Predicting suicidality in Veterans/Service members over 5 years after TBI: A VA model systems study

Abstract: Objective: To examine demographic and injury-related predictors of suicidal attempts (SA) and ideation (SI) during the 5 years after traumatic brain injury (TBI) among Veterans and Service members (V/SMs) enrolled in the Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC) TBI Model Systems study. Design: Multi-center, longitudinal observational cohort study. Setting: Inpatient rehabilitation at one of the VA’s 5 PRCs. Participants: A sample of 812 V/SMs with TBI enrolled within 14 months of injury and survived to at least the year 1 data collection. Main Outcome Measures: Past year SA and past-2-week SI were assessed at follow-ups. Results: SA prevalence rate across the years varied between 2.2% and 2.5%, with 4.8% of the sample reporting SA at least once. SI rates were higher and varied between 13.2% and 14.3%, with 21.7% reporting SI at least once. After controlling for other predictors, V/SMs aged <30 years had 5.32 times greater odds of SA post-TBI compared with those aged ≥50 years. Those with a preinjury history of mental health treatment or psychiatric hospitalization had 3.89 times greater odds of SA over time. Nonviolent TBI etiologies increased SI odds by 1.94 times. Preinjury history of mental health treatment or psychiatric hospitalization increased SI odds by 1.69 times; and those with a preinjury history of SA had 2.86 times greater SI odds. Conclusions: These rates, though high, are likely underestimates of 5-year post-TBI suicidality among V/SMs with TBI. V/SMs with TBI should be screened regularly for suicidality—even years after injury. Future research should explore the contributions of the identified risk factors to inform targeted screening and appropriate mental health referral to prevent, assess, monitor, and treat SA and SI.