VHA Rocky Mountain Mental Illness Research Education and Clinical Center, Aurora, Colorado (Mss Hostetter and Stearns-Yoder and Drs Hoffmire, Forster, Adams, and Brenner); Institute for Behavioral Health, Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts (Dr Adams); and Department of Physical Medicine and Rehabilitation (Drs Hoffmire and Forster), Department of Physical Medicine and Rehabilitation, and Marcus Institute for Brain Health (Ms Stearns-Yoder), and Departments of Physical Medicine and Rehabilitation, Psychiatry, and Neurology and Marcus Institute for Brain Health (Dr Brenner), University of Colorado Anschutz Medical Campus, Aurora.
J Head Trauma Rehabil. 2019 Sep/Oct;34(5):E1-E9. doi: 10.1097/HTR.0000000000000489.
Examine associations between traumatic brain injury (TBI) and (1) suicide and (2) suicide method among individuals receiving Veterans Health Administration (VHA) care.
VHA, Fiscal Years 2006-2015.
Veterans with a TBI diagnosis during/prior to the study window (n = 215 610), compared with a 20% random sample of those without TBI (n = 1 187 639).
Retrospective, cohort study. Cox proportional hazards models were fit accounting for time-dependent measures, chronic conditions, and demographics for those with TBI compared with those without. Additional models evaluated the impact of TBI severity on the association between TBI and suicide, and method.
Death by and method of suicide.
The hazard of suicide was 2.19 times higher for those with TBI than for those without TBI (95% CI = 2.02-2.37), and was still significant after accounting for covariates (hazard ratio [HR] = 1.71; 95% confidence interval [CI] = 1.56-1.87). Considering severity, mild TBI compared with no TBI was significantly associated with an elevated hazard of suicide, after adjusting for covariates (HR = 1.62; 95% CI = 1.47-1.78). There was also a significant difference in death by suicide between moderate/severe TBI when compared with no TBI, after adjusting for covariates (HR = 2.45; 95% CI = 2.02-2.97). Moderate/severe TBI was significantly associated with an increase in the odds of suicide by firearm among decedents (odds ratio = 2.39; 95% CI = 1.48-3.87).
Traumatic brain injury is associated with an elevated risk for suicide. Particular concern is warranted for those with moderate/severe TBI. Lethal means safety should be explored as an intervention.
探讨在接受退伍军人健康管理局（VHA）治疗的个体中，创伤性脑损伤（TBI）与（1）自杀和（2）自杀方式之间的关联。
VHA，2006 财政年度至 2015 财政年度。
在研究期间/之前有 TBI 诊断的退伍军人（n = 215610），与无 TBI 的退伍军人的 20%随机样本（n = 1187639）进行比较。
回顾性队列研究。对于有 TBI 的个体与无 TBI 的个体进行比较，使用 Cox 比例风险模型拟合随时间变化的测量值、慢性疾病和人口统计学数据。另外的模型评估了 TBI 严重程度对 TBI 与自杀之间关联以及自杀方式的影响。
自杀死亡和自杀方式。
与无 TBI 的个体相比，有 TBI 的个体自杀的风险高 2.19 倍（95%CI = 2.02-2.37），在考虑了协变量后仍然显著（风险比[HR] = 1.71；95%置信区间[CI] = 1.56-1.87）。考虑严重程度，与无 TBI 相比，轻度 TBI 与自杀风险升高显著相关，在调整了协变量后（HR = 1.62；95%CI = 1.47-1.78）。与无 TBI 相比，中度/重度 TBI 与调整了协变量后的自杀死亡之间也存在显著差异（HR = 2.45；95%CI = 2.02-2.97）。中度/重度 TBI 与死者中枪支自杀的几率增加显著相关（优势比= 2.39；95%CI = 1.48-3.87）。
创伤性脑损伤与自杀风险升高相关。对于患有中度/重度 TBI 的个体，需要特别关注。应探索致命手段的安全性作为干预措施。
