A perspectives approach to suicide after traumatic brain injury: case and review.

ABSTRACT

BACKGROUND: Suicidal behavior after traumatic brain injury (TBI) is an increasingly recognized phenomenon. Both TBI and suicide are major public health problems and leading causes of death. The interaction between both of them is complex, and understanding it requires a multifaceted approach. Epidemiologic studies have shown a markedly higher incidence of suicide in individuals with TBI as compared with the general population, but imprecise definitions of suicide and suicidality as well as sample characteristics caution conclusive interpretation. Risk factors for suicide after TBI include male gender, presence of substance abuse or psychiatric disorders, and the severity of the injury. Evaluation of a suicidal patient with previous TBI currently relies on careful clinical examination. Established assessment tools can be useful but have not all been validated in this population. Intervention strategies should stress a multidimensional approach incorporating neurologic, behavioral, psychologic, pharmacotherapeutic, and psychosocial factors. OBJECTIVE: This article serves to review the currently available literature on suicidal behavioral after TBI. METHODS: It uses a case to illustrate how one might conceptualize this complex problem. CONCLUSION: It is hoped that this review stimulates further research in an area where there are still large gaps in our knowledge of this very important problem.