Brain injuries linked with increased military suicide risk

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1. Service members who had multiple traumatic brain injuries (TBIs) were at greater suicide risk than those who had zero or one TBI.

2.  Among service members with multiple TBIs, there was a positive relationship between depression severity and suicide risk.

Evidence Rating Level: 3 (Fair)

Study Rundown: This study found that military personnel who suffered multiple TBIs were at greater risk for suicide and might be particularly vulnerable to suicide if depressed. Given that suicide is the second leading cause of death among service members, these results suggest that healthcare providers treating military patients should discuss past TBI history, particularly if patients exhibit signs of depression. Strengths of this investigation include the use of validated questionnaires to determine psychological symptom severity, as well as clinical interview to determine the number of lifetime TBIs. However, the study may have limited generalizability because of its size (n=161), primarily male population (93%), and location (Iraq combat zone). Future studies might employ a prospective design, enrolling a military cohort without any history of TBIs and better accounting for preexisting mental health issues.

Click to read the study in JAMA Psychiatry

Relevant Reading: Suicide and traumatic brain injury among individuals seeking Veterans Health Administration services

In-Depth [cross-sectional study]: This study examined the relationship between TBIs and psychological problems in 161 participants based in Iraq (157 US military personnel, 4 civilian contractors; average age 27 years). Eligible participants were referred for diagnosis and care of a possible TBI over a 6-month period in 2009. Participants self-reported suicide ideation, depression, post-traumatic stress disorder, and concussion symptoms through questionnaires and received clinical examination and interview to determine number of lifetime TBIs. Depression severity was measured using the Behavioral Health Measure depression scale.

Compared to participants with 0-1 TBIs, participants with ≥2 TBIs were at greater suicide risk (p=0.03). For service members with multiple TBIs, suicide risk increased as depression severity increased (p=0.04). More lifetime TBIs were associated with more severe depression, post-traumatic stress disorder, and TBI symptoms.

By Caroline Huang and Marc Succi

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