Abstract

Objective

The aim of this research was to examine predictors and characterize causes of suicide death in people with traumatic brain injury (TBI) and conduct sensitivity analyses with and without people whose first diagnosis of TBI occurred within 3 days of their suicide death.

Methods

This case-control study examined suicide risk for people with TBI in eight Mental Health Research Network–affiliated healthcare systems. Sample 1 included 61 persons with TBI who died by suicide and their 75 matched controls with TBI who did not die by suicide between January 1, 2000, and December 31, 2013. Sample 2 excluded the 34 persons with TBI whose first TBI diagnosis occurred within 3 days of their suicide death and their 46 matched controls. Descriptive statistics characterized the sample stratified by cases and controls, while conditional logistic regression models estimated the adjusted odds of suicide.

Results

Over half of suicide deaths occurred within 3 days of a person’s first diagnosis of TBI in the larger sample. After excluding these persons, people with TBI were 2.84 (95% confidence interval [CI]: 2.15–2.73) times more likely to die by suicide than were people without TBI. Among those with TBI, men were 16.39 times (95% CI: 1.89–142.15) more likely to die by suicide than were women.

Conclusions

Accounting for TBI as a potential consequence of suicide attenuates the association between TBI and suicide, but a robust association persists—especially among men. Ultimately, all people with TBI should be carefully screened and monitored for suicide risk.

• HIGHLIGHTS

• People with traumatic brain injury (TBI) were at considerably elevated risk for suicide death

• Men with TBI had significantly increased risk of suicide death compared to women with TBI

• TBI timing suggests confusion of risk factors for and consequences of suicide

中文翻译：

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使用电子健康记录数据了解 TBI 作为风险因素与自杀死亡的方式

摘要

客观的

本研究的目的是检查预测因子并描述创伤性脑损伤 (TBI) 患者自杀死亡的原因，并对首次诊断为 TBI 的患者在自杀死亡后 3 天内发生的患者进行敏感性分析。

方法

这项病例对照研究调查了八个心理健康研究网络附属医疗保健系统中 TBI 患者的自杀风险。样本 1 包括 2000 年 1 月 1 日至 2013 年 1 月 1 日至 2013 年 12 月 31 日期间死于自杀的 61 名 TBI 患者及其 75 名未死于自杀的 TBI 匹配对照。样本 2 排除了 34 名首次 TBI 诊断发生在他们自杀死亡的 3 天和他们的 46 名匹配的对照组。描述性统计对按病例和对照分层的样本进行了描述，而条件逻辑回归模型估计了调整后的自杀几率。

结果

在较大样本中，超过一半的自杀死亡发生在一个人首次诊断为 TBI 后 3 天内。排除这些人后，患有 TBI 的人死于自杀的可能性是没有 TBI 的人的 2.84（95% 置信区间 [CI]：2.15–2.73）。在 TBI 患者中，男性死于自杀的可能性是女性的 16.39 倍（95% CI：1.89–142.15）。

结论

将 TBI 视为自杀的潜在后果会削弱 TBI 与自杀之间的关联，但这种关联仍然存在——尤其是在男性中。最终，所有 TBI 患者都应仔细筛查和监测自杀风险。

• 强调

• 创伤性脑损伤 (TBI) 患者自杀死亡的风险显着升高

• 与患有 TBI 的女性相比，患有 TBI 的男性自杀死亡的风险显着增加

• TBI 时间表明混淆了自杀的危险因素和后果