Multiple Traumatic Brain Injuries: Link to Suicidal Thoughts?
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Psychological Impacts of Multiple Brain Injuries

June 10, 2013

BY: Justin Boyle

Suicide has outpaced heart disease, cancer, traffic accidents and all other forms of death for U.S. soldiers since 2010. As the second-most common cause of death in the armed services, it ranks not far behind number one -- combat. In 2011, 20 percent of military deaths occurred by suicide.

A new study of military personnel links multiple brain injuries and thoughts of suicide. In May 2013, University of Utah researchers released the findings of a six-month field study on traumatic brain injuries and suicidal thoughts, conducted at an Iraqi combat hospital. The study, published in JAMA Psychiatry, looked at 161 servicemembers, mostly male subjects with an average age of 27 and 6.5 years of service. Each had suffered at least one possible traumatic brain injury.

Patients were screened for internal head injuries and divided into three groups -- those who had suffered a single brain trauma event, those who had suffered multiple traumas and those who had escaped serious brain injury. Patients in each group were then surveyed about their suicidal thoughts, symptoms of depression, concussions and possible post-traumatic stress syndrome.

While head trauma can range from extreme to moderate to mild, most of the cases evaluated in this study fell at the mild end of the spectrum. Causes can vary -- traumatic brain injury is usually caused by a blunt impact or sudden jolt to the head, but it can also result from penetration of the skull by a foreign object.

Craig Bryan, the study's lead author and associate director of the National Center for Veterans Studies at the University of Utah, said his team went the extra mile to situate themselves on the ground in Iraq, which helped them to collect data first-hand regarding brain injuries and active military personnel. The combat hospital location allowed the team to begin gathering data almost immediately after the traumatic impacts were experienced, in most cases within two days.

Single vs. multiple brain traumas

One in five patients who had suffered two or more traumatic brain injuries indicated that they had experienced suicidal thoughts or preoccupation with self-harm at least once in their past, according to Bryan's team. This contrasted with 6.9 percent (about one in 15) among patients who had suffered a single brain trauma.

The difference between the groups persisted when subjects were asked about suicidal thoughts from the past year. For those who had sustained multiple brain injuries, about 12 percent of their group, or about one in eight, reported suicidal thoughts in the preceding year. The group who had experienced just one brain injury, however, showed a rate of 3.4 percent -- about one in 29. And for those with no brain injuries, there were no reports of suicidal thinking.

Implications of the research

The survey did not discuss whether or not servicemembers had spent time in professional counseling. The study also suggested that multiple experiences of head trauma were associated with a sizeable increase in symptoms of depression. The potency of the symptoms of concussion seemed to rise as the number of brain injuries increased, and subjects with multiple brain injuries reported a higher rate and intensity of thoughts and feelings typically associated with post-traumatic stress disorder (PTSD) as well.

According to Craig Bryan, who is also an assistant professor of psychology at the university, other researchers have studied head injuries and psychological effects augmenting the risk of suicide. However, a study showed the association between an individual's risk factor for suicide and the repeated occurrence of brain trauma. The study does not offer conclusive evidence of a causal relationship, and the team hopes to perform more extensive research. Bryan believes this data on recurring traumatic brain injury and vulnerability to suicidal thoughts and behaviors may provide valuable insight into long-term care practices for military personnel abroad as well as on the home front.


Multiple Head Injuries Raise Soldiers' Suicide Risk, Study Finds, HealthDay, Mary Elizabeth Dallas, May 15, 2013,

Repeat Brain Injury Raises Soldiers' Suicide Risk, University of Utah News, May 15, 2013,

Suicides No. 2 cause of death in military, USA Today, Gregg Zoroya, June 14, 2012,