Understanding TBI as a Risk Factor Versus a Means of Suicide Death Using Electronic Health Record Data

Abstract

Objective

The aim of this research was to examine predictors and characterize causes of suicide death in people with traumatic brain injury (TBI) and conduct sensitivity analyses with and without people whose first diagnosis of TBI occurred within 3 days of their suicide death.

Methods

This case-control study examined suicide risk for people with TBI in eight Mental Health Research Network–affiliated healthcare systems. Sample 1 included 61 persons with TBI who died by suicide and their 75 matched controls with TBI who did not die by suicide between January 1, 2000, and December 31, 2013. Sample 2 excluded the 34 persons with TBI whose first TBI diagnosis occurred within 3 days of their suicide death and their 46 matched controls. Descriptive statistics characterized the sample stratified by cases and controls, while conditional logistic regression models estimated the adjusted odds of suicide.

Results

Over half of suicide deaths occurred within 3 days of a person’s first diagnosis of TBI in the larger sample. After excluding these persons, people with TBI were 2.84 (95% confidence interval [CI]: 2.15–2.73) times more likely to die by suicide than were people without TBI. Among those with TBI, men were 16.39 times (95% CI: 1.89–142.15) more likely to die by suicide than were women.

Conclusions

Accounting for TBI as a potential consequence of suicide attenuates the association between TBI and suicide, but a robust association persists—especially among men. Ultimately, all people with TBI should be carefully screened and monitored for suicide risk.

HIGHLIGHTS

• People with traumatic brain injury (TBI) were at considerably elevated risk for suicide death

• Men with TBI had significantly increased risk of suicide death compared to women with TBI

• TBI timing suggests confusion of risk factors for and consequences of suicide

Keywords:

• Depressive disorders
• mental illness
• suicide
• TBI

ACKNOWLEDGEMENTS

All authors made substantial contributions to the analysis or interpretation of data for this paper, revised it critically for important intellectual content, and approved the final version for publication. The authors have no financial disclosures to report.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by grant awards R01MH103539 and U19MH092201 from the National Institute of Mental Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Notes on contributors

Rebecca C. Rossom

Dr. Rebecca C. Rossom, MD, MS, HealthPartners Institute, Minneapolis, MN, USA;

Edward L. Peterson

Dr. Edward L. Peterson, PhD, Henry Ford Health System, Public Health Sciences, Detroit, MI, USA;

Mansi Sethi Chawa

Dr. Mansi Sethi Chawa, MD, Henry Ford Health System, Behavioral Health Services, Detroit, MI, USA;

Deepak Prabhakar

Dr. Deepak Prabhakar, MD, MPH, Sheppard Pratt, Baltimore, MD, USA;

Yong Hu

Yong Hu, MS, Dr. Hsueh-Han Yeh, PhD, Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA;

Hsueh-Han Yeh

Yong Hu, MS, Dr. Hsueh-Han Yeh, PhD, Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA;

Ashli A. Owen-Smith

Dr. Ashli A. Owen-Smith, PhD, School of Public Health, Georgia State University, Atlanta, GA, USA; Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA;

Gregory E. Simon

Dr. Gregory E. Simon, MD, MPH, Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA;

L. Keoki Williams

Dr. L. Keoki Williams, MD, MPH, Department of Internal Medicine, Henry Ford Health System, Detroit, MI, USA;

Samuel Hubley

Dr. Samuel Hubley, PhD, Department of Family Medicine, University of Colorado at Denver, Denver, CO, USA;

Frances Lynch

Dr. Frances Lynch, PhD, Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA;

Arne Beck

Dr. Arne Beck, PhD, Kaiser Permanente Colorado, Institute for Health Research, Denver, CO, USA;

Yihe G. Daida

Dr. Yihe G. Daida, PhD, Center for Integrated Health Care Research, Kaiser Permanente Hawaii, Honolulu, HI, USA;

Christine Y. Lu

Dr. Christine Y. Lu, PhD, MSc, Department of Population Medicine and Harvard Pilgrim Health Care Institute, Harvard Medical School, Boston, MA, USA;

Brian K. Ahmedani

Brian K. Ahmedani, PhD, LMSW, Henry Ford Health System, Behavioral Health Services, Detroit, MI, USA; Henry Ford Health System, Center for Health Policy and Health Services Research, Detroit, MI, USA.