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Risk Factors for Suicidal Ideation Following Mild Traumatic Brain Injury: A TRACK-TBI Study
Laura Campbell-Sills1, Sonia Jain, Xiaoying Sun
1Departments of Psychiatry (Drs Campbell-Sills, Agtarap, and Stein) and Family Medicine and Public Health (Drs Jain and Stein and Ms Sun), University of California, San Diego, La Jolla; Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston (Dr Fisher); Departments of Rehabilitation Medicine (Dr Dikmen) and Neurological Surgery and Biostatistics (Dr Temkin), University of Washington, Seattle; Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee (Drs Nelson and McCrea); Departments of Radiology (Dr Yuh) and Neurological Surgery (Dr Manley), University of California, San Francisco; Brain and Spinal Injury Center, Zuckerberg San Francisco General Hospital, San Francisco, California (Drs Yuh and Manley); Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts (Dr Giacino); Spaulding Rehabilitation Hospital, Charlestown, Massachusetts (Dr Giacino); and VA San Diego Healthcare System, San Diego, California (Dr Stein).
Objective:
To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI).
Setting:
Eleven US level 1 trauma centers.
Participants:
A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.
Design:
Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury.
Main Measures:
Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire.
Results:
Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, P values <.05) and history of prior TBI predicted SI at 2 weeks (AOR = 2.36, 95% confidence interval [CI] = 1.16-4.81, P = .018), 3 months (AOR = 2.62, 95% CI = 1.33-5.16, P = .005), and 6 months postinjury (AOR = 2.54, 95% CI = 1.19-5.42, P = .016). Adjusting for these baseline factors, post-TBI symptoms were strongly associated with SI at concurrent (AORs = 1.91-2.88 per standard deviation unit increase in Rivermead Post-Concussion Symptoms Questionnaire score; P values <.0005) and subsequent follow-up visits (AORs = 1.68-2.53; P values <.005). Most of the associations between post-TBI symptoms and SI were statistically explained by co-occurring depression.
Conclusion:
Screening for psychiatric and prior TBI history may help identify patients at risk for SI following mTBI. Awareness of the strong associations of post-TBI symptoms with SI may facilitate interventions to prevent suicide-related outcomes in patients with mTBI.
