Traumatic Brain Injury and Suicide

By Rachel Dorman, M.S. & Kacy Mixon, PhD, LMFT

We’ve discussed brain development in children and how traumatic experiences can have negative impacts. We’ll now switch gears focusing on research about traumatic brain injury (TBI), or a neurocognitive condition emerging for individuals after a sudden physical trauma occurs and causes brain damage. TBI affects many service members who have been deployed. In fact, it is estimated that 15-23% of military personnel deployed during Operation Enduring Freedom and/or operation Iraqi Freedom have experienced some form of TBI [1].  Symptoms associated with TBI include: loss of consciousness, headache, confusion, lightheadedness, dizziness, unpleasant taste in the mouth, blurred vision, ringing in the ears, fatigue, shift in sleep patterns, and changes in behavior or mood. The severity of TBI ranges from mild (i.e. a short shift in  mental status or consciousness) to severe (i.e. a lengthy period of unconsciousness or amnesia after the injury).

X-ray of a brain
[Flickr, r deangelo, CC BY-ND 2.0] Retrieved on September 23, 2015
Bryan, Clemans, Hernandez, and Rudd (2013) [1] examined the association between mild traumatic brain injury and suicidal behaviors in deployed military personnel. Researchers examined potential variables and mediators that may impact suicidality of military personnel who were diagnosed with TBI. They sampled 155 military personal and 3 civilian contractors who were evaluated for TBI days after their index injury in Iraq, of which 135 patients were diagnosed with TBI. Diagnoses were made using the 2008 TBI Task Force’s criteria of the Department of Defense and the Department of Veteran Affairs. The researchers also measured for suicidal behaviors, depression symptoms, PTSD symptoms, insomnia symptoms, TBI symptoms, and loss of consciousness to analyze for potential predictors of mediators.  Suicidal behaviors were measured using the Suicidal Behaviors Questionnaire-Revised (SBQ-R), depression symptoms were measured using the 5-item Depression subscale of the Behavioral Health Measure-20, PTSD symptoms were measured by the PTSD Checklist-Military Version, insomnia symptoms were measured using the Insomnia Severity Index, TBI symptoms were measured through a self-report questionnaire and clinical interview, and loss of consciousness was assessed by patient self-report and confirmed by other collateral military personnel present at the indexed event.

Of the patients diagnosed with TBI, 16% reported having suicidal behaviors. The researchers also found suicidal behaviors to be positively associated with all variables except loss of consciousness; this includes the number TBI symptoms, depression, PTSD, and insomnia severity. The researchers reported that patients who were diagnosed with TBI showed significantly more severe depression, PTSD, insomnia, TBI,  and suicidal symptoms as compared to patients who were not diagnosed with TBI. Results found that depression symptoms, PTSD symptoms, insomnia, and TBI symptoms were all independently associated with an increase in suicidal behaviors. Unlike previous research on this topic, the researchers found the longer duration of loss of consciousness was negatively associated with likelihood of suicidality.

Hand reaching out
[Flickr, 07.01.2012 His Hand by Jlhopgood, CC BY-ND 2.0] Retrieved September 23, 2015
The researchers recognize that most of their findings support previous research, with the exception of the longer duration of loss of consciousness resulting in decreased likelihood of suicidality. Bryan, Clemans, Hernandez, and Rudd state this may be due to the fact that evaluations of patients were done within days of the indexed event, whereas it is most common among previous research to evaluate patients months or years after an event. This means that the patient might not have had the opportunity to display increased suicidality that might occur related to TBI. The researchers also ponder whether the loss of consciousness could have served as a protective factor that may have prevented the patient from being exposed to more traumatic war-time material.The results of this research are very relevant for therapists and other professionals who work with military personnel and their families, because it highlights the important link between TBI and adjustment. Many symptoms shown post-deployment could be related to TBI, and these variables also have the potential to show broad impact on family functioning, and the likelihood of suicide risk.



[1] Bryan, C.J., Clemans, T.A., Hernandez, A.M. & Rudd, M.D. (2013). Loss of consciousnees, depression, posttraumatic stress disorder and suicide risk among deployed military personnel with mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 28(1), 13-20. 

This post was written by Rachel Dorman, M.S. and Kacy Mixon, PhD, LMFT.  Both are members of the MFLN Family Development (FD) team which aims to support the development of professionals working with military families. Find out more about the Military Families Learning Network FD concentration on our website, on Facebook, on Twitter, YouTube, and on LinkedIn.

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