摘要：Objectives. We examined rates of suicidal ideation (SI) after traumatic brain injury (TBI) and investigated whether demographic characteristics, preinjury psychiatric history, or injury-related factors predicted SI during the first year after injury. Methods. We followed a cohort of 559 adult patients who were admitted to Harborview Medical Center in Seattle, Washington, with a complicated mild to severe TBI between June 2001 and March 2005. Participants completed structured telephone interviews during months 1 through 6, 8, 10, and 12 after injury. We assessed SI using item 9 of the Patient Health Questionnaire (PHQ-9). Results. Twenty-five percent of the sample reported SI during 1 or more assessment points. The strongest predictor of SI was the first PHQ-8 score (i.e., PHQ-9 with item 9 excluded) after injury. Other significant multivariate predictors included a history of a prior suicide attempt, a history of bipolar disorder, and having less than a high school education. Conclusions. Rates of SI among individuals who have sustained a TBI exceed those found among the general population. Increased knowledge of risk factors for SI may assist health care providers in identifying patients who may be vulnerable to SI after TBI. Suicide is a major public health problem among the 1.7 million people who sustain traumatic brain injury (TBI) each year in the United States. 1 People with a history of TBI in both civilian and military populations are 1.55 to 4.05 times more likely to die by suicide than the general population. 2–5 In a study of Australian outpatients with a history of TBI, the majority of whom had no preinjury history of suicide attempts, suicide attempts were reported by 17.4% (30 of 172) of the sample over a 5-year period. 6 Nearly half of the individuals who attempted suicide had made multiple attempts. 6,7 The Centers for Disease Control and Prevention recently called for investigations of individual-level risk and protective factors for self-directed violence among people with TBI as an important component of improving long-term outcomes. 8 Rates of suicidal ideation (SI) after TBI have been found to exceed 20% in some studies 6,9–14 ; however, in a recent systematic review of SI and behavior after TBI, Bahraini et al. highlighted the paucity of research in this area. 15 They concluded that additional research is needed to determine the prevalence of SI and behavior after brain injury, as well as to ascertain patient-level factors that may be associated with increased suicide risk. Studies examining whether injury severity predicts post-TBI suicidality have yielded inconclusive findings. 6,13,16,17 In perhaps the most thorough study on this topic to date, Tsaousides et al. 12 surveyed 356 community-dwelling adults with a self-reported history of TBI and found that preinjury substance abuse was the only correlate of current SI. Risk factors for SI after TBI have been underinvestigated. Research in this area has been limited by reliance on retrospective reporting and self-reported history of TBI, 12,18–20 with only a few studies including objective indicators of TBI severity. 6 Most studies have involved cross-sectional designs and have included participants whose time since injury varied from several months to many years. 12,21 Finally, because most existing studies have included relatively small, potentially biased samples 21 recruited from outpatient clinics or TBI survivor programs, 6,7,12 they may not be representative of the population of people who sustain TBI. Given these gaps in the existing literature, our objectives were (1) to investigate rates of SI during the first year after complicated mild to severe TBI in a representative sample of adults who had been admitted to a level I trauma center and (2) to investigate whether demographic characteristics, preinjury psychiatric history, or injury-related factors predicted SI.
