title: Suicide and traumatic brain injury among individuals seeking Veterans Health Administration services.
abstract: OBJECTIVE
  To examine associations between history of traumatic brain injury (TBI) diagnosis and death by suicide among individuals receiving care within the Veterans Health Administration (VHA).
  
  
  METHODS
  Individuals who received care between fiscal years 2001 to 2006 were included in analyses. Cox proportional hazards survival models for time to suicide, with time-dependent covariates, were utilized. Covariance sandwich estimators were used to adjust for the clustered nature of the data, with patients nested within VHA facilities. Analyses included all patients with a history of TBI (n = 49626) plus a 5% random sample of patients without TBI (n = 389053). Of those with a history of TBI, 105 died by suicide. Models were adjusted for demographic and psychiatric covariates.
  
  
  RESULTS
  Veterans with a history of TBI were 1.55 (95% confidence interval [CI], 1.24-1.92) times more likely to die by suicide than those without a history of TBI. Analyses by TBI severity were also conducted, and they suggested that in comparison to those without an injury history, those with (1) concussion/cranial fracture were 1.98 times more likely (95% CI, 1.39-2.82) to die by suicide and (2) cerebral contusion/traumatic intracranial hemorrhage were 1.34 times more likely (95% CI, 1.09-1.64) to die by suicide. This increased risk was not explained by the presence of psychiatric disorders or demographic factors.
  
  
  CONCLUSIONS
  Among VHA users, those with a diagnosis of TBI were at greater risk for suicide than those without this diagnosis. Further research is indicated to identify evidence-based means of assessment and treatment for those with TBI and suicidal behavior.
authors: VISN 19 Mental Illness Research Education and Clinical Center (MIRECC), Denver, Colorado 80220, USA. Lisa.Brenner@va.gov
authors: Lisa A
authors: LA
authors: Brenner
authors: Rosalinda V
authors: RV
authors: Ignacio
authors: Frederic C
authors: FC
authors: Blow
mesh_terms: D001930:Brain Injuries / Q000453:epidemiology* / Q000523:psychology; D002423:Cause of Death; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data