Repetitive Traumatic Brain Injury, Psychological Symptoms, and Suicide Risk in a Clinical Sample of Deployed Military Personnel
Repetitive Traumatic Brain Injury, Psychological Symptoms, and Suicide Risk in a Clinical Sample of Deployed Military Personnel
复制标题
DOI：
10.1001/jamapsychiatry.2013.1093
复制
发表时间：
2013-07-01
期刊：
影响因子：
25.8
通讯作者：
Clemans, Tracy A.
中科院分区：
文献类型：
--
作者：
Bryan, Craig J.;Clemans, Tracy A.
重要性创伤性脑损伤(TBI)被认为是导致军人和退伍军人自杀率上升的因素之一。本研究以临床样本为研究对象，探讨累积性脑外伤与自杀风险之间的关系。目的研究是否有多次脑外伤的军人比无脑损伤或单一脑外伤的军人自杀风险更高。设计患者完成了抑郁、创伤后应激障碍(PTSD)、自杀想法和行为的标准化自我报告量表、临床访谈和体格检查。研究对象包括161名在伊拉克某军队医院颅脑损伤诊所接受评估和治疗的疑似颅脑损伤的军人。主要结果和测量包括行为健康量表抑郁量表、创伤后应激障碍检查表-军用版、脑震荡症状和自杀行为问卷-修订版。结果随着颅脑损伤次数的增加，抑郁、创伤后应激障碍和脑外伤症状严重程度显著增加。终生自杀念头或行为的发生率与脑外伤的数量有关(无脑损伤，0%；单一脑损伤，6.9%；多脑损伤，21.7%；P=0.009)，过去一年内有自杀念头(分别为0%，3.4%，12.0%；P=0.04)。在控制了抑郁、创伤后应激障碍和脑外伤症状的影响后，脑外伤的数量与更大的自杀风险相关(β[SE]=.214[.098]；P=.03)。抑郁和累积脑外伤之间的显著交互作用也被发现(Beta=.580[.283]；P=.04)。结论：即使在控制了临床症状严重程度之后，终生脑损伤越多的军人自杀风险也越高。结果表明，军事人员中常见的多发性脑外伤可能会增加自杀风险。
IMPORTANCE Traumatic brain injury (TBI) is believed to be one factor contributing to rising suicide rates among military personnel and veterans. This study investigated the association of cumulative TBIs with suicide risk in a clinical sample of deployed military personnel referred for a TBI evaluation.OBJECTIVE To determine whether suicide risk is more frequent and heightened among military personnel with multiple lifetime TBIs than among those with no TBIs or a single TBI.DESIGN Patients completed standardized self-report measures of depression, posttraumatic stress disorder (PTSD), and suicidal thoughts and behaviors; clinical interview; and physical examination. Group comparisons of symptom scores according to number of lifetime TBIs were made, and generalized regression analyses were used to determine the association of cumulative TBIs with suicide risk.PARTICIPANTS Patients included 161 military personnel referred for evaluation and treatment of suspected head injury at a military hospital's TBI clinic in Iraq.MAIN OUTCOMES AND MEASURES Behavioral Health Measure depression subscale, PTSD Checklist-Military Version, concussion symptoms, and Suicide Behaviors Questionnaire-Revised.RESULTS Depression, PTSD, and TBI symptom severity significantly increased with the number of TBIs. An increased incidence of lifetime suicidal thoughts or behaviors was associated with the number of TBIs (no TBIs, 0%; single TBI, 6.9%; and multiple TBIs, 21.7%; P = .009), as was suicidal ideation within the past year (0%, 3.4%, and 12.0%, respectively; P = .04). The number of TBIs was associated with greater suicide risk (beta [SE] = .214 [.098]; P = .03) when the effects of depression, PTSD, and TBI symptom severity were controlled for. A significant interaction between depression and cumulative TBIs was also found (beta = .580 [.283]; P = .04).CONCLUSIONS AND RELEVANCE Suicide risk is higher among military personnel with more lifetime TBIs, even after controlling for clinical symptom severity. Results suggest that multiple TBIs, which are common among military personnel, may contribute to increased risk for suicide.