People with traumatic brain injury (TBI) have an increased risk of suicide, suicide attempts and suicide ideation compared with the general population.
Most suicide deaths and attempts involve self-poisoning.
General practitioners are strategically placed to make a significant contribution to preventing suicide in this group.
Assessment approaches need to take into account the chronic nature of suicide risk in people with TBI. The assessment of post-TBI depression is complicated by the confounding effect of post-TBI motor–sensory and cognitive impairments, but psychological symptoms (feelings of hopelessness, worthlessness, and anhedonia, in particular) suggest the diagnosis of depression after TBI.
Management includes close attention to how medications are prescribed, dispensed and administered. Family and community brain injury agencies can be enlisted to provide emotional support and monitoring of people with TBI.
GPs can facilitate access to needed mental health services for people with TBI during times of suicidal crisis.
Clinical practice guidelines for the care of people living with traumatic brain injury in the community, recently published for general practice, may be of use in managing people with TBI (http://www.maa.nsw.gov.au/default.aspx?MenuID=188).
- 1. Anstey K, Butterworth P, Jorm AF, et al. A population survey found an association between self-reports of traumatic brain injury and increased psychiatric symptoms. J Clin Epidemiol 2004; 57: 1202-1209.
- 2. Fortune N, Wen X. The definition, incidence and prevalence of acquired brain injury in Australia. Canberra: Australian Institute of Health and Welfare, 1999. (AIHW Cat. No. DIS15.) http://www.aihw.gov.au/publications/index.cfm/title/4980 (accessed Jun 2007).
- 3. Trevena L, Cameron ID, Porwal M. Clinical practice guidelines for the care of people living with traumatic brain injury in the community: full report. Sydney: University of Sydney, 2004. http://www.maa.nsw.gov.au/default.aspx?MenuID=188 (accessed Jun 2007).
- 4. Khan F, Baguley IJ, Cameron ID. Rehabilitation after traumatic brain injury. Med J Aust 2003; 178: 290-295. <MJA full text>
- 5. Teasdale TW, Engberg AW. Suicide after traumatic brain injury: a population study. J Neurol Neurosurg Psychiatry 2001; 71: 436-440.
- 6. Silver JM, Kramer R, Greenwald S, Weissman M. The association between head injuries and psychiatric disorders: findings from the New Haven NIMH Epidemiologic Catchment Area Study. Brain Inj 2001; 15: 935-945.
- 7. Simpson GK, Tate RL. Suicidality after traumatic brain injury: demographic, injury and clinical correlates. Psychol Med 2002; 32: 687-697.
- 8. Tate RL, Simpson GK, Flanagan S, Coffey M. Completed suicide after traumatic brain injury. J Head Trauma Rehabil 1997; 12: 16-28.
- 9. Achte KA, Lonnquist J, Hillbom E. Suicide following war brain injuries. Acta Psychiatr Scand 1971; 225 (Suppl): 1-94.
- 10. Simpson GK, Tate RL. Clinical features of suicide attempts after traumatic brain injury. J Nerv Ment Dis 2005; 193: 680-685.
- 11. Hibbard MR, Uysal S, Sliwinski M, Gordon WA. Undiagnosed health issues in individuals with traumatic brain injury living in the community. J Head Trauma Rehabil 1998; 13: 47-57.
- 12. Seel RT, Kreutzer JS, Rosenthal M, et al. Depression after traumatic brain injury: a National Institute on Disability and Rehabilitation Research Model Systems multicenter investigation. Arch Phys Med Rehabil 2003; 84: 177-184.
- 13. Seel RT, Kreutzer JS. Depression assessment after traumatic brain injury: an empirically based classification method. Arch Phys Med Rehabil 2003; 84: 1621-1628.
- 14. Hodgkinson A, Veerabangsa A, Drane D, McCluskey A. Service utilization following traumatic brain injury. J Head Trauma Rehabil 2000; 15: 1208-1226.
- 15. Beautrais AL. National strategies for the reduction and prevention of suicide. Crisis 2005; 26: 1-3.
- 16. Commonwealth Department of Health and Aged Care. LIFE: a framework for prevention of suicide and self-harm in Australia. Learnings about suicide. Canberra: Publications Production Unit, Commonwealth of Australia, 2000.
- 17. McKelvey RS, Pfaff JJ, Acres JG. The relationship between chief complaints, psychological distress and suicide ideation in 15–24-year-old patients presenting to general practitioners. Med J Aust 2001; 175: 550-552.
- 18. Haste F, Charlton F, Jenkins R. Potential for suicide prevention in primary care? An analysis of factors associated with suicide. Br J Gen Pract 1998; 48: 1759-1763.
- 19. Folstein MF, Folstein SE, McHugh PR. Mini-mental state. J Psychiatr Res 1975; 12: 189- 198.
- 20. Simpson GK. Suicide prevention after traumatic brain injury: a resource manual. Sydney: Brain Injury Rehabilitation Unit, South Western Sydney Area Health Service, 2001.
- 21. Mrazek PJ, Haggerty RJ, editors; Committee on Prevention of Mental Disorders, Institute of Medicine. Reducing risks of mental disorders: frontiers of intervention research. Washington, DC: National Academy Press, 1994.
- 22. Gunnell D, Frankel S. Prevention of suicide: aspirations and evidence. BMJ 1994; 308: 1227-1230.
- 23. Kuipers P, Lancaster A. Developing a suicide prevention strategy based on the perspective of people with brain injuries. J Head Trauma Rehabil 2000; 15: 1275-1284.
- 24. Williams WH. Neuro-rehabilitation and cognitive therapy for emotional disorders in acquired brain injury. In: Wilson BA, editor. Neuropsychological rehabilitation: theory and practice. Lisse, The Netherlands: Swets & Zeitlinger, 2003: 115-136.
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