Findings shows that person who have suffered a Traumatic Brain Injuries have almost double the risk of suicide compared with individuals who did not sustain a brain injury.
New research from Denmark suggests that persons who suffered a traumatic brain injury (TBI) are at increased risk for suicide compared with persons without a documented history of TBI. The findings, published in August 2018 in the Journal of the American Medical Association, concluded that people with the most severe brain injuries had the highest increased risk and were about 2.4 times more likely to attempt suicide than people without a TBI.
“We expected to find a link, but we were a bit shocked at the strength of the link,” says Trine Madsen, PhD, lead author of the study and a postdoctoral fellow at Copenhagen Mental Health Center in Denmark. “We found a nearly twice as high suicide rate in those with a medical contact with TBI compared with those without that, even after adjusting the estimate for a number of important factors,” she says.
Scientists examined more than 34,000 people from the Danish Cause of Death registry who died by suicide between 1980 and 2014. For people without a head injury, the rate of suicide was 20 out of every 100,000 people per year, compared with 41 out of every 100,000 people for people who had experienced a TBI.
The rate of suicide was highest during the first six months after the head injury, a period in which the suicide risk was elevated more than threefold, according to Dr. Madsen. “The risk does fade with time; however, after seven years the associated risk between TBI and suicide is still elevated and is 76 percent higher than the background population without TBI,” she notes.
“Studies like this are really important because it helps to highlight the experience we see with our patients in clinic,” says Matthew Peters, MD, a teacher and researcher at Johns Hopkins Medicine in Baltimore, who sees patients in the Acquired Brain Injury Clinic. (Dr. Peters was not involved in this study.)
“Traumatic brain injury is a public health issue that does go underrecognized,” Peters adds.
Initiating a Conversation About Suicide Risks
TBI can be hard to talk about; very few people have this type of injury and afterward go on to be better than they were before, Peters says.
Due to the large amount of patient data, the researchers were able more accurately capture the association between TBI and suicide risk as they made adjustments to account for sex, age, month and year of the suicide, marital status, socioeconomic status, as well as any pre-existing psychiatric disorder. “We were also able to explore TBI’s association with suicide in more detail, such as number of Traumatic Brain Injuries, length of treatment for TBI, age when TBI was sustained, and when the risk of suicide is highest after a TBI,” says Madsen.
Although this study took great measures to account for many mitigating factors, it is important to note that it’s still hard to know with certainty if the TBI is the actual causative event that leads to a person committing suicide, says Peters.
“Statistically, no matter how much you control for things, that’s always going to be an issue,” he says. Take the example of a person who comes to the doctor with a history of a traumatic brain injuries who is now diagnosed with a depressive disorder, says Peters. “We don’t know if there’s a link between the TBI and the depression,” he says. “We don’t get to see two versions of a person’s life. If the TBI didn’t happen, would this person have depression? We can’t know that for certain.”
Although the study is informative, it doesn’t provide much direction for doctors as far as identifying TBI patients who may try to commit suicide, says Peters. Injury severity and lingering symptoms are two factors highlighted in the study, he notes, and often those patients do end up struggling more.
“What we don’t know is if that’s because their underlying brain is actually damaged, or those lingering symptoms are causing other problems with work, relationships, or symptoms like headaches and dizziness,” he says. Those people can get on a bad path, and it can be harder to help them return to their prior, pre-injury baseline, he adds.
According to Madsen, once a person who has experienced a TBI is released from the hospital, their healthcare providers should make them aware of the increased risk for developing post-TBI emotional problems or psychiatric symptoms. People with lingering symptoms that aren’t going away are at the highest risk, says Peters.
If a TBI patient develops emotional issues or psychiatric symptoms, they should be recommended to seek help or treatment to prevent suicidal ideation or behavior, says Masden.
To get emotional support and assistance for suicide feelings, call or visit your local mental health resources, call 911 or go to your local emergency room. There is also the suicide prevention lifeline which you can also access by calling 1-800-273-8255.