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A Guide for the Assessment and Treatment of Suicidal Patients With Traumatic Brain Injuries

Dennis, John P. PhD; Ghahramanlou-Holloway, Marjan PhD; Cox, Daniel W. PhD; Brown, Gregory K. PhD

The Journal of Head Trauma Rehabilitation: July/August 2011 - Volume 26 - Issue 4 - p 244–256
doi: 10.1097/HTR.0b013e3182225528
Original Articles

People with traumatic brain injuries (TBIs) are at elevated risk for suicide. Postinjury cognitive limitations, personality factors, and psychological problems may independently or in conjunction with preinjury correlates contribute to suicidal thoughts and behaviors. Rehabilitation practitioners can best serve the needs of this high-risk population by increasing their knowledge and competence in evidence-informed approaches to suicide prevention. This article provides a review of suicide nomenclature, epidemiology, risk and protective factors, as well as evidence-informed assessment, management, and treatment practices for suicidal patients. The science of clinical practice in the area of rehabilitation and suicide prevention is in its infancy. Practitioners who provide treatment for suicidal patients with TBI are encouraged to adapt and individualize existing evidence-informed suicide assessment and prevention practices for implementation within their settings. Each patient with a TBI who endorses suicidal thoughts and/or behaviors presents a complex array of clinical challenges associated with the nature of his or her brain injury, preinjury, and postinjury functioning. Clinical as well as research recommendations are provided in the context of an understanding of such challenges and an overriding objective of minimizing suicide risk during the recovery process and maximizing treatment gains.

Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Drs Dennis, Ghahramanlou-Holloway, and Cox); and Psychopathology Research Unit, Department of Psychiatry, University of Pennsylvania, Philadelphia (Dr Brown).

Corresponding Author: John P. Dennis, PhD, Department of Medical & Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814 (

Funding for this manuscript was received from the Department of Health and Human Services, PHS grant number 5-T32-MH019931 and the Department of Defense Congressionally Directed Medical Research Program, grant number W81XWH-08-2-0172.

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of their employing institutions.

© 2011 Lippincott Williams & Wilkins, Inc.