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Loss of Consciousness, Depression, Posttraumatic Stress Disorder, and Suicide Risk Among Deployed Military Personnel With Mild Traumatic Brain Injury

Bryan, Craig J. PsyD, ABPP; Clemans, Tracy A. PsyD; Hernandez, Ann Marie PhD; Rudd, Michael David PhD

The Journal of Head Trauma Rehabilitation: January/February 2013 - Volume 28 - Issue 1 - p 13–20
doi: 10.1097/HTR.0b013e31826c73cc
Original Articles

Objective: To identify clinical variables associated with suicidality in military personnel with mild traumatic brain injury (mTBI) while deployed to Iraq.

Setting: Outpatient TBI clinic on a US military base in Iraq.

Participants: Military personnel (N = 158) referred to an outpatient TBI clinic for a standardized intake evaluation, 135 (85.4%) who had a diagnosis of mTBI and 23 (14.6%) who did not meet criteria for TBI.

Main Measures: Suicidal Behaviors Questionnaire–Revised, Depression subscale of the Behavioral Health Measure-20, Posttraumatic Stress Disorder Checklist-Military Version, Insomnia Severity Index, self-report questionnaire, and clinical interview addressing TBI-related symptoms.

Results: Among patients with mTBI, increased suicidality was significantly associated with depression and the interaction of depression with posttraumatic stress disorder symptoms. Longer duration of loss of consciousness was associated with decreased likelihood for any suicidality.

Conclusion: Assessment after TBI in a combat zone may assist providers in identifying those at risk for suicidality and making treatment recommendations for service members with mTBI.

National Center for Veterans Studies, University of Utah, Salt Lake City (Drs Bryan and Rudd); VISN 19 Mental Illness Research Education Clinical Center, Department of Psychiatry, University of Colorado Denver School of Medicine, Denver (Dr Clemans); and Department of Psychiatry, University of Texas Health Science Center at San Antonio (Dr Hernandez).

Corresponding Author: Craig J. Bryan, PsyD, ABPP, National Center for Veterans Studies, The University of Utah, 260 S Central Campus Dr, Room 205, Salt Lake City, UT 84112 (

No sources of financial support exist for this study.

The views expressed in this article are those of the authors and do not reflect the official position or policy of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Army, Department of the Air Force, Department of Defense, Department of Veterans Affairs, or the United States Government.

The authors declare no conflicts of interest.

© 2013 Lippincott Williams & Wilkins, Inc.