Veterans with multiple brain injuries are twice as likely to think of suicide as those who have had only one or none

A new study from the Department of Veterans Affairs reveals that post-9-11 veterans with a history of repeated traumatic brain injuries (and none) pose a much greater risk of suicide.

The study, funded by the Center for Research, Education and Research on Mental Illness of the Center of the Atlantic Coast (MIRECC), was published online in the journal Psychological services in November 2018.

The researchers found that Iraqi and Afghan veterans with multiple head injuries were about twice as likely to report recent suicidal thoughts (suicidal thoughts over the past week) as veterinarians with TBI or not at all.

Dr. Robert Shura, a neuropsychologist at the W.G. (Bill) Hefner VA Medical Center in North Carolina, led the study.

"Suicide is a major concern for veterans," he says. "At the present time, the focus of intervention is the level of thinking about suicide. Therefore, identifying the characteristics of veterans who are more likely to think of suicide is a top priority. "

The findings were gathered during interviews with more than 800 veterans who played combat roles in Iraq and Afghanistan. The researchers focused on whether veterinarians had had suicidal thoughts in the past week. About half of the veterans reported at least one BIT. Of these, nearly 20% with a history of multiple TBIs reported recent suicidal ideation, compared to 11% with TBI and 9% with no history of traumatic brain injury.

The level of suicidal thinking was defined by Beck's scale for suicidal ideation.

Veterans with at least one TBI were much younger and more likely to be men and white women than those who had no brain injuries. The TBI group also reported significantly worse sleep quality and much higher rates of depression, two risk factors for suicidal ideation. Among Veterans with at least one brain injury, 18% met the criteria for Major Depressive Disorder (MDD), which is intense feelings of sadness over long periods of time.

All participants were registered for HAV benefits, but some did not use VA for care, says Shura. The researchers used specific elements in the interviews, such as a positive response on the Beck scale, to identify those who might need help. In these cases, a licensed mental health professional quickly completed a suicide risk badessment and was based on clinical judgment, he explained.

Shura said the results were consistent with previous research that showed a link between multiple TBIs and suicide. "But we have to be careful not to oversimplify things," he adds. "There are people with only one TBI in their past who have had suicidal thoughts, and there are those who have a lot of TBI who do not have any."

However, he found "somewhat unexpected" that PTSD is not systematically badociated with suicidal ideation among veterans with TBI.

"Research suggests a relationship between PTSD and suicidal ideation," he says. "Our findings are just one piece of a complex puzzle and should not be interpreted to mean that veterans suffering from PTSD do not have suicidal ideation. are not a critical symptom of PTSD, but well in the case of a major depressive disorder.Because of how we defined the diagnosis, the results are more interesting and clinically relevant: poor quality of sleep is related to recent suicidal ideation Providers probably need to pay more attention to returning veterans who continue to sleep, problems after readjustment of the deployment. "

The results of the Shura study are similar to those of a study on civilians published in August 2018 in Journal of the American Medical Association. The study included more than 7 million people living in Denmark between 1980 and 2014, of whom nearly 35,000 committed suicide.

Ten percent of those who died were diagnosed with TBI. According to this study, the risk of suicide is almost twice as high in these people as in those without a diagnosis of TBI. In addition, people with severe brain trauma had a much higher suicide risk than those with mild brain injury.

Shura does not know why traumatic brain injury can increase the risk of suicide. His best guess is that the risk is not primarily related to brain injury, but to the theory that a series of difficult life events can have a cumulative effect on a person.

"For example, during a deployment, a service member is exposed to traumatic events, possible stressful situations at home and chronic sleep deprivation," he said. "Back home, the veteran may have chronic pain, difficulty adjusting, persistent sleep problems, depression and heavy alcohol consumption. may have nothing to do with it, but people with multiple BITs may be more likely than others to have this cumulative trajectory and therefore suicide ideas. "

Another possibility is evoked by a study published earlier this month in the Journal of the International Society of Neuropsychology by a VA team in San Diego. Based on the badessments of 282 Iraqi and Afghan veterans with a history of mild brain trauma, researchers have linked certain specific cognitive deficits that often occur in brain trauma to higher rates of suicidal thoughts. They concluded, "Slowing the speed of treatment and / or memory difficulties can make it difficult to access past experiences to solve current problems and imagine future outcomes, leading to increased hopelessness and suicidal ideation. in veterans with three or more TBIs ".

A number of other VA studies to date have focused on TBIs and suicidal tendencies, and Shura hopes to see more research on the subject.

"One or two studies do not tell the whole story," he says. "It is necessary to accumulate research from various samples and methodologies to even begin to understand some of the complex relationships of this subject."

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