Patients with a first medical contact between 16 and 20 years of age had the highest suicide risk, compared with individuals with no TBI (IRR, 3.01; 95% CI, 2.74-3.30). In addition, individuals who were diagnosed with a psychiatric illness after TBI had a higher risk of suicide than that of those with TBI only (IRR, 4.90; 95% CI, 4.55-5.29; P less than .001), as did those who had engaged in self-harm after TBI (IRR, 7.54; 95% CI, 6.91-8.22; P less than .001). Patients diagnosed with a psychological illness before their TBI had a higher risk of suicide than did those with TBI only (IRR, 2.32; 95% CI, 2.10-2.55; P less than .001), as did those who had engaged self-harm before TBI (IRR, 2.85; 95% CI, 2.53-3.19; P less than .001), the authors noted.
Dr. Madsen and her coauthors cited several limitations. One is that information was not available on which treatment patients with TBIs received. This information “would have been useful to estimate whether different treatment regimens or subsequent follow-up would have reduced the suicide risk,” they wrote.
“Traumatic brain injury is a major public health problem that has many serious consequences, including suicide,” Dr. Madsen and her colleagues wrote. Since falls and traffic accidents account for the largest share of TBIs, helmet use may be a useful protective measure, particularly for injuries related to bicycling and falls that occur at work, the researchers wrote.
“The high prevalence of TBI globally emphasizes the importance for preventing TBI in order to ameliorate its sequelae, such as increased suicide risk,” they concluded.
The study was funded in part by the Mental Health Services Capital Region Denmark and the Lundbeck Foundation. No other disclosures were reported.
SOURCE: Madsen T et al. JAMA. 2018 Aug 14;320(6):580-8.