Traumatic brain injury is associated with suicide attempts among active-duty United States service members.

Man after Accident

Many veterans who return home from deployment encounter significant challenges as they readjust to daily life in the United States. Mental health problems in particular are pervasive among recently deployed service members, who are at high risk for experiencing poor mental health outcomes such as depression, anxiety, and post-traumatic stress disorder (PTSD). They are also significantly more likely to attempt suicide.

Given the high suicide rate among deployed service members, researchers are motivated to identify and address the underlying factors that might increase a veteran’s risk of attempting suicide. Some researchers have used civilian studies as a starting point to understand similar risk factors in the military population. For example, recent evidence suggests that traumatic brain injury (TBI), a condition caused by a jolt or blow to the head, is a predictor of suicidal behavior among civilians. Because TBI is considered a hallmark injury of the Iraq and Afghanistan wars, researchers suspect that service members who experienced combat-related TBI may be at high risk for suicidal behavior upon returning home.

To investigate this hypothesis, a research team used data from the Army Study to Assess Risk and Resilience in Service-members (Army STARRS), a large-scale survey of combat teams that were deployed to Afghanistan in 2012. Army STARRS researchers collected data from soldiers before deployment, and then at 1 month, 3 months, and 9 months after returning home. This comprehensive survey includes items related to lifetime incidence of TBI, potential TBI-related symptoms, and mental disorders (including suicidal behavior).

The research team analyzed data from 7,677 eligible service members who completed the Army STARRS survey. They found that 103 (1.3%) of these soldiers had attempted suicide during the study follow-up period. Approximately two-thirds of the soldiers had experienced at least one TBI (the vast majority of which were “mild” or “very mild”) at some point in their life, typically during childhood or adolescence. Importantly, however, the only predictor of suicidal behavior among service members was the presence of post-TBI symptoms within the last month. That is, suicide attempts were not associated with the number of TBIs sustained over a lifetime—rather, they were associated with the recency of TBI symptoms.

These findings indicate that service members returning from deployment are at high risk for suicidal behavior in the month following a TBI or ongoing TBI symptoms. Army suicide prevention programs may benefit from efforts to track TBI and detect post-TBI symptoms in recently deployed service members, enabling the Army to target these veterans for intervention.

Campbell-Sills L, Stein MB, Liu H, et al. Associations of lifetime traumatic brain injury characteristics with prospective suicide attempt among deployed US army soldiers. Head Trauma Rehabilitation. (February 2020).

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