Abstract
Objective
To determine whether severity of head and extracranial injuries (ECI) is associated
with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI).
Design
Factors associated with SI and SA were assessed in this inception cohort study using
data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic
Brain Injury Model Systems (TBIMS) databases.
Setting
Level I trauma centers, inpatient rehabilitation centers, and the community.
Participants
Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank
trauma data (N=3575).
Interventions
Not applicable.
Main Outcome Measures
SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last
year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead)
and categorized as none, mild, moderate, or severe.
Results
There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA
at least once in the first 5 years postinjury. Random effects logit modeling showed
a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval,
1.55–4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95%
confidence interval, 1.11–2.86; P=.015). Severity of ECI was not associated with SA.
Conclusions
Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was
not related to SA. Head injury severity and less severe ECI were not associated with
SI or SA. These findings warrant additional work to identify factors associated with
severe ECI that make individuals more susceptible to SI after TBI.
Keywords
List of abbreviations:
ECI (extracranial injury), ISS (Injury Severity Score), SA (suicide attempt), SCI (spinal cord injury), SI (suicidal ideation), TBI (traumatic brain injury), TBIMS (Traumatic Brain Injury Model Systems)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 14, 2016
Footnotes
Support for the collection of the original data was by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90DP0041); and the National Trauma Data Bank. Support for the content of this article was by the NIDILRR (grant nos. 90DP0038 and 90DP0047); the National Institutes of Health (grant no. NIH K23GM093032); the National Institute of Mental Health Medical Student Research Fellowship (fellowship no. TL1TR000005) administered by the University of Pittsburgh (grant no. R25 MH054318); a Rusk Advanced Rehabilitation Research Training Postdoctoral Fellowship (grant no. NIDILRR 90AR5014-01-00); and the Polytrauma Rehabilitation Center Traumatic Brain Injury Model System.
The Polytrauma Rehabilitation Center Traumatic Brain Injury Model System is a funded collaboration between the Department of Veterans Affairs (VA) and the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR). The NIDILRR is a center within the Administration for Community Living (ACL), Department of Health and Human Services (HHS). The contents of this article do not necessarily represent the policy of the VA, NIDILRR, ACL, NIH, or HHS, and endorsement of this content by the Federal Government should not be assumed.
Disclosures: none.
Identification
Copyright
© 2016 by the American Congress of Rehabilitation Medicine
