Objective: To examine associations between history of traumatic brain injury (TBI) diagnosis and death by suicide among individuals receiving care within the Veterans Health Administration (VHA).
Method: Individuals who received care between fiscal years 2001 to 2006 were included in analyses. Cox proportional hazards survival models for time to suicide, with time-dependent covariates, were utilized. Covariance sandwich estimators were used to adjust for the clustered nature of the data, with patients nested within VHA facilities. Analyses included all patients with a history of TBI (n = 49626) plus a 5% random sample of patients without TBI (n = 389053). Of those with a history of TBI, 105 died by suicide. Models were adjusted for demographic and psychiatric covariates.
Results: Veterans with a history of TBI were 1.55 (95% confidence interval [CI], 1.24–1.92) times more likely to die by suicide than those without a history of TBI. Analyses by TBI severity were also conducted, and they suggested that in comparison to those without an injury history, those with (1) concussion/cranial fracture were 1.98 times more likely (95% CI, 1.39–2.82) to die by suicide and (2) cerebral contusion/traumatic intracranial hemorrhage were 1.34 times more likely (95% CI, 1.09–1.64) to die by suicide. This increased risk was not explained by the presence of psychiatric disorders or demographic factors.
Conclusions: Among VHA users, those with a diagnosis of TBI were at greater risk for suicide than those without this diagnosis. Further research is indicated to identify evidence-based means of assessment and treatment for those with TBI and suicidal behavior.
VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), Denver, Colorado (Dr Brenner); School of Medicine, University of Colorado, Denver (Dr Brenner); Veteran Affairs Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Ann Arbor, Michigan (Ms Ignacio and Dr Blow); University of Michigan Ann Arbor (Ms Ignacio and Dr Blow).
Corresponding Author: Lisa A. Brenner, PhD, ABPP, VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO 80220 (Lisa.Brenner@va.gov).
Preliminary data regarding traumatic brain injury (TBI), all combined, and suicide were presented at the International Brain Injury Association's Eighth World Congress on Brain Injury. An abstract of the presentation will appear in the journal Brain Injury. This abstract is approximately 412 words. A VA memo containing similar information was distributed and discussed with clinical providers. The data regarding TBI by severity have not been previously presented.
Drs Brenner and Blow and Ms Ignacio report no competing interests. The authors thank Drs Ira Katz, Jan Kemp, and John McCarthy for their assistance in obtaining and analyzing data presented in this manuscript.
The project was supported by the VISN 19 MIRECC, VA SMITREC, and the VA Office of Mental Health Services.