Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury.
Nabil Awan, Dominic DiSanto, Shannon B Juengst and 7 others
PMID 32769828WHAT IT FOUND
Suicidal thoughts after brain injury were linked to depression, substance misuse, and injury severity.
Injury severity predicted these thoughts even when depression was absent. Screen all patients for suicidal thoughts, not just those with diagnosed depression.
Key findings
01Depression, substance misuse, and higher injury severity scores were independently associated with a higher likelihood of suicidal ideation at one year post-injury.
02Nearly one in nine individuals reporting suicidal thoughts did not meet the diagnostic criteria for depression, indicating that screening based on depression alone misses cases.
03Injury severity score predicted suicidal ideation at year one independently of depression, meaning patients with severe extracranial injuries may have suicidal thoughts without endorsing depressive symptoms.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
The study excluded individuals aged 60 and older and students, limiting generalizability to older adults in the workforce. Pre-injury suicide attempt and mental health history were not included in the main analyses due to missing data, though they are important risk factors. The primary measure for suicidal ideation was a single item from the PHQ-9, which does not assess all aspects of suicidality, such as having an actionable plan. The study did not examine suicide attempts, and risk factors for ideation may differ from those for completed suicide. Selection bias may exist because inclusion required follow-up data at year one or two, potentially excluding those with worse outcomes.
Declared interests
The authors declared no conflicts of interest. The study was supported by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) and the Department of Defense.
The easy way to misread this
Do not assume that a patient is safe from suicidal ideation simply because they do not meet the criteria for depression. The study found that over 10% of those with suicidal thoughts did not have concurrent depression, and injury severity predicted ideation independently of depressive symptoms.