Suicidality and Self-Harm Among Individuals With Traumatic Brain Injury: Risk and Protective Factors and Coping...

The authors examined lived experience perspectives of suicidality and nonsuicidal self-injury (NSSI) after moderate-to-severe traumatic brain injury (TBI), risk and protective factors, and methods of coping.

A record review of suicide risk assessments was completed as part of routine clinical risk management for a research study. The authors used a semistructured interview approach developed from existing clinical tools and extracted data from assessment records by using content analysis to categorize common responses.

Data were extracted from records of 68 participants (mean±SD age=45.9±14.4 years; 82% male) with a history of moderate-to-severe TBI (mean=10.7±9.1 years after TBI). Most participants (86%) were currently experiencing suicidal thoughts, and 50% had experienced NSSI thoughts in their lifetime. Fifteen participants (28%) reported a lifetime suicide attempt. The most common protective factors for suicidal ideation reported by participants were support from family (59%) and the personal attributes of openness and being optimistic (49%). The most common risk factors were emotional distress or presence of a psychiatric diagnosis (62%), TBI sequelae (such as fatigue; 49%), work-related stress (43%), and lack of family support (34%). Engaging with health professionals (62%) and seeking support from family (57%) were the most common healthy coping strategies, whereas substance use (38%) and social withdrawal (32%) were the most common unhealthy coping strategies.

The findings of this study provide detailed insights into the lived experiences of suicidality and NSSI after moderate-to-severe TBI, how survivors conceptualize factors that may increase or attenuate risk, and common coping strategies.