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Suicidal Behavior and Mild Traumatic Brain Injury in Major Depression

Oquendo, Maria A. MD*; Friedman, Jill Harkavy PhD*; Grunebaum, Michael F. MD*; Burke, Ainsley PhD*; Silver, Jonathan M. MD; Mann, J John MD*

The Journal of Nervous and Mental Disease: June 2004 - Volume 192 - Issue 6 - p 430-434
doi: 10.1097/01.nmd.0000126706.53615.7b
Original Articles

Traumatic brain injury (TBI) is associated with psychiatric illness, suicidal ideation, suicide attempts, and completed suicide. We investigated the relationship between mild TBI and other risk factors for suicidal behavior in major depressive episode. We hypothesized that mild TBI would be associated with suicidal behavior at least partly because of shared risk factors that contribute to the diathesis for suicidal acts. Depressed patients (N = 325) presenting for treatment were evaluated for psychopathology, traumatic history, and suicidal behavior. Data were analyzed using Student t -test, chi-square statistic, or Fisher exact test. A backward stepwise logistic regression model (N = 255) examined the relationship between attempter status and variables that differed in the TBI and non-TBI patients. Forty-four percent of all subjects reported mild TBI. Subjects with TBI were more likely to be male, have a history of substance abuse, have cluster B personality disorder, and be more aggressive and hostile compared with subjects without TBI. They were also more likely to be suicide attempters, although their suicidal behavior was not different from that of suicide attempters without TBI. Attempt status was mostly predicted by aggression and hostility, but not the presence of TBI. Of note, for males, a history of TBI increased the likelihood of being a suicide attempter, whereas the risk was elevated for females regardless of TBI history. Our data suggest that suicidal behavior and TBI share antecedent risk factors: hostility and aggression. Future studies may yield confirmation using a prospective design.

*Department of Neuroscience, New York State Psychiatric Institute, Columbia University; and †Lenox Hill Hospital and New York University School of Medicine, New York, NY.

This work was supported by MH48514-09 and MH62185.

Send reprint requests to Dr. Maria A. Oquendo, Department of Neuroscience, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, Unit 42, New York, NY 10032.

© 2004 Lippincott Williams & Wilkins, Inc.