Department of Physical Medicine & Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Department of Neuroscience; Center for Neuroscience, University of Pittsburgh; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. Electronic address: wagnerak@upmc.edu.
OBJECTIVE: To determine whether severities of head and extra-cranial injuries (ECI) were 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 Databank (NTDB) and TBI model system (TBI-MS) databases. SETTING: Level I Trauma, Inpatient Rehabilitation Centers, the community PARTICIPANTS: 3,575 participants with TBI from 15 TBI-MS Centers with linked NTDB trauma data. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES(S): SI was measured via the Patient Health Questionnaire 9 (PHQ-9, question #9). SA in the past year was assessed via interview. ECI was measured by Injury Severity Scale (non-head) and categorized as none, mild, moderate, and severe.
RESULTS: 293 (8.2%) participants had SI without SA and 109 (3.0%) had SA at least once in the first 5 years post-injury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (OR: 2.730; 95%CI: 1.55-4.82, p=0.001). Drug use at time of injury was also associated with SI (OR: 1.69; 95%CI: 1.11-2.86; p=0.015). 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 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.