Faculty Bibliography

Traumatic brain injury (TBI) is associated with psychiatric illness, suicidal ideation, suicide attempts, and completed suicide. We investigated the relationship between mild TBI and other risk factors for suicidal behavior in major depressive episode. We hypothesized that mild TBI would be associated with suicidal behavior at least partly because of shared risk factors that contribute to the diathesis for suicidal acts. Depressed patients (N = 325) presenting for treatment were evaluated for psychopathology, traumatic history, and suicidal behavior. Data were analyzed using Student t -test, chi-square statistic, or Fisher exact test. A backward stepwise logistic regression model (N = 255) examined the relationship between attempter status and variables that differed in the TBI and non-TBI patients. Forty-four percent of all subjects reported mild TBI. Subjects with TBI were more likely to be male, have a history of substance abuse, have cluster B personality disorder, and be more aggressive and hostile compared with subjects without TBI. They were also more likely to be suicide attempters, although their suicidal behavior was not different from that of suicide attempters without TBI. Attempt status was mostly predicted by aggression and hostility, but not the presence of TBI. Of note, for males, a history of TBI increased the likelihood of being a suicide attempter, whereas the risk was elevated for females regardless of TBI history. Our data suggest that suicidal behavior and TBI share antecedent risk factors: hostility and aggression. Future studies may yield confirmation using a prospective design

OBJECTIVE: To examine the preinjury rates of Axis I disorders and the prospective rates within the first 6 years after traumatic brain injury (TBI). DESIGN: Cross-sectional, longitudinal, and cross-sequential. SETTING: Community-based research and training center. PARTICIPANTS: Persons (N=188) who had sustained TBI within 4 years of enrollment into the project were interviewed at either 2 and 3 assessments. Each assessment was approximately 1 year apart. Several Axis I diagnoses were analyzed to detect cross-sectional differences (by age and time postinjury) and average individual changes over the multiple measurement time points. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. RESULTS: The odds ratios changed longitudinally within each subject, indicating a decreased probability of having an Axis I diagnosis over time. There were few cross-sectional differences in age; therefore, age at the time of injury had little impact on Axis I diagnoses. Cross-sectional time since injury was not associated with more psychiatric disorders, whereas cross-sectional preinjury history of psychiatric disorders was predictive of postinjury psychiatric disorders. After controlling for cross-sectional effects, the frequencies of Axis I disorders increased in depression, anxiety, and posttraumatic stress disorders in the first assessment postinjury and declined in subsequent assessments. CONCLUSIONS: Cross-sequential analyses that control for cross-sectional and longitudinal differences produced a more complete description of psychiatric disorders after TBI