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Abstract
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The association of deployment-acquired Traumatic Brain Injury (TBI) and suicide risk remains an important clinical and research area. There remains little known about the brain and psychological mechanisms that may be related to such risk. Perhaps, the association of TBI is through, or related to, the often-present Posttraumatic Stress Disorder (PTSD) and other psychiatric illness. In addition, what may protect from suicide risk associated with TBI? Do social support and "resilience"--a complex concept--operate as protective mechanisms as they do in those without TBI? The answers from this well-done and well-written study from the Marine Resiliency Study: Yes, maybe, and no/yes. And then how would one use such findings?
Let us walk through some of the highlights of this prospective, 1 week before deployment and 3 months post-deployment, study of risk factors for suicide ideation (SI). In this group of Navy and Marine enlisted service members from four infantry battalions deployed to Iraq and Afghanistan (2008-2012), about 7% reported SI in the 2 weeks before deployment and about 4% at 3 months post-deployment (of these nearly 69% were new onset). Of note, this 2-week rate is in the same ballpark as findings based on Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) data in which the 30-day prevalence of suicidality (SI, plans, or attempts) was 2.9% at 3 months post-deployment and 5.7% at 9 months post-deployment.1 The high proportion of SI that is new onset requires study in itself, as its new onset may both increase risk and indicate it is treatable.
Those who reported post-deployment SI did not differ from those who did not on demographics (e.g., rank, race, and prior deployments). Of note, slightly more than half of those who reported SI post-deployment had TBI before deployment; about the same as those who did not report post-deployment SI. Thus, before deployment, there was not an association of SI with preexisting TBI. Many explanations are possible for this, including that it is true, or that those with TBI-associated SI were more likely to have been discharged or not selected for deployment.
Combat exposure during the deployment was not associated with post-deployment SI. However...
Language: en |