Risk Factors for Suicidal Ideation Following Mild Traumatic Brain Injury: A TRACK-TBI Study

J Head Trauma Rehabil. 2021 Jan-Feb;36(1):E30-E39. doi: 10.1097/HTR.0000000000000602.


Objective: To identify risk factors for suicidal ideation (SI) following mild traumatic brain injury (mTBI).

Setting: Eleven US level 1 trauma centers.

Participants: A total of 1158 emergency department patients with mTBI (Glasgow Coma Scale score = 13-15) enrolled in the Transforming Research and Clinical Knowledge in Traumatic Brain Injury (TRACK-TBI) study.

Design: Prospective observational study; weights-adjusted multivariable logistic regression models (n's = 727-883) estimated associations of baseline factors and post-TBI symptoms with SI at 2 weeks and 3, 6, and 12 months postinjury.

Main measures: Patient Health Questionnaire, Rivermead Post-Concussion Symptoms Questionnaire.

Results: Preinjury psychiatric history predicted SI at all follow-ups (adjusted odds ratios [AORs] = 2.26-6.33, P values <.05) and history of prior TBI predicted SI at 2 weeks (AOR = 2.36, 95% confidence interval [CI] = 1.16-4.81, P = .018), 3 months (AOR = 2.62, 95% CI = 1.33-5.16, P = .005), and 6 months postinjury (AOR = 2.54, 95% CI = 1.19-5.42, P = .016). Adjusting for these baseline factors, post-TBI symptoms were strongly associated with SI at concurrent (AORs = 1.91-2.88 per standard deviation unit increase in Rivermead Post-Concussion Symptoms Questionnaire score; P values <.0005) and subsequent follow-up visits (AORs = 1.68-2.53; P values <.005). Most of the associations between post-TBI symptoms and SI were statistically explained by co-occurring depression.

Conclusion: Screening for psychiatric and prior TBI history may help identify patients at risk for SI following mTBI. Awareness of the strong associations of post-TBI symptoms with SI may facilitate interventions to prevent suicide-related outcomes in patients with mTBI.

Trial registration: ClinicalTrials.gov NCT02119182.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Brain Concussion* / diagnosis
  • Brain Concussion* / epidemiology
  • Brain Injuries, Traumatic* / diagnosis
  • Brain Injuries, Traumatic* / epidemiology
  • Glasgow Coma Scale
  • Humans
  • Risk Factors
  • Suicidal Ideation

Associated data

  • ClinicalTrials.gov/NCT02119182