Many patients who have suffered a traumatic brain injury (TBI) attempt to commit suicide, with many more considering taking their own lives, study findings show. The researchers, from Liverpool Hospital and the University of Sydney, Australia, say that physicians should take into account patients' previous history of suicide attempts after injuries and carefully monitor the degree of post-injury emotional and psychiatric disturbance.

A total of 172 outpatients with traumatic brain injury were screened for suicidal ideation and hopelessness using the Beck Scale for Suicide Ideation and the Beck Hopelessness Scale. The researchers also collected data on the injury type, pre-morbid and post-injury psychosocial variables, and known risk factors for suicide.

The team reports in the journal Psychosocial Medicine that a significant proportion of patients had high levels of hopelessness, at 35%, and suicide ideation (23%), while 18% made an attempt at suicide after their injury.

Many patients who made suicide attempts were also found to have emotional and psychiatric disturbance, with hopelessness the most significant association with suicide ideation.

Perhaps unsurprisingly, the team found that patients who had a high level of suicide ideation were most likely to attempt suicide.

However, neither the severity of the injury nor the presence of pre-morbid suicide risk factors affected levels of suicidal tendencies after the injury.

The team concludes: 'A closer examination is needed of the role of specific psychiatric conditions, the role of cognitive impairments in reducing an individual's coping abilities, the potential interaction between cognitive impairments and clinical factors in increasing risk of suicidal behaviour, and further study of the patterns of suicide attempts post-injury.

'The challenge is to then link the emerging findings into improved clinical management and prevention strategies.'

Psychol Med 2002; 32: 687–697

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