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Updated: Dec 12, 2025
Controlled Cortical Impact Model for Traumatic Brain Injury
Published on: August 5, 2014
Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain
Nabil Awan1, Dominic DiSanto, Shannon B Juengst
1Departments of Physical Medicine and Rehabilitation (Messrs Awan and DiSanto and Dr Wagner), Biostatistics (Mr Awan), Surgery (Dr Sperry), and Neuroscience (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Center for Neuroscience (Dr Wagner), Safar Center of Resuscitation Research (Dr Wagner), School of Medicine (Mr Kesinger), and Clinical and Translational Science Institute (Dr Wagner), University of Pittsburgh, Pittsburgh, Pennsylvania; Institute of Statistical Research and Training, University of Dhaka, Dhaka, Bangladesh (Mr Awan); Departments of Physical Medicine & Rehabilitation (Dr Juengst) and Rehabilitation Counseling (Dr Juengst), University of Texas-Southwestern Medical Center, Dallas; Department of Rehabilitation Medicine, Brain Injury Research Center, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Kumar); Department of Psychology, NYU Rusk Rehabilitation, Brooklyn (Dr Bertisch); Department of Physical Medicine & Rehabilitation, UAB Spain Rehabilitation Center, Birmingham, Alabama (Dr Niemeier); and Departments of Psychiatry and Behavioral Sciences (Dr Fann), Epidemiology (Dr Fann), and Rehabilitation Medicine (Dr Fann), University of Washington, Seattle.
Objective:
Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI).
Design:
Prospective cohort study.
Setting:
Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States.
Participants:
Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377).
Main Outcome Measure:
Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury.
Results:
Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI.
Conclusions:
Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
