Intentional Self-Harm Among US Veterans With Traumatic Brain Injury or Posttraumatic Stress Disorder: Retrospective...

Area of Science:

• Public Health
• Epidemiology
• Veterans Affairs Healthcare

Background:

• Veterans with traumatic brain injury (TBI) and/or post-traumatic stress disorder (PTSD) face elevated risks for suicide attempts and intentional self-harm compared to peers without these conditions.
• Understanding the interplay between TBI, PTSD, and self-harm is crucial for developing effective veteran support strategies.

Purpose of the Study:

• To investigate the association between diagnoses of TBI and/or PTSD and subsequent intentional self-harm diagnoses in US veterans.
• To analyze these associations based on healthcare utilization levels within the Veterans Health Administration (VHA).

Main Methods:

• Utilized administrative VHA data from 2008-2017, including 6.7 million veterans.
• Identified intentional self-harm, TBI, and PTSD diagnoses using ICD codes and external cause of injury codes.
• Stratified analyses by VHA utilization (low, medium, high) and adjusted for demographic and clinical factors.

Main Results:

• Veterans with TBI, PTSD, or comorbid TBI/PTSD diagnoses showed significantly higher prevalence and odds of intentional self-harm diagnoses.
• The association was most pronounced in veterans with high VHA utilization; comorbid TBI/PTSD cases were 4.26 times more likely to receive self-harm diagnoses.
• Prevalence of intentional self-harm was 11.63% for comorbid TBI/PTSD versus 1.92% for veterans with neither diagnosis.

Conclusions:

• Veterans diagnosed with TBI and/or PTSD are substantially more likely to be diagnosed with intentional self-harm.
• Frequent healthcare users with comorbid TBI/PTSD exhibit the highest risk, underscoring the need for tailored suicide prevention initiatives.
• Findings emphasize the importance of integrated care and screening for self-harm risk in veterans with TBI and PTSD.