800 veterans+ studied
The findings stemmed from interviews with more than 800 veterans who held combat roles in Iraq and Afghanistan. The researchers were mainly interested in whether the vets had experienced suicidal thoughts in the past week.
About half of the veterans reported at least one TBI. Of those, nearly 20 percent with a history of multiple TBIs told of recent suicidal ideation, compared with 11 percent with one TBI and 9 percent with no history of a traumatic brain injury.
The researchers found that Iraq and Afghanistan veterans who have suffered multiple traumatic brain injuries (TBIs) were about twice as likely to report recent suicidal ideation–suicidal thoughts over the past week–compared with vets with one TBI or none at all.
Shura says the results were consistent with prior research that has found a link between multiple TBIs and suicide. “But we need to be careful not to oversimplify things,” he adds. “There are folks with a single TBI in their past who have had suicidal ideation, and there are those with many TBIs who have not.”
However, he found it “somewhat unexpected” that PTSD wasn’t consistently associated with suicidal ideation in veterans with TBI.
The study, funded by VA’s Mid-Atlantic Mental Illness Research, Education and Clinical Center (MIRECC), appeared online in the journal Psychological Services in November 2018.
Similar findings in earlier study
The results in Shura’s study mirrored those in a civilian-based study that appeared in August 2018 in the Journal of the American Medical Association. The study included more than 7 million people living in Denmark between 1980 and 2014, of which nearly 35,000 died by suicide.
Ten percent of those who killed themselves were diagnosed with some form of a TBI. Those people were nearly twice as likely to die by suicide, compared with those with no TBI diagnosis, according to the research. In addition, people with a severe TBI were at much higher risk of suicide than those with a mild brain injury.
Shura isn’t certain why traumatic brain injury may increase the possibility of suicide. His best guess is that the risk isn’t related primarily to the brain injury, but to the theory that a series of difficult life events can have a cumulative effect on someone.
“For example, during deployment, a service member is exposed to traumatic events, possible stressful situations at home, and chronic sleep deprivation,” he says. “On returning home, the veteran may struggle with chronic pain, difficulty adjusting, continued sleep issues, depression, and heavy alcohol use. TBI may have little to do with all of that. But those with multiple TBIs may be more likely than others to have that cumulative trajectory and thus thoughts of suicide.”
A number of other VA studies to date have looked at TBI and suicidality, and Shura expects to see yet more research on the subject.
“One or two studies does not tell the whole story,” he says. “Accumulating research from a variety of samples and methodologies is necessary to even begin to understand some of the complex relationships of this topic.”