Suicide Ideation and Brain Injury 

Individuals with traumatic brain injuries can experience a variety of symptoms such as physical, cognitive, and emotional changes that significantly impact their lives. As a result, survivors may exhibit personality changes, memory problems, seizures, sleep disorders, chronic pain, tremors, vision problems, and other disabling symptoms that can affect their quality of life. This can lead to feeling hopeless, chronic anxiety or depression, and relationships to breakdown, making survivors more susceptible to having suicide attempts.

Research has found that traumatic brain injury survivors, which includes civilian and military population, had an increased suicide risk compared to the general population.

According to the Centers for Disease Control and Prevention, approximately 97 percent of traumatic brain injuries are the result of a firearm each year. A 2018 retrospective cohort study that examined over 7 million patients over 10 years old in Denmark from 1980 to 2014, found the risk of suicide higher is doubled for patients with a traumatic brain injury including concussions, and even higher for a severe traumatic brain injury, numerous medical visits, and longer hospital stays. Additionally, there is an increased risk during the first six months post-injury.

The correlation between suicide after a brain injury is speculated to be due to psychiatric conditions that arise after a TBI. Other studies have found similar traits between TBI and suicidal ideation such as bipolar disorder, depression, dysthymia (persistent depressive disorder), anxiety disorders, substance abuse and perceived burdensomeness. While survivors who have a prior history of suicidal ideation have an increased risk, survivors without a history are still significantly vulnerable of suicidal ideation. Lastly, it is important from various research studies, veterans who sustained a traumatic brain injury are twice as likely to commit suicide than veterans without a TBI.

Learning about suicide prevention is crucial along with educating health care professionals and the community to identify the risk factors and signs of suicidal ideation. Preventative strategies can include teaching problem-solving skills and promoting connectedness among each other.

Shared Risk Factors for Traumatic Brain Injury Survivors and Suicide	Warning Signs (in addition to risk factors)
Psychiatric disorders and symptoms (e.g., anxiety)  Substance use/abuse  Aggressive behaviors  Executive Dysfunction (e.g., impulsivity and problem-solving)  Social isolation  Gender: Men are more likely	Feeling guilt or shame  Feeling like a burden to others  Threatening to hurt or kill themself  Finding ways to hurt or kill themself  Seeking access to pills or lethal weapons  Talking or writing about hurting or killing themself  Withdrawing from friends, giving away important items, or creating a will

Strategies  Removing access to dangerous and lethal objects in the environment  Providing and teaching the individual a variety of coping strategies to manage their emotional distress  Including coping strategies for immediate gratification such as calling a loved on  Helping the individual identifying triggers (e.g., journaling activities)  Promoting connectedness  Engaging in meaningful activities, connecting with others, joining support groups, etc.  Cognitive-Behavioral Therapy to help individual manage their thoughts and identify their triggers  Enhancing individual’s resilience (e.g., enhancing your sense of purpose, positive thinking, ability adapting to change) through skills training, self-help books, or mobile apps.

Resources  Emergency number: 911 National Suicide Prevention Lifeline:  988 – http://www.suicidepreventionlifeline.org/ Suicide Prevention Resource Center: http://www.sprc.org National Suicide Prevention Lifeline: American Association of Suicidology: http://www.suicidology.org/ American Foundation for Suicide Prevention: http://www.afsp.org/ Veteran Suicide Prevention – https://www.va.gov/health-care/health-needs-conditions/mental-health/suicide-prevention/ Crisis Text Line – Text “HELLO” to 741741 National Institute of Mental Health (Suicide Prevention) – www.nimh.nih.gov/suicideprevention

References:

Madsen, T., Erlangsen, A., Orlovska, S., Mofaddy, R., Nordentoft, M., & Benros, M. E. (2018). Association Between Traumatic Brain Injury and Risk of Suicide. JAMA: Journal of the American Medical Association, 320(6), 580–588. https://doi-org.westcoastuniversity.idm.oclc.org/10.1001/jama.2018.10211 

Miller, G. F., Kegler, S. R., & Stone, D. M. (2020). Traumatic Brain Injury–Related Deaths From Firearm Suicide: United States, 2008–2017. American Journal of Public Health, 110(6), 897–899. https://doi-org.westcoastuniversity.idm.oclc.org/10.2105/AJPH.2020.305622 

Bryson, C. N., Cramer, R. J., & Schmidt, A. T. (2017). Traumatic brain injury and lifetime suicidality: Applying the interpersonal-psychological theory perspective. Death Studies, 41(7), 399–405. https://doi-org.westcoastuniversity.idm.oclc.org/10.1080/07481187.2017.1320340 

Mental Illness Research Education Clinical, Centers of Excellence (MIRECC). 2013. Conceptualizing Suicide Risk in TBI. VA Rocky Mountain Network. www.mirecc.va.gov/visn19/docs/conceptualizing_suicide_risk_in_tbi.pdf 

National Institute of Mental Health. (n.d.) Warning Signs of Suicide. https://www.nimh.nih.gov/health/publications/warning-signs-of-suicide/index.shtml 

Suicide Prevention Resource Center. (n.d.) A Comprehensive Approach to Suicide Prevention. https://www.sprc.org/effective-prevention/comprehensive-approach