Clinical Topics   /   Oncology

Multiple TBIs, Chronic Pain Linked to Increased Risk of Military Suicides

By U.S. Medicine

By Brenda L. Mooney

SALT LAKE CITY, UT – Two new studies may offer important clues as to why suicide rates are on the increase among military personnel and veterans.

Servicemembers who suffer more than one mild traumatic brain injury (TBI) face a significantly higher risk of suicide, according to research by the National Center for Veterans Studies at the University of Utah.1

Furthermore, the effect appears to last a lifetime, according to the study, based on a survey of 161 military personnel who were stationed in Iraq and evaluated for a possible TBI. Suicide ideation was used as the indicator of suicide risk because too few of the patients had actually made suicide attempts for statistically valid conclusions to be drawn.

Another study, which looked at more than 4 million VA health records, found that chronic back pain, migraine, and psychogenic pain are all associated with greater suicide risk.2

Both reports were published online by JAMA Psychiatry.

The Utah study found that the risk of suicidal thoughts increased significantly in concert with the number of TBIs, even when taking other psychological factors into account.

“Up to now, no one has been able to say if multiple TBIs, which are common among combat veterans, are associated with higher suicide risk or not,” said lead author, Craig J. Bryan, PsyD, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies. “This study suggests they are, and it provides valuable information for professionals treating wounded combat servicemen and women to help manage the risk of suicide.”

TBI is considered a “signature injury” of the Iraq and Afghanistan conflicts, with  estimated prevalence for deployed troops ranging from 8-20%, according to DoD statistics.

Suicide rates, meanwhile, have been rising unabated. A recent VA study estimated that an average 22 veterans die by suicide every day in the United States. Earlier this year, the Army reported 325 total suicides among active and reserve troops in 2012, an increase over 283 suicides in 2011.

In this study, about 1 in 5 patients, 21.7%, who had ever sustained more than one TBI reported suicidal ideation at any time. For patients experiencing only one TBI, 6.9% reported having suicidal thoughts. None of the study subjects who had avoided a TBI reported suicide ideation, according to the researchers.

Increases were similar when the Iraq-based warriors were questioned about suicidal thoughts during the previous year, as opposed to at any time. Survey responses noted that 12% of those with multiple TBIs had entertained suicidal ideas during the past year, compared with 3.4% with one TBI and 0% for no TBIs.

“That head injury and resulting psychological effects increase the risk of suicide is not new,” Bryan suggested. “But knowing that repetitive TBIs may make patients even more vulnerable provides new insight for attending to military personnel over the long-term, particularly when they are experiencing added emotional distress in their lives.”


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