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
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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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