Associations of Military-Related Traumatic Brain Injury With New-Onset Mental Health Conditions and Suicide Risk.
Associations of Military-Related Traumatic Brain Injury With New-Onset Mental Health Conditions and Suicide Risk.
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DOI：
10.1001/jamanetworkopen.2023.26296
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发表时间：
2023-07-03
影响因子：
13.8
通讯作者：
Adams, Rachel Sayko
中科院分区：
文献类型：
--
作者：
Brenner, Lisa A.;Forster, Jeri E.;Gradus, Jaimie L.;Hostetter, Trisha A.;Hoffmire, Claire A.;Walsh, Colin G.;Larson, Mary Jo;Stearns-Yoder, Kelly A.;Adams, Rachel Sayko
Is military-related traumatic brain injury (TBI) associated with increased incidence of new-onset mental health conditions and suicide risk? In this cohort study including 860 892 soldiers, individuals with a history of military-identified TBI had significantly higher rates of new-onset mental health conditions than those without TBI. Increased risk for suicide was associated indirectly (through new-onset mental health diagnoses) and directly with history of TBI. These findings suggest that conceptualizing exposures (physical, psychological) as events that accumulate over an individual’s lifetime and increase risk for negative outcomes (eg, suicide) may assist in identifying mechanisms underlying frequently co-occurring conditions, as well as evidence-based interventions. This cohort study examines rates of new-onset mental health conditions among soldiers with and without a history of military-related traumatic brain injury and explores direct and indirect associations of traumatic brain injury with suicide risk. Research to identify the direct and indirect associations of military-related traumatic brain injury (TBI) with suicide has been complicated by a range of data-related challenges. To identify differences in rates of new-onset mental health conditions (ie, anxiety, mood, posttraumatic stress, adjustment, alcohol use, and substance use disorders) among soldiers with and without a history of military-related TBI and to explore the direct and indirect (through new-onset mental health disorders) associations of TBI with suicide. This retrospective cohort study used data from the Substance Use and Psychological Injury Combat Study (SUPIC) database. Demographic, military, and health data from the Department of Defense within SUPIC were compiled and linked with National Death Index records to identify deaths by suicide. Participants included US Army soldiers who returned from an Afghanistan or Iraq deployment. Data were analyzed from September to December 2022. Military-related TBI. The outcome of interest was suicide. Secondary outcomes were incidence of new-onset mental health conditions. Mediation analyses consisted of accelerated failure time (AFT) models in conjunction with the product of coefficients method. The 6 new-onset mental health diagnosis categories and the 2 or more categories variable were each considered separately as potential mediators; therefore, a total of 14 models plus the overall AFT model estimating the total effect associated with TBI in suicide risk were fit. The study included 860 892 soldiers (320 539 soldiers [37.2%] aged 18-24 at end of index deployment; 766 454 [89.0%] male), with 108 785 soldiers (12.6%) with at least 1 documented TBI on their military health record. Larger increases in mental health diagnoses were observed for all conditions from before to after documented TBI, compared with the matched dates for those without a history of TBI, with increases observed for mood (67.7% vs 37.5%) and substance use (100% vs 14.5%). Time-to-suicide direct effect estimates for soldiers with a history of TBI were similar across mediators. For example, considering new-onset adjustment disorders, time-to-suicide was 16.7% faster (deceleration factor, 0.833; 95% CI, 0.756-0.912) than for soldiers without a history of TBI. Indirect effect estimates of associations with TBI were substantial and varied across mediators. The largest indirect effect estimate was observed through the association with new-onset substance use disorder, with a time to suicide 63.8% faster (deceleration factor, 0.372; 95% CI, 0.322-0.433) for soldiers with a history of TBI. In this longitudinal cohort study of soldiers, rates of new-onset mental health conditions were higher among individuals with a history of TBI compared with those without. Moreover, risk for suicide was both directly and indirectly associated with history of TBI. These findings suggest that increased efforts are needed to conceptualize the accumulation of risk associated with multiple military-related exposures and identify evidence-based interventions that address mechanisms associated with frequently co-occurring conditions.
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DOI：
10.1097/00001648-199001000-00010
发表时间：
1990-01-01
期刊：
Epidemiology (Cambridge, Mass.)
影响因子：
--
作者：
Rothman, K J
通讯作者：
Rothman, K J
影响因子：
2.4
作者：
Adams, Rachel Sayko;Hoover, Peter;Forster, Jeri E.;Caban, Jesus;Brenner, Lisa A.
通讯作者：
Brenner, Lisa A.
DOI：
10.1097/phm.0000000000001985
发表时间：
2022-12-01
影响因子：
3
作者：
Wilder, J. Heath;Gupta, Sanchita S.;Sherman, William F.
通讯作者：
Sherman, William F.
影响因子：
17.7
作者：
Bryant, Richard A.;O'Donnell, Meaghan L.;Silove, Derrick
通讯作者：
Silove, Derrick
影响因子：
1.5
作者：
通讯作者：
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