A new article published this month in the Journal of Affective Disorders extends a growing body of research examining the link between traumatic brain injury (TBI) and suicide. The researchers, Hsuan-Kan Chang of the Department of Psychiatry at Taipei Veterans General Hospital and a team of his colleagues in Taiwan, set out to determine the extent to which the effects of childhood TBI were related to suicide risk in later life.
The team identified risks among young adults with TBI comparable to those found in adults with early histories of TBI, indicating more immediate effects than previously realized. Additionally, they teased out risk factors associated with increased risk of attempted suicide, including TBI severity, repetitive injury, female sex, young age at injury, and certain psychiatric comorbidities.
“To our knowledge, no peer-reviewed journal has published a large cohort study to evaluate the risk of attempted suicide for adolescents and young adults who have experienced TBI,” the authors write. “Therefore, our study also investigated the influences of injury severity, repetitive injury, and comorbid psychiatric conditions on attempted suicide among adolescents and young adults.”
Suicide is the number one cause of death among individuals in the 25-44 age bracket in the US. According to the National Institute of Mental Health, it is the second leading cause of death among individuals 10-34. Past research has revealed factors associated with a heightened risk of attempts among youth and young adults, including exposure to adversity, antidepressant use, history of psychiatric hospitalization, and more. Many additional features have been implicated in the increase in depression and mood disorders among youth.
Recent years have seen an increase in attention to TBI and football. This has perhaps distracted from the many other potential sources for TBI with a lack of appropriate access to response and support (e.g., falls, household accidents, other sports, etc.). Whatever the cause, severe or frequent TBI in childhood has been associated with compromised school performance, social functioning, and cognitive ability among youth that can extend into adulthood.
One study found that individuals who have experienced childhood TBI are 2.5 times more likely to be incarcerated as adults than those without. The body of work exploring TBI is growing parallel to that of suicide risk among youth, and there may be significant overlaps between both worlds.
“In the United States, TBI accounts for approximately 840,000 hospital and emergency department visits annually in patients younger than 25 years. Overall prevalence can reach as high as nearly 30% for individuals between 0 and 25 years of age. Although 70%–90% of the TBIs in the present study were classified as mild injury or concussion, a typical TBI has long-lasting consequences.”
The latest research represents a longitudinal record follow-up study featuring data from “the National Health Insurance Research Database (NHIRD), a database of insurance claims consisting of healthcare data from >99% of the population of Taiwan.” Their large, exclusively Taiwanese sample included adolescents and young adults with TBI (n = 31,599) and a random comparison group without a history of prior exposure (n = 126,396).
Inclusion criteria for those with TBI required “no history of suicide attempts before enrollment, […] and diagnoses of TBI from board-certificated surgeons, internal medicine physicians, pediatricians, or emergency medicine physicians on the basis of either their clinical judgment or brain imaging assessment between January 1, 1998, and December 31, 2008.”
The researchers found that “the incidence of attempted suicide markedly increased following TBI events in adolescents and young adults.”
“Severe TBI, female sex, adolescent status, and repeated TBI events were associated with higher risks of attempted suicide compared respectively with milder TBI, male sex, young adult status, and a single TBI event.”
Although Chang and colleagues’ work offers a great deal to consider and explore, one particularly important takeaway is the 4.6% incidence of attempted suicide among those who had experienced TBI compared to 1% of those who had not.
In addition to the many recognized factors contributing to increasing rates of mood disorders, depression, and suicide rates among youth, an appreciation for the link between TBI and suicide risk may clarify more targeted opportunities for prevention and support, and reduction of unsuitable treatment attempts.
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Chang, H., Hsu, J., Wu, J., Huang, K., Chang, H., Bai, Y., . . . Chen, M., (2019). Risk of attempted suicide among adolescents and young adults with traumatic brain injury: A nationwide longitudinal study. Journal of Affective Disorders, 250, 21-25. (Link)
This the study of TBI, should be a standard course in the first year medical and other medical field related professions.
There is neuroplascity but the underlying history of traumatic brain injury has been completely ignored by Psychiatry.
Sports, car accidents, falls, all could possibly make one have issues that could be easily misinterpreted as so called crazy. Add to that ECT is TBI in reverse. Go figure that one out.
The crux is psychiatry has missed multiple balls on multiple levels throughout its history but since the advent of Big Pharma it has lost its center- though I know some here would say it never had a moral core.
I still say despite my own patient malpractice since I worked in the field beforehand there were some who had a caring core and some may still be around.
The question how to handle the human being either in distress and or living in a state that is on or beyond the cultural borders. So far we as a species have failed except for those eras when there were better cultural supports and even in more open indeginious cultures there were and are issues.
Back to the drawing board for all healthcare.
So, the FDA’s immoral, ignorant, and insane “final rule” on ECT, allowing for the shocking of children as young as 13, causing repeated TBI’s is really really brilliant and should help to increase suicide attempts and completions.
That’s an astute observation. For what is ECT but intentional, repeated TBIs?
Years from now, will a researcher look back at data about people subjected to electroshock as children and find increased suicide rates in these people? By then it will be too late to do anything about it.
“will a researcher look back at data about people subjected to electroshock as children and find increased suicide rates in these people?” I would find it shocking if the answer would not be yes, electroshocking children will most likely cause those children to want to kill themselves. Electroshocking children is a really bad idea!
There are probably other things which could be done to decrease the suicide risk and overall increase quality of life, and for everyone.
Studies seem to show that cannabis can help reduce the brain inflammation that typically results from a TBI. But of-course, that’s a taboo subject. Children with epilepsy seem also to benefit from a low THC strain of cannabis. Epilepsy is recurring brain injury.
I don’t doubt the TBI could have a direct effect on suicide. The context of a TBI includes before and after factors.
Before: Ideally, a child does not experience TBI. What went wrong in the lives of children whose brains are injured? Any relation to suicide rates? (Was the child on drugs for ADHD, ‘bipolar disorder’, etc, which affect blood pressure, sleep and alertness, and have their own separate roles in suicide rates?)
After: What happens when a child has a TBI? Is treatment uniformly helpful? Are the parents adversely affected by financial or legal problems in the aftermath?
Glad to see you’re pointing out that psychiatric treatment itself, particularly hospitalization, and with the antidepressants, increases suicides in children. And glad to see you’re also mentioning that environmental factors, like ACEs, can cause suicides as well.
“All distress is caused by chemical imbalances inside people’s brains,” was an insane belief system. And lying to people, claiming your made up disorders are “lifelong, incurable, genetic” diseases, takes hope from people, so you should stop spewing such lies to people.
I would imagine another additional feature, which could be causing “the increase in depression and mood disorders among youth,” is the mere existence of the “mental health” workers being in the schools, working to reel as many innocent children into the “mental health” system, as they possibly can. And we must not forget that completely iatrogenic “childhood bipolar epidemic” societal problem.
I think we should get the “mental health” workers out of the schools, since their entire DSM “bible” belief system was declared to be “invalid” and “unreliable” six years ago. And, rather than taking this disclaimer out of the DSM5, the ADHD drugs should be added to it, and it should be put back in the DSM5.
“Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”
Doing these things would very likely greatly decrease the prevalence of “depression and mood disorders among youth.” And I will say, my experience with “mental health” workers is they are obsessed with suicides. Maybe our “mental health” workers should stop being so OCD about suicides? Learn to live and let live instead, especially when it comes to our children.
On the website of the International Public Movement, ALLATRA saw a video https://allatra.tv/en/video/game-of-professionals-what-is-consciousness-film-1 where an international group of psychologists discusses precisely the causes of depression and obsessive suicidal states, tells what it is, in simple, not professional language, where they think how to resist them and how to cure them. . After all, any human being can be attacked like this, and even they admit that psychology academics have thoughts like maniacs … This is what really helps to understand everything not only to specialists, but also to us simple people of completely different professions.
As a brain injury survivor, I find this article deeply disturbing.
Because most blows are to the head and face, abused women sustain more brain injuries than NFL football players, yet there are no class action law suits or brain banks investigating the CTE and debilitating life long injuries we sustain. In fact most women have NO access into court to address the torts against us that the accused criminals who destroy our lives enjoy.
Assuming ER “drs” bother to dx our head trauma, what typically happens is that women and children fleeing abuse are tossed into the shelter system that by design is part of the toxic “mental health” system. Against the CPA recommendations and standards of practice for “family violence” victims of abuse are typically labeled and shelters are little more than drug dispensing factories dolling out drugs to ensure abuse victims never think or feel anything about what happened to them, but that they silently goose step in line and become fodder for shrinks and counselors who earn a living off the 1 in 3 abused women stupid enough to think the system is here to help them.
Further to that 50 to 80% of all homeless persons, those in and out of psych wards and in and out of prison, have histories of diagnosed and un-diagnosed head injuries.
Even neurologists and others who SHOULD KNOW better, are fraudulently diagnosing the NORMAL sequelae
(symptoms and progression of brain injury) as if they were SPECIOUS “Mental illness” in order to justify drugging vulnerable survivors with psych drugs known for over 40 years to CAUSE Brain injury. This is sheer stupidity, across the board medical malpractice and blatant insurance fraud.
Brain injury is NOT an event, its a PROCESS wherein damage can occur for up to 2 years.
The ignorance is so astounding, it’s no wonder we are being experimented on, profited off of, killed and self death at such high rates.