4014 — Suicide and Traumatic Brain Injury among Individuals Seeking Veterans Health Administration Services between Fiscal Years 2006 to 2015

Lead/Presenter: Trisha Hostetter,  Rocky Mountain MIRECC
All Authors: Hostetter TA (VHA Rocky Mountain Mental Illness Research Education and Clinical Center), Hoffmire CA (VHA Rocky Mountain Mental Illness Research Education and Clinical Center; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus), Forster JE (VHA Rocky Mountain Mental Illness Research Education and Clinical Center; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus) Sayko Adams R (Heller School for Social Policy and Management, Brandeis University; VHA Rocky Mountain Mental Illness Research Education and Clinical Center) Stearns-Yoder KA (VHA Rocky Mountain Mental Illness Research Education and Clinical Center; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus) Brenner LA (VHA Rocky Mountain Mental Illness Research Education and Clinical Center; Department of Physical Medicine and Rehabilitation, University of Colorado Anschutz Medical Campus)

Objectives:
To examine associations 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.

Methods:
Veterans with a history of a TBI diagnosis (n = 215,610) were compared to a 20% random sample of those without a history of TBI (n = 1,187,639). Cox proportional hazards models were fit to determine the hazard for suicide, accounting for age, gender, psychiatric conditions, comorbidities, and other chronic conditions. Similar models evaluated the association between the severity of TBI and suicide, and logistic regression was used to investigate the association between TBI and suicide method among suicide decedents.

Results:
The unadjusted hazard of suicide was 2.19 times higher for those with TBI compared to those without TBI (95% CI = 2.02-2.37), and remained significant after accounting for covariates (HR = 1.71; 95% CI = 1.56-1.87). Considering severity, mild TBI compared to no TBI was significantly associated with an elevated hazard of suicide, after adjusting for covariates (HR = 1.62; 95% CI = 1.47-1.78). Similarly, those with moderate/severe TBI were at increased risk for suicide after controlling for covariates (HR = 2.45; 95% CI = 2.02-2.97). Moderate/severe TBI was also significantly associated with an increase in the odds of suicide by firearm among suicide decedents (OR = 2.39; 95% CI = 1.48-3.87).

Implications:
TBI is associated with an elevated risk for suicide. Particular concern is warranted for those with moderate/severe TBI.

Impacts:
Clinicians are encouraged to screen for a history of TBI, as well as include injury history in their formulation of suicide risk. Findings regarding the use of firearms among Veterans with severe TBI, suggests the need to further explore lethal means safety as a method of suicide prevention.