Here is something that shouldn’t come as a surprise: People in the military who suffer more than one mild traumatic brain injury (TBI) face a significantly higher risk of suicide — throughout their lives!
That’s the finding of new research by the National Center for Veterans Studies at the University of Utah.
A survey of 161 military personnel who were stationed in Iraq and evaluated for a possible TBI – found that the risk for suicidal thoughts or behaviors increased not only in the short term, as measured during the past 12 months, but during the individual’s lifetime, according to a press release on the study. What a terrible burden for our combat veterans – at risk for a lifetime.
Again not a surprise: The risk of suicidal thoughts increased significantly with the number of TBIs, even when controlling for other psychological factors, researchers reported in the study published online Wednesday in the journal JAMA Psychiatry.
“Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” the study’s lead author, Craig Bryan, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies, said in a statement.
“This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide,” Bryan said.
The research is disturbing because TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts, where our warriors experience a high frequency of concussive injuries from explosions and other combat-related incidents. The estimated prevalence of TBI for those deployed in these two countries ranges from 8 percent to 20 percent, according to a 2008 study.
According to the new research, one-in-five patients, or 21.7 percent, who had ever sustained more than one TBI reported suicidal ideation – thoughts about or preoccupation with suicide – at any time in the past.
For patients who had received one TBI, 6.9 percent reported having suicidal thoughts, and none for those with no TBIs. In evaluating the lifetime risk, patients were asked if they had ever experienced suicidal thoughts and behaviors up to the point they were assessed, according to the press release.
“The increases were similar for suicidal thoughts during the previous year rather than at any time: 12 percent of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4 percent with one TBI and zero percent for no TBIs,” the press release said.
“In this study, suicidal ideation was used as the indicator of suicide risk because too few patients reported a history of suicide plan or had made a suicide attempt for statistically valid conclusions to be made,” according to the release.
The researchers also discovered that multiple TBIs also were associated with a significant increase in other psychological symptoms already tied to single traumatic head injuries, including depression, post-traumatic stress disorder or PTSD, and the severity of the concussive symptoms. However, only the increase in depression severity predicted an increased suicide risk.
“That head injury and resulting psychological effects increase the risk of suicide is not new,” Bryan said. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.”
The study was conducted during a six-month period in 2009, with 161 patients who received a suspected brain injury while on duty in Iraq were referred to an outpatient TBI clinic at a combat support hospital there.
The TBI diagnosis was made by a clinical psychologist specifically trained in the assessment, diagnosis and management of the condition. Only patients with mild or no TBI completed all assessments; patients with moderate to severe TBI were immediately evacuated from Iraq.
TBI was confirmed if at least one clinical event was newly presented or worsened following the injury: loss of consciousness or memory, alteration of mental state, some neurological decline or brain damage.
The patients were divided into three groups based the total number of TBIs they sustained during their entire lives – zero, single TBI and two or more – the most recent of which was typically within the days immediately preceding their evaluation and inclusion in the study.
Each subject was also given surveys as part of his or her evaluation and treatment. Using standard evaluation tools, patients were surveyed about their symptoms of depression, PTSD and concussions, and their suicidal thoughts and behaviors.
“An important feature of the study is that by being on the ground in Iraq, we were able to compile a unique data set on active military personnel and head injury,” Bryan says. “We collected data on a large number of service members within two days of impact.”
The researchers did warn that because the results of their study were based on a single clinical sample – active military in a war zone within days of the injury – care should be taken before assuming that the results from this particular group will apply to every other group.
“Studies with larger sample sizes and conducted over longer periods of time will be needed,” the researchers said.
According to studies by the RAND Corp., suicide is the second-leading cause of death among U.S. military personnel, and the rate has risen steadily since the conflicts began in Iraq and Afghanistan. Prevalence of PTSD, depression and substance abuse have risen as well, especially among those in combat, and each has been shown to increase risk for suicidal behaviors.
“Being aware of the number of a patient’s head injuries and the interrelation with depression and other psychological symptoms may help us better understand, and thus moderate, the risk of suicide over time,” Bryan says. “Ultimately, we would like to know why people do not kill themselves. Despite facing similar issues and circumstances, some people recover. Understanding that is the real goal.”