Multivariate Prediction of 5-year Trajectories of Suicidal Ideation and Attempts in Veterans and Service Members with TBI: A U.S. Veterans Affairs Model Systems Study

Research Objectives: To examine trajectories of suicidal ideation (SI) and attempts (SA) during the first 5 years after TBI and significant demographic and injury-related predictors among V/SMs enrolled in the Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC) TBI Model Systems Study (TBIMS).

Design: Multi-center, longitudinal observational cohort study of V/SMs enrolled in the VA/PRC TBIMS with data collected at 1, 2, and 5 years after TBI.

Setting: V/SMs with TBI who received inpatient rehabilitation at one of five PRCs.

Participants: 812 V/SMs who sustained TBI between 2008-2017 and received inpatient rehabilitation at a PRC. Participants enrolled within 14 months of injury and survived to at least the Y1 follow-up.

Interventions: N/A

Main Outcome Measures: SA history in the past year was endorsed by participants (or their proxy). SI was by assessed Patient Health Questionnaire-9, item 9 (self-report).

Results: At years 1, 2, and 5, 13.6%, 14.3%, and 13.2% reported SI, respectively; 2.5%, 2.2%, and 2.4% reported SA. Across the 5-year period, 21.7% reported any SI, and 4.8% reported any SA. Linear mixed-effects models assessing SI/SA trajectories across all years were not statistically significant for effect of time, indicating SI/SA rates were statistically constant. After controlling for other predictors, V/SMs with a violent cause of injury had 1.94 higher odds of SI over time (95% CI=1.01, 3.74). Pre-injury mental health treatment or hospitalization increased odds of SI 1.69 times (95% CI=1.08, 2.63); pre-injury history of SA increased SI likelihood over time by 2.86 times (95% CI=1.58, 5.19). V/SMs under age 30 at injury had 5.32 times more likelihood of SA over time (95% CI=1.51, 18.81) compared to the group aged ≥50 years. Finally, pre-injury mental health services or hospitalization was associated with 3.89 times greater odds of SA over time (95% CI=1.99, 7.62).

Conclusions: These findings underscore the importance of monitoring suicidality with V/SMs with TBI who were under age 30 at injury, previously engaged mental health services, had pre-injury SA, and experienced violent injuries.

Author(s) Disclosures: The views expressed in this manuscript are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. This work was prepared under Contract HT0014-22-C-0016 with DHA Contracting Office (CO-NCR) HT0014 and, therefore, is defined as U.S. Government work under Title 17 U.S.C.§101. Per Title 17 U.S.C.§105, copyright protection is not available for any work of the U.S. Government. For more information, please contact dha.TBICOEinfo@health.mil. UNCLASSIFIED