title: Acute Trauma Factor Associations With Suicidality Across the First 5 Years After Traumatic Brain Injury.
abstract: To determine whether severity of head and extracranial injuries (ECI) is associated with suicidal ideation (SI) or suicide attempt (SA) after traumatic brain injury (TBI).
  
  
  
  Factors associated with SI and SA were assessed in this inception cohort study using data collected 1, 2, and 5 years post-TBI from the National Trauma Data Bank and Traumatic Brain Injury Model Systems (TBIMS) databases.
  
  
  
  Level I trauma centers, inpatient rehabilitation centers, and the community.
  
  
  
  Participants with TBI from 15 TBIMS Centers with linked National Trauma Data Bank trauma data (N=3575).
  
  
  
  Not applicable.
  
  
  
  SI was measured via the Patient Health Questionnaire 9 (question 9). SA in the last year was assessed via interview. ECI was measured by the Injury Severity Scale (nonhead) and categorized as none, mild, moderate, or severe.
  
  
  
  There were 293 (8.2%) participants who had SI without SA and 109 (3.0%) who had SA at least once in the first 5 years postinjury. Random effects logit modeling showed a higher likelihood of SI when ECI was severe (odds ratio=2.73; 95% confidence interval, 1.55-4.82; P=.001). Drug use at time of injury was also associated with SI (odds ratio=1.69; 95% confidence interval, 1.11-2.86; P=.015). Severity of ECI was not associated with SA.
  
  
  
  Severe ECI carried a nearly 3-fold increase in the odds of SI after TBI, but it was not related to SA. Head injury severity and less severe ECI were not associated with SI or SA. These findings warrant additional work to identify factors associated with severe ECI that make individuals more susceptible to SI after TBI.
authors.affiliation: University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Kesinger
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA. Electronic address: sbj7@pitt.edu.
authors.forename: Shannon B
authors.initials: SB
authors.lastname: Juengst
authors.affiliation: Department of Rehabilitation Medicine, New York University School of Medicine, New York, NY.
authors.forename: Hillary
authors.initials: H
authors.lastname: Bertisch
authors.affiliation: Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, NC; University of North Carolina, Chapel Hill, Chapel Hill, NC.
authors.forename: Janet P
authors.initials: JP
authors.lastname: Niemeier
authors.affiliation: Department of Rehabilitation Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Krellman
authors.affiliation: South Texas Veterans Health Care System, San Antonio, TX; University of Texas Health Science Center, San Antonio, TX.
authors.forename: Mary Jo
authors.initials: MJ
authors.lastname: Pugh
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Raj G
authors.initials: RG
authors.lastname: Kumar
authors.affiliation: Department of Surgery, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Jason L
authors.initials: JL
authors.lastname: Sperry
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Arenth
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Department of Neuroscience, University of Pittsburgh, Pittsburgh, PA; Center for Neuroscience, University of Pittsburgh, Pittsburgh, PA; Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Wagner
mesh_terms: D000328:Adult; D000367:Age Factors; D000070642:Brain Injuries, Traumatic / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044469:Racial Groups; D012737:Sex Factors; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology* / Q000706:statistics & numerical data; D013997:Time Factors; D015599:Trauma Severity Indices
keywords: Brain injuries; Injury Severity Score; Multiple trauma; Rehabilitation; Suicidal ideation; Suicide, attempted