients with history of TBI were at greater risk for suicide than those without TBI.

“High prevalence rates of TBI have been identified among veterans on whole,” Lisa A. Brenner, PhD, VHA Rocky Mountain Mental Illness Research Education and Clinical Center, and colleagues wrote. “While the Veterans Health Administration (VHA) has developed numerous selective and indicated prevention strategies to direct clinical services to veterans at elevated risk for suicide, more information is needed to identify and target subgroups at increased risk for suicide.”

Using a retrospective cohort design, researchers examined the connections between TBI, suicide and suicide method among 215,610 veterans with a previous/current TBI diagnosis compared with 1,187,683 veterans without TBI receiving VHA care between 2006 and 2015. They also assessed participants’ history of comorbid and psychiatric conditions, including mood disorders, bipolar disorder, psychotic disorder, PTSD, anxiety disorder and substance use disorder.

The prevalence estimates of psychiatric conditions were two to four times higher among veterans with TBI compared with those without TBI, especially for PTSD (60.5% vs. 15%), according to the results.

After controlling for age and gender, Brenner and colleagues reported that veterans with a history of TBI were 2.15 times more likely to die by suicide (95% CI, 1.97-2.34) than veterans without TBI. Even after also controlling for psychiatric diagnoses and other chronic conditions, they found a greater risk among those with TBI (HR = 1.71; 95% CI: 1.56-1.87).

When controlling for TBI in the fully adjusted model, the data showed an increased risk for suicide among veterans with psychiatric conditions, especially depression (HR = 2.22; 95% CI, 2.06-2.41) and bipolar disorder (HR = 1.88; 95% CI, 1.7-2.09).

In addition, the researchers reported that severity of TBI effected the risk for suicide. Although the risk for suicide was higher among veterans with mild TBI than those without TBI (HR = 1.62; 95% CI, 1.47-1.78), veterans with moderate/severe TBI were much more likely to die by suicide than those with no TBI (HR = 2.45; 95% CI, 2.02-2.97). Also, those with moderate/severe TBI were at increased risk for suicide by firearm (OR = 2.39; 95% CI, 1.48-3.87).

“These findings underscore the importance of understanding veterans’ lifetime history of TBI to prevent future deaths by suicide and support the implementation of screening initiatives for lifetime history of TBI among all individuals utilizing the VHA,” Brenner and colleagues wrote. “Additional efforts are needed to identify injury histories, as well as to introduce interventions, including lethal means safety, into rehabilitative settings.” – by Savannah Demko

Disclosure: The authors report no relevant financial disclosures.