Article open access publication

Association Between Traumatic Brain Injury and Risk of Suicide

JAMA, American Medical Association (AMA), ISSN 0098-7484

Volume 320, 6, 2018

DOI:10.1001/jama.2018.10211, Dimensions: pub.1106156470, PMC: PMC6142987, PMID: 30120477,

Affiliations

Organisations

  1. (1) Mental Health Services, grid.466916.a, Central Denmark Region
  2. (2) Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark
  3. (3) Australian National University, grid.1001.0
  4. (4) Johns Hopkins University, grid.21107.35
  5. (5) PSYCH – The Lundbeck Foundation Initiative for Integrated Psychiatric Research, Aarhus, Denmark

Description

Importance: Traumatic brain injuries (TBIs) can have serious long-term consequences, including psychiatric disorders. However, few studies have assessed the association between TBI and risk of suicide. Objective: To examine the association between TBI and subsequent suicide. Design, Setting, and Participants: Retrospective cohort study using nationwide registers covering 7 418 391 individuals (≥10 years) living in Denmark (1980-2014) with 164 265 624 person-years' follow-up; 567 823 (7.6%) had a medical contact for TBI. Data were analyzed using Poisson regression adjusted for relevant covariates, including fractures not involving the skull, psychiatric diagnoses, and deliberate self-harm. Exposure: Medical contacts for TBI recorded in the National Patient Register (1977-2014) as mild TBI (concussion), skull fracture without documented TBI, and severe TBI (head injuries with evidence of structural brain injury). Main Outcomes and Measures: Suicide recorded in the Danish Cause of Death register until December 31, 2014. Results: Of 34 529 individuals who died by suicide (mean age, 52 years [SD, 18 years]; 32.7% women; absolute rate 21 per 100 000 person-years [95% CI, 20.8-21.2]), 3536 (10.2%) had medical contact: 2701 with mild TBI, 174 with skull fracture without documented TBI, and 661 with severe TBI. The absolute suicide rate was 41 per 100 000 person-years (95% CI, 39.2-41.9) among those with TBI vs 20 per 100 000 person-years (95% CI, 19.7-20.1) among those with no diagnosis of TBI. The adjusted incidence rate ratio (IRR) was 1.90 (95% CI, 1.83-1.97). Compared with those without TBI, severe TBI (absolute rate, 50.8 per 100 000 person-years; 95% CI, 46.9-54.6) was associated with an IRR of 2.38 (95% CI, 2.20-2.58), whereas mild TBI (absolute rate, 38.6 per 100 000 person-years; 95% CI, 37.1-40.0), and skull fracture without documented TBI (absolute rate, 42.4 per 100 000 person-years; 95% CI, 36.1-48.7) had an IRR of 1.81 (95% CI, 1.74-1.88) and an IRR of 2.01 (95% CI, 1.73-2.34), respectively. Suicide risk was associated with number of medical contacts for TBI compared with those with no TBI contacts: 1 TBI contact, absolute rate, 34.3 per 100 000 person-years (95% CI, 33.0-35.7; IRR, 1.75; 95% CI, 1.68-1.83); 2 TBI contacts, absolute rate, 59.8 per 100 000 person-years (95% CI, 55.1-64.6; IRR, 2.31; 95% CI, 2.13-2.51); and 3 or more TBI contacts, absolute rate, 90.6 per 100 000 person-years (95% CI, 82.3-98.9; IRR, 2.59; 95% CI, 2.35-2.85; all P < .001 for the IRR's). Compared with the general population, temporal proximity since the last medical contact for TBI was associated with risk of suicide (P<.001), with an IRR of 3.67 (95% CI, 3.33-4.04) within the first 6 months and an incidence IRR of 1.76 (95% CI, 1.67-1.86) after 7 years. Conclusions and Relevance: In this nationwide registry-based retrospective cohort study individuals with medical contact for TBI, compared with the general population without TBI, had increased suicide risk.

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University of Copenhagen

Danish Open Access Indicator

2018: Blocked

Research area: Medicine

Danish Bibliometrics Indicator

2018: Level 3

Research area: Medicine

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Times Cited: 44

Field Citation Ratio (FCR): 27.68

Relative Citation ratio (RCR): 7.32

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