Associations of Military-Related Traumatic Brain Injury With New-Onset Mental Health Conditions and Suicide Risk

Abstract

ImportanceResearch to identify the direct and indirect associations of military-related traumatic brain injury (TBI) with suicide has been complicated by a range of data-related challenges.ObjectiveTo identify differences in rates of new-onset mental health conditions (ie, anxiety, mood, posttraumatic stress, adjustment, alcohol use, and substance use disorders) among soldiers with and without a history of military-related TBI and to explore the direct and indirect (through new-onset mental health disorders) associations of TBI with suicide.Design, Setting, and ParticipantsThis retrospective cohort study used data from the Substance Use and Psychological Injury Combat Study (SUPIC) database. Demographic, military, and health data from the Department of Defense within SUPIC were compiled and linked with National Death Index records to identify deaths by suicide. Participants included US Army soldiers who returned from an Afghanistan or Iraq deployment. Data were analyzed from September to December 2022.ExposuresMilitary-related TBI.Main Outcomes and MeasuresThe outcome of interest was suicide. Secondary outcomes were incidence of new-onset mental health conditions. Mediation analyses consisted of accelerated failure time (AFT) models in conjunction with the product of coefficients method. The 6 new-onset mental health diagnosis categories and the 2 or more categories variable were each considered separately as potential mediators; therefore, a total of 14 models plus the overall AFT model estimating the total effect associated with TBI in suicide risk were fit.ResultsThe study included 860 892 soldiers (320 539 soldiers [37.2%] aged 18-24 at end of index deployment; 766 454 [89.0%] male), with 108 785 soldiers (12.6%) with at least 1 documented TBI on their military health record. Larger increases in mental health diagnoses were observed for all conditions from before to after documented TBI, compared with the matched dates for those without a history of TBI, with increases observed for mood (67.7% vs 37.5%) and substance use (100% vs 14.5%). Time-to-suicide direct effect estimates for soldiers with a history of TBI were similar across mediators. For example, considering new-onset adjustment disorders, time-to-suicide was 16.7% faster (deceleration factor, 0.833; 95% CI, 0.756-0.912) than for soldiers without a history of TBI. Indirect effect estimates of associations with TBI were substantial and varied across mediators. The largest indirect effect estimate was observed through the association with new-onset substance use disorder, with a time to suicide 63.8% faster (deceleration factor, 0.372; 95% CI, 0.322-0.433) for soldiers with a history of TBI.Conclusions and RelevanceIn this longitudinal cohort study of soldiers, rates of new-onset mental health conditions were higher among individuals with a history of TBI compared with those without. Moreover, risk for suicide was both directly and indirectly associated with history of TBI. These findings suggest that increased efforts are needed to conceptualize the accumulation of risk associated with multiple military-related exposures and identify evidence-based interventions that address mechanisms associated with frequently co-occurring conditions.

Magnesium–ibogaine therapy in veterans with traumatic brain injuries

“…Current treatment options include cognitive rehabilitation, psychotherapy and medications that target specific symptoms, but there is limited evidence of efficacy 52 – 54 . Given the alarming rates of suicide in veterans 11 , as well as evidence that military-related TBI increases the risk of suicide in veterans 55 (as TBI also does in the general population 56 ), the substantial reduction in SI that we observed—which must be interpreted cautiously as an exploratory analysis—is noteworthy. TBI also is associated with increased impulsivity 53 , a well-known risk factor for suicide 57 , and MISTIC resulted in a measurable improvement in cognitive inhibition.…”

Traumatic Injuries Among Service Members and Veterans in North Carolina: A Pressing Public Health Problem

“…In North Carolina, where Service Members and Veterans make up less than 10% of the state's population, Veterans have a suicide rate that is two times that of the state's average [2]. Traumatic brain injuries (TBIs) caused by explosions and other hazards during military service have been linked to mental health issues, including suicide; research published just this August analyzing a cohort of almost 900,000 Service Members found that individuals with a history of military-identified TBI had significantly higher rates of new-onset mental health conditions than those without TBI [3]. Although the US Department of Defense (DoD) has pledged to track exposure to TBIs, its efforts have been far from adequate [4].…”