A national study of TBI and risk of suicide and unintended death by overdose and firearms

ABSTRACT

Objective: Evidence guiding suicide-prevention efforts in patients with traumatic brain injury (TBI) is imperative. We evaluated association between TBI and risk of death by drug overdose and firearms, including suicide and unintentional injury.

Methods: Cohort study of all patients 18 years and older in Veterans Health Administration databases from October 1, 2001 to December 31, 2014 with TBI diagnosis (N = 230,200), and age-matched 1:1 to random sample of patients without TBI (N = 230,200).

Results: After adjusting for demographics, comorbidities, and accounting for competing risk of other deaths, hazard ratios for death by drug overdose were 1.40 (95% CI = 1.21–1.62) for mild TBI and 1.51 (95% CI = 1.31–1.74) for moderate-to-severe TBI, while hazard ratios for death by firearms were 1.09 (95% CI = 0.89–1.33) for mild TBI and 1.33 (95% CI = 1.10–1.60) for moderate-to-severe TBI. Risk of overdose death due to TBI severity was mainly observed for middle and older age groups.

Conclusions: Findings suggest that veterans with mild and moderate-to-severe TBI are at increased risk of death by drug overdose and firearms, with overdose risk heightened with age. Data indicate that prevention efforts in patients with TBI include targeted means reduction.

KEYWORDS:

• Suicide
• unintended death
• traumatic brain injury
• firearms
• overdose

Disclosure statement

The authors have no competing interests, including specific financial interests or relationships or affiliations relevant to the subject of this manuscript.

Disclaimer

Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the US Government, or the US Department of Veterans Affairs. No official endorsement should be inferred.

Additional information

Funding

This material is based upon work supported by the US Army Medical Research and US Army Medical Research and Materiel Command and from the US Department of Veterans Affairs [Chronic Effects of Neurotrauma Consortium] under Award Nos. W81XWH-13-2-0095 and I01 CX001246. The US Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick MD 21702-5014 is the awarding and administering acquisition office. In addition, this work was supported by Award Number I01 CX001119 (PI: Dr. Byers) from the Clinical Science Research & Development Service of the US Department of Veterans Affairs Office of Research and Development. Support for the Suicide Data Repository (SDR) is provided by the Department of Veterans Affairs Center of Excellence for Suicide Prevention. The sponsors had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; or the preparation, review, or approval of the manuscript.