Posttraumatic Stress Disorder, Traumatic Brain Injury, and Suicide Attempt History among Veterans Receiving Mental Health Services

VA VISN 19 Mental Illness Research, Education and Clinical Center (MIRECC), Denver, CO 80220, USA.
Suicide and Life-Threatening Behavior (Impact Factor: 1.4). 05/2011; 41(4):416-23. DOI: 10.1111/j.1943-278X.2011.00041.x
Source: PubMed


History of posttraumatic stress disorder (PTSD) or traumatic brain injury (TBI) has been found to increase risk of suicidal behavior. The association between suicide attempt history among veterans with PTSD and/or TBI was explored. Cases (N = 81) and 2:1 matched controls (N = 160) were randomly selected from a Veterans Affairs Medical Center clinical database. PTSD history was associated with an increased risk for a suicide attempt (OR = 2.8; 95% CI: 1.5, 5.1). This increased risk was present for those with and without a history of TBI. Results support incorporating PTSD history when assessing suicide risk among veterans with and without TBI.

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    • "The only study of which we are aware to examine PTSD as a predictor of non-fatal ISH among VHA patients found that patients with PTSD had nearly three times the odds of ISH compared with patients without PTSD, adjusting for traumatic brain injury only (Brenner et al. 2011). Given the paucity of literature on the association between PTSD and non-fatal self-harm specifically among VHA patients, the literature on PTSD and death from suicide in this population may provide additional context for future research on non-fatal self-harm. "
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    ABSTRACT: The literature on the association between Posttraumatic Stress Disorder (PTSD) and fatal and non-fatal intentional self-harm (ISH) among Veterans who receive care within the Veterans Health Administration (VHA) is limited in scope and contradictory. The current study examines the association between PTSD and non-fatal ISH in a gender-stratified sample of patients who received care at a Massachusetts VHA treatment facility between 2000 and 2008. VHA electronic medical record data were obtained for patients who received a PTSD diagnosis at a Massachusetts treatment facility (n = 16,004) and a gender/age matched comparison group (n = 52,502). Rate ratios for the association between PTSD and non-fatal ISH were computed adjusting for marital status, depression, alcohol or drug abuse or dependence, anxiety disorder diagnoses and prior ISH and clustering by hospital using Poisson regression. The interaction between PTSD and depression diagnoses in predicting non-fatal ISH was assessed as the departure from additive effects by calculating the interaction contrast (IC) while adjusting for identified confounders. Over the eight year study period 146 (0.91%) of those with PTSD experienced non-fatal ISH, while 71 (0.14%) of those without PTSD experienced non-fatal ISH. Strong adjusted associations between PTSD and non-fatal ISH were found for both male (RR = 3.3, 95% CI = 2.3, 4.6) and female (RR = 16, 95% CI = 4.7, 55) VHA patients. Evidence of an interaction between PTSD and depression diagnoses in predicting non-fatal ISH was found as a departure from additive effects for both sexes, but this association was more marked among women than among men. Our results indicate that non-fatal ISH among women may be more strongly related to PTSD than prior work focusing on suicide has suggested and highlight the importance of gender-stratified examinations of these associations. Further, our results suggest that suicide prevention approaches in the VHA should integrate treatment for PTSD and depression.
    08/2014; 1(1):20. DOI:10.1186/s40621-014-0020-5
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    • "Those unique service members and veterans exposed to blast have been given particular attention in numerous VA and DOD publications as well (e.g., French, 2010; Hampton, 2011; Hoge et al., 2008; McCrea et al., 2008; Terrio, Nelson, Betthauser, Harwood, & Brenner, 2011). Current estimates suggest that blast exposure accounts for 70–85 % of all recent combat injuries (French et al., 2012; Owens et al., 2008) and that veterans with history of blast exposure are at significantly higher risk for TBI (McCrea et al., 2008). "
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    ABSTRACT: Traumatic brain injury (TBI) is a frequent occurrence in the United States, and has been given particular attention in the veteran population. Recent accounts have estimated TBI incidence rates as high as 20 % among US veterans who served in Afghanistan or Iraq, and many of these veterans experience a host of co-morbid concerns, including psychiatric complaints (such as depression and post-traumatic stress disorder), sleep disturbance, and substance abuse which may warrant referral to behavioral health specialists working in primary care settings. This paper reviews many common behavioral health concerns co-morbid with TBI, and suggests areas in which behavioral health specialists may assess, intervene, and help to facilitate holistic patient care beyond the acute phase of injury. The primary focus is on sequelae common to mild and moderate TBI which may more readily present in primary care clinics.
    Journal of Clinical Psychology in Medical Settings 11/2012; 19(4). DOI:10.1007/s10880-012-9345-9 · 1.49 Impact Factor
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    ABSTRACT: A number of psychiatric and neurological problems may occur following traumatic brain injury (TBI). Anxiety and depression are common. There is evidence that there may be a correlation between TBI and increased risk of suicide. This article will explore current literature on the risk of suicidal behavior in people who have experienced TBI. Risk factors for suicide, recognition and assessment of suicidal behavior, and treatment issues will be discussed.
    Journal of Psychosocial Nursing and Mental Health Services 03/2012; 50(3):32-8. DOI:10.3928/02793695-20120207-02 · 0.72 Impact Factor
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