Suicidal Behavior and Mild Traumatic Brain Injury in Major Depression

Department of Neuroscience, New York State Psychiatric Institute, Columbia University, New York, NY 10032, USA.
Journal of Nervous & Mental Disease (Impact Factor: 1.69). 07/2004; 192(6):430-4. DOI: 10.1097/01.nmd.0000126706.53615.7b
Source: PubMed


Traumatic brain injury (TBI) is associated with psychiatric illness, suicidal ideation, suicide attempts, and completed suicide. We investigated the relationship between mild TBI and other risk factors for suicidal behavior in major depressive episode. We hypothesized that mild TBI would be associated with suicidal behavior at least partly because of shared risk factors that contribute to the diathesis for suicidal acts. Depressed patients (N = 325) presenting for treatment were evaluated for psychopathology, traumatic history, and suicidal behavior. Data were analyzed using Student t -test, chi-square statistic, or Fisher exact test. A backward stepwise logistic regression model (N = 255) examined the relationship between attempter status and variables that differed in the TBI and non-TBI patients. Forty-four percent of all subjects reported mild TBI. Subjects with TBI were more likely to be male, have a history of substance abuse, have cluster B personality disorder, and be more aggressive and hostile compared with subjects without TBI. They were also more likely to be suicide attempters, although their suicidal behavior was not different from that of suicide attempters without TBI. Attempt status was mostly predicted by aggression and hostility, but not the presence of TBI. Of note, for males, a history of TBI increased the likelihood of being a suicide attempter, whereas the risk was elevated for females regardless of TBI history. Our data suggest that suicidal behavior and TBI share antecedent risk factors: hostility and aggression. Future studies may yield confirmation using a prospective design.

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Available from: Maria A. Oquendo, Oct 03, 2015
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    • "In a study of 650 TBI patients, five individuals had completed suicide (Harris & Barraclough, 1997), which puts the rate of suicide among this population at approximately three times the United States national average. Oquendo et al. (2004) studied 325 patients who fit criteria for either Major Depressive Disorder or Bipolar I Disorder; 109 of them had experienced a mTBI (Oquendo, 2004). They found that the patients with mTBI were much more likely to attempt suicide than the patients with no history of mTBI. "
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    ABSTRACT: Alterations in personality and behavior following traumatic brain injury (TBI) are examined in a review of the literature. Research suggests that changes in personality and behavior could be caused by the injury at an organic level, as well as the patient’s response to the injury and the subsequent deficits that are experienced. Currently, various treatment options are available and practitioners would serve patients best by sampling from many areas of psychological and medical interventions in order to create custom rehabilitation programs to suit the individual patient’s needs. Future research into the level of permanency of the personality changes, compensatory skill building for affect deficits, and increased involvement of social supports in treatment are suggested.
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    • "As with other factors associated with suicidal ideation, the prevalence of TBI is elevated in prisoner populations [24]. It is thought that TBI increases the risk of suicide via two pathways; the injury itself may act as a stressor, precipitating suicidal ideation, and increased impulsivity as a result of the injury may increase the tendency to act on suicidal thoughts [36]. Impulsivity may also underlie the observed association between suicidal ideation and violent offending [15]. "
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    ABSTRACT: We aimed to estimate the prevalence of suicidal ideation and suicide attempt among prisoners in New South Wales, Australia; and, among prisoners reporting suicidal ideation, to identify factors associated with suicide attempt. A cross-sectional design was used. Participants were a random, stratified sample of 996 inmates who completed a telephone survey. The estimated population prevalence of suicidal ideation and suicide attempt were calculated and differences by sex and Aboriginality were tested using χ2 tests. Correlates of suicidal ideation and suicide attempt were tested using logistic regression. One-third of inmates reported lifetime suicidal ideation and one-fifth had attempted suicide. Women and Aboriginal participants were significantly more likely than men and non-Aboriginal participants, respectively, to report attempting suicide. Correlates of suicidal ideation included violent offending, traumatic brain injury, depression, self-harm, and psychiatric hospitalisation. Univariate correlates of suicide attempt among ideators were childhood out-of-home care, parental incarceration and psychiatric hospitalization; however, none of these remained significant in a multivariate model. Suicidal ideation and attempts are highly prevalent among prisoners compared to the general community. Assessment of suicide risk is a critical task for mental health clinicians in prisons. Attention should be given to ensuring assessments are gender- and culturally sensitive. Indicators of mental illness may not be accurate predictors of suicide attempt. Indicators of childhood trauma appear to be particularly relevant to risk of suicide attempt among prisoners and should be given attention as part of risk assessments.
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    ABSTRACT: An estimated 877,000 lives were lost through suicide worldwide in 2002. In the United States, in 2003, more than 31,000 individuals died by suicide, making it the 11th leading cause of death. Men are four times more likely than women to die by suicide, however women make more nonfatal suicide attempts than men. There are many contributory factors to suicide and suicide attempts, the most important of which is having psychiatric disorder. More than 90% of suicides have a diagnosable psychiatric disorder at the time of their death, the most common being mood disorders. Other disorders with increased risk for suicidal behavior are psychotic disorders, alcohol and substance use disorders, and personality disorders, particularly Cluster B personality disorders. Other risk factors for suicide and suicide attempt include a family history of suicide and suicide attempt, a history of previous suicidal behavior, aggressive/impulsive traits, hopelessness and pessimism, a history of childhood abuse, head injury, and access to lethal means such as firearms. Assessing a suicidal patient involves evaluating current stressors as well as assessing enduring risk factors and indicators that an individual has a propensity to engage in suicidal behavior when under stress. Stressors include current life events or an episode of psychiatric illness, particularly a depressive episode. Longer-term risk factors include aggressive and impulsive traits, trait pessimism, and a history of past suicidal behavior because it indicates a predisposition to suicidal acts. Individuals who present with severe suicidal ideation, a definite plan for suicide, and who have ready access to lethal means are at high risk and require immediate intervention, up to and including hospitalization. Long-term treatment strategies should also include addressing enduring risk factors.
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