TY - JOUR
T1 - Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation following Traumatic Brain Injury
AU - Awan, Nabil
AU - DIsanto, Dominic
AU - Juengst, Shannon B.
AU - Kumar, Raj G.
AU - Bertisch, Hilary
AU - Niemeier, Janet
AU - Fann, Jesse R.
AU - Kesinger, Matthew R.
AU - Sperry, Jason
AU - Wagner, Amy K.
N1 - Funding Information:
Work for this manuscript was supported by the National Institutes of Health TL1 TR0001858, R21 HD 089075-01, and NIH P2C HD065702 NIH Center for Large Data Research and Data Sharing in Rehabilitation. The National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) supported the collection of original data for this manuscript.
Funding Information:
The contents of this manuscript were developed under NIDILRR Grants 90DP0031, 90DP0041, 90DPTB0013-01-00, 90DP0044-01, 90DPTB0011-01-00, 90DP0037, and with postdoctoral fellow support by NIDILRR Grant 90AR5025. Additional support was received from VA Central Office VA TBI Model System Program of Research, and Subcontract from General Dynamics Health Solutions grant number W91YTZ-13-C-0015, and from the Defense and Veterans Brain Injury Center, U.S. Department of Veterans Affairs Health Services Research and Development COIN grant number 1 I50 HX001233-01.
Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/1
Y1 - 2021/1
N2 - Objective: Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. Participants: Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). Main Outcome Measure: Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. Results: Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. Conclusions: Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
AB - Objective: Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. Participants: Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). Main Outcome Measure: Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. Results: Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. Conclusions: Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
KW - depression
KW - employment
KW - substance misuse
KW - suicide
KW - traumatic brain injury
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U2 - 10.1097/HTR.0000000000000588
DO - 10.1097/HTR.0000000000000588
M3 - Article
C2 - 32769828
AN - SCOPUS:85098699594
SN - 0885-9701
VL - 36
SP - E18-E29
JO - Journal of Head Trauma Rehabilitation
JF - Journal of Head Trauma Rehabilitation
IS - 1
ER -