- Campbell-Sills, Laura;
- Jain, Sonia;
- Sun, Xiaoying;
- Fisher, Lauren B;
- Agtarap, Stephanie D;
- Dikmen, Sureyya;
- Nelson, Lindsay D;
- Temkin, Nancy;
- McCrea, Michael;
- Yuh, Esther;
- Giacino, Joseph T;
- Manley, Geoffrey T;
- Stein, Murray B
Objective
To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI).Setting
Eleven US level 1 trauma centers.Participants
A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.Design
Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury.Main measures
Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire.Results
Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, P values <.05) and history of prior TBI predicted SI at 2 weeks (AOR = 2.36, 95% confidence interval [CI] = 1.16-4.81, P = .018), 3 months (AOR = 2.62, 95% CI = 1.33-5.16, P = .005), and 6 months postinjury (AOR = 2.54, 95% CI = 1.19-5.42, P = .016). Adjusting for these baseline factors, post-TBI symptoms were strongly associated with SI at concurrent (AORs = 1.91-2.88 per standard deviation unit increase in Rivermead Post-Concussion Symptoms Questionnaire score; P values <.0005) and subsequent follow-up visits (AORs = 1.68-2.53; P values <.005). Most of the associations between post-TBI symptoms and SI were statistically explained by co-occurring depression.Conclusion
Screening for psychiatric and prior TBI history may help identify patients at risk for SI following mTBI. Awareness of the strong associations of post-TBI symptoms with SI may facilitate interventions to prevent suicide-related outcomes in patients with mTBI.