Suicide after traumatic brain injury: a population study

Abstract

Objectives-To determine the rates of suicide among patients who have had a traumatic brain injury. Methods-From a Danish population register of admissions to hospital covering the years 1979-93 patients were selected who had had either a concussion (n=126 114), a cranial fracture (n=7560), or a cerebral contusion or traumatic intracranial haemorrhage (n=11 766). All cases of deaths by the end of the study period were identified. Results-In the three diagnostic groups there had been 750 (0.59%), 46 (0.61%), and 99 (0.84%) cases of suicide respectively. Standardised mortality ratios, stratified by sex and age, showed that the incidence of suicide among the three diagnostic groups was increased relative to the general population (3.0, 2.7, and 4.1 respectively). In all diagnosis groups the ratios were higher for females than for males, and lower for patients injured before the age of 21 or after the age of 60. The presence of a codiagnosis relating to substance misuse was associated with increased suicide rates in all diagnosis groups. There was a tendency, among patients with cerebral contusions or traumatic intracranial haemorrhages, for suicide risk to increase with duration of stay in hospital. Cox regression analyses for proportional hazards confirmed that there was a significantly greater risk of suicide among patients with cerebral contusions or traumatic intracranial haemorrhages than among patients with concussion or cranial fractures (hazard ratios=1.42 and 1.50 respectively). There was, however, no evidence of a specific risk period for suicide after injury. Conclusion-The increased risk of suicide among patients who had a mild traumatic brain injury may result from concomitant risk factors such as psychiatric conditions and psychosocial disadvantage. The greater risk among the more serious cases implicates additionally the physical, psychological, and social consequences of the injuries as directly contributing to the suicides. (J Neurol Neurosurg Psychiatry 2001;71:436-440)

Spinal cord and related injuries after attempted suicide: psychiatric diagnosis and long-term follow-up

“…36 Eighteen percent of our study population suffered head injury as well as ASCI. Several studies have demonstrated increased suicide risk following head injury, [37][38][39] which is independent of pre-injury mental state. 40 Although previous reports have highlighted the importance of intervention against suicide in the ASCI population as a whole, 34,41,42 it appears from our study that there is a real and particular need for such action in the group of people with ASCI suffered after suicide attempt.…”

Bicycle helmets — does the dental profession have a role in promoting their use?

“…26 There is now evidence that these effects are noticeable throughout adult life 26 and that a head injury may be associated with an increased risk of developing Alzheimer's disease and other dementias. 27,28 Table 2 summarises two studies 22,25 on the outcome of head injuries. It is worth highlighting that, of the individuals with an initial diagnosis of 'mild head injury':…”

“…These effects appear to be time sensitive ie the time of injury influences the type of academic skill deficit and may influence its severity. 25 …”

“…43 Reliance on death rates to compute this type of cost/benefit figure is misleading as it fails to take into account any of the physical, mental and social morbidities that can be caused by even quite mild head injuries and the cost to the State of special education and employment provision and of supporting families as a result of relationship breakdowns secondary to head injury. [23][24][25]44 CONCLUSIONS This review of the literature, shows that the case made against the wearing of bicycle helmets is weak, relying on:…”

Neuropsychiatry

“…After TBI, the standardised mortality rate for suicide is increased threefold so that about 1% will commit suicide over a 15-year follow-up, the risk remaining fairly constant over this period 4 .…”