Traumatic Brain Injury and Suicidal Behavior: A Review

Article type: Review Article

Authors: Wadhawan, Abhishek^{a; b} | Stiller, John W.^{a; c; d} | Potocki, Eileen^e | Okusaga, Olaoluwa^{a; f; g} | Dagdag, Aline^{a; h} | Lowry, Christopher A.^{i; j; k} | Benros, Michael E.^l | Postolache, Teodor T.^{a; k; m; *}

Affiliations: [a] Department of Psychiatry, Mood and Anxiety Program, University of Maryland School of Medicine, Baltimore, MD, USA | [b] Saint Elizabeths Hospital, Psychiatry Residency Training Program, Washington, DC, USA | [c] Saint Elizabeths Hospital, Neurology Consultation Service, Washington, DC, USA | [d] Maryland State Athletic Commission, Baltimore, MD, USA | [e] VA Maryland Healthcare System, Baltimore VA Medical Center, Baltimore, MD, USA | [f] Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA | [g] Michael E DeBakey VA Medical Center, Houston, TX, USA | [h] Department of Psychiatry, University of Maryland Medical Center, Baltimore, MD, USA | [i] Department of Integrative Physiology and Center for Neuroscience, University of Colorado Boulder, Boulder, CO, USA | [j] Department of Physical Medicine and Rehabilitation and Center for Neuroscience, University of Colorado Anschutz Medical Campus, Aurora, CO, USA | [k] Rocky Mountain Mental Illness Research Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 19, Military and Veteran Microbiome: Consortium for Research and Education (MVM-CoRE), Aurora, CO, USA | [l] Mental Health Centre Copenhagen, Copenhagen University Hospital, Copenhagen, Denmark | [m] Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Integrated Service Network (VISN) 5, VA Capitol Health Care Network, Baltimore, MD, USA

Correspondence: [*] Correspondence to: Teodor T. Postolache, MD, 685 W. Baltimore Street, MSTF Building, Suite # 930, Mood and Anxiety Program, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD 21201, USA. Tel.: +1 (410) 706-2323; E-mail: tpostola@som.umaryland.edu.

Abstract: Given the increasing rate of death by suicide in the United States, it is imperative to examine specific risk factors and to identify possible etiologies of suicidal behavior in at-risk clinical subpopulations. There is accumulating evidence to support an elevated risk of death by suicide in individuals with a history of traumatic brain injury (TBI). In this review article, after defining terms used in suicidology, we discuss the associations of TBI with death by suicide, suicide attempt, and suicidal ideation. A model for repetitive TBIs, leading to chronic traumatic encephalopathy, is also discussed as a neuroinflammatory process, with discussion about its possible link with suicide. The review concludes with an overview of interventions to prevent suicidal behavior.

Keywords: Chronic traumatic encephalopathy, death by suicide, inflammation, neuroinflammation, suicidal behavior, traumatic brain injury

DOI: 10.3233/JAD-181055

Journal: Journal of Alzheimer's Disease, vol. 68, no. 4, pp. 1339-1370, 2019