Multiple TBIs May Boost Suicide Risk

Pam Harrison

May 15, 2013

Multiple traumatic brain injuries (TBIs) have been linked to more severe psychological symptoms and an increased risk for suicide, new research shows.

Craig Bryan, PsyD, ABPP, National Center for Veterans Studies, Salt Lake City, Utah, and Tracy Clemans, PsyD, Mental Illness Research Education Clinical Center, Denver, Colorado, found that among military personnel, the severity of depression, posttraumatic stress disorder (PTSD), and TBI symptoms themselves significantly increased as the number of TBIs increased.

An increased incidence of lifetime suicidal thoughts or behaviors was also associated with multiple TBIs.

"Suicide risk is higher among military personnel with more lifetime TBIs, even after controlling for clinical symptom severity," investigators write.

"Results suggest that multiple TBIs, which are common among military personnel, may contribute to increased risk for suicide."

The study was published online May 15 in JAMA Psychiatry.

A total of 157 military personnel and 4 civilian contractors were recruited for the study. Participants had been referred to an outpatient TBI clinic located at a hospital in Iraq.

Participants were predominantly male, white, and had been in the military for a mean of 6.6 years.

Outcome measures were obtained through the use of the Behavioral Health Measure depression subscale, the PSTSD Checklist–Military Version, concussion symptoms, and Suicide Behaviors Questionnaire–Revised.

Depression, PTSD, and TBI symptom severity significantly increased with the number of TBIs.

Table. Increased Psychiatric and Concussive Symptom Severity

  No TBIs Single TBI Multiple TBIs
Depression 0.3 0.6 1.2
PTSD 18.9 27.5 35.3
Concussive symptoms 0.7 2.2 4.1


The likelihood of individuals reporting any past suicidal ideation also significantly increased with the number of TBIs, occurring in none of those who had no TBIs, in 6.9% of those with a single TBI, and in 21.7% of those with multiple TBIs.

Within the past year, the likelihood of participants reporting suicidal ideation similarly increased with the number of TBIs, from none in those with no TBIs to 3.4% of those with a single TBI and to 12% of those with multiple TBIs.

Investigators also found that the relationship between depression and suicide risk strengthened as the number of lifetime TBIs increased.

"The effects of depression on suicide risk are augmented by cumulative TBIs. This is noteworthy because military personnel who have sustained multiple head injuries might be especially vulnerable to suicide risk when experiencing emotional distress," they write.

JAMA Psychiatry. Published online May 15, 2013. Abstract


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