Military and Veterans Affairs
Health Services Research
This presentation examines the association between traumatic brain injury (TBI) and 1) suicide and 2) suicide method among individuals receiving Veterans Health Administration (VHA) care in Fiscal Years 2006-2015. Findings reveal that individuals with TBI are at elevated risk for death by suicide. Particular concern is warranted for those with moderate or severe TBI. We discuss implications for lethal means safety as an intervention.
Objective : To examine the association between receiving a TBI diagnosis and risk of death by suicide among those using Veterans Health Affairs (VHA) services between fiscal years 2006-2015. A secondary objective was to determine whether TBI was associated with suicide method (firearm versus other).
Design : Retrospective, cohort study.
Veterans who received health care at the VHA during fiscal years 2006-2015 (n = 1,403,249).
Participants (or Animals, Specimens, Cadavers):
All Veterans with a TBI diagnosis in VHA electronic medical records during, or prior to, the study window (n=215,610), compared to a 20% random sample of VHA patients without a TBI diagnosis (n=1,187,639).
Interventions : Not applicable.
Main Outcome Measure(s):
Death by suicide and method of suicide, obtained from the National Death Index.
The hazard of suicide was 2.19 times higher for those with TBI (95% CI=2.02-2.37) compared to those without TBI. TBI was still significant after accounting for psychiatric conditions and other covariates (HR=1.71; 95% CI=1.56-1.87). Considering TBI severity, moderate to severe TBI compared to no TBI remained significantly associated with an elevated hazard of suicide after adjustment (HR=2.45; 95% CI=2.02-2.97), as well as mild TBI compared to no TBI (HR=1.62 95% CI=1.47-1.78). With regards to suicide method, moderate to severe TBI was significantly associated with an increase in the odds of suicide by firearm among decedents (OR=2.39; 95% CI = 1.48-3.87).
Conclusions : History of TBI is associated with an elevated risk for suicide among VHA patients, even after accounting for psychiatric conditions. Firearm safety could be an effective upstream prevention approach within this patient population.