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

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.

[1]  R. Tate,et al.  Suicidality in people surviving a traumatic brain injury: Prevalence, risk factors and implications for clinical management , 2007, Brain injury.

[2]  M. Rudd,et al.  Student veterans: A national survey exploring psychological symptoms and suicide risk. , 2011 .

[3]  T. Ownsworth,et al.  Depression after traumatic brain injury: conceptualization and treatment considerations. , 1998, Brain injury.

[4]  J. Guralnik,et al.  Head injury in early adulthood and the lifetime risk of depression. , 2002, Archives of general psychiatry.

[5]  L. Brenner,et al.  Posttraumatic stress disorder, traumatic brain injury, and suicide attempt history among veterans receiving mental health services. , 2011, Suicide & life-threatening behavior.

[6]  Charles W Hoge,et al.  Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. , 2006, JAMA.

[7]  D. Warden,et al.  Traumatic Brain Injury Screening: Preliminary Findings in a US Army Brigade Combat Team , 2009, The Journal of head trauma rehabilitation.

[8]  S. Arndt,et al.  Comparison between acute- and delayed-onset depression following traumatic brain injury. , 1994, The Journal of neuropsychiatry and clinical neurosciences.

[9]  T. Tanielian,et al.  Invisible Wounds of War Psychological and Cognitive Injuries, Their Consequences, and Services to Assist Recovery , 2022 .

[10]  P. Esselman,et al.  Psychiatric disorders and functional disability in outpatients with traumatic brain injuries. , 1996, The American journal of psychiatry.

[11]  R. Robinson,et al.  Suicidal Ideation Among Patients During the Rehabilitation Period After Life-Threatening Physical Illness , 2001, The Journal of nervous and mental disease.

[12]  H. Christensen,et al.  A population survey found an association between self-reports of traumatic brain injury and increased psychiatric symptoms. , 2004, Journal of clinical epidemiology.

[13]  M. Oquendo,et al.  Suicidal Behavior and Mild Traumatic Brain Injury in Major Depression , 2004, The Journal of nervous and mental disease.

[14]  A. Osman,et al.  The Suicidal Behaviors Questionnaire-Revised (SBQ-R):Validation with Clinical and Nonclinical Samples , 2001, Assessment.

[15]  L. Sher Suicide in war veterans: the role of comorbidity of PTSD and depression , 2009, Expert review of neurotherapeutics.

[16]  T. Teasdale,et al.  Suicide after traumatic brain injury: a population study , 2001, Journal of neurology, neurosurgery, and psychiatry.

[17]  C. Morin,et al.  Validation of the Insomnia Severity Index as an outcome measure for insomnia research. , 2001, Sleep medicine.

[18]  J. Silver,et al.  Axis I Psychopathology in Individuals with Traumatic Brain Injury , 1998, The Journal of head trauma rehabilitation.

[19]  S. Deb,et al.  Rate of psychiatric illness 1 year after traumatic brain injury. , 1999, The American journal of psychiatry.

[20]  S. M. Kopta,et al.  Psychometric Evaluation of the Behavioral Health Questionnaire-20: A Brief Instrument for Assessing Global Mental Health and the Three Phases of Psychotherapy Outcome , 2002 .

[21]  George F. Ronan,et al.  Association for Behavioral and Cognitive Therapies , 2010 .

[22]  P. Wehman,et al.  Psychosocial and emotional sequelae of individuals with traumatic brain injury: a literature review and recommendations. , 1996, Brain injury.

[23]  J. Leon-Carrion,et al.  Neurobehavioural and cognitive profile of traumatic brain injury patients at risk for depression and suicide. , 2001, Brain injury.

[24]  M. Ghahramanlou-Holloway,et al.  A Comparative Review of U.S. Military and Civilian Suicide Behavior: Implications for OEF/OIF Suicide Prevention Efforts , 2009 .

[25]  Benedicto Crespo-Facorro,et al.  Major depression following traumatic brain injury. , 2004, Archives of general psychiatry.

[26]  D. G. Campbell,et al.  Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions , 2007, Journal of General Internal Medicine.

[27]  Lori Wasserman,et al.  An overview of traumatic brain injury and suicide , 2008, Brain injury.