CoChat
Sign Up
Cited by 159Traumatic Brain Injury ResearchTraumatic Brain Injury and Neurovascular DisturbancesSuicide and Self-Harm Studies

Suicide, Fatal Injuries, and Other Causes of Premature Mortality in Patients With Traumatic Brain Injury: A 41-Year Swedish Population Study

Open access
Fazel, Seena, Wolf, Achim, Pillas, Demetris, Lichtenstein, Paul, Långström, Niklas·2014·JAMA Psychiatry
DOI 10.1001/jamapsychiatry.2013.3935PMC PMC4058552
Open this paper in CoChat — free account

Abstract

UNLABELLED: : IMPORTANCE: Longer-term mortality in individuals who have survived a traumatic brain injury (TBI) is not known. OBJECTIVES: To examine the relationship between TBI and premature mortality, particularly by external causes, and determine the role of psychiatric comorbidity. DESIGN, SETTING, AND PATIENTS: We studied all persons born in 1954 or later in Sweden who received inpatient and outpatient International Classification of Diseases-based diagnoses of TBI from 1969 to 2009 (n = 218,300). We compared mortality rates 6 months or more after TBI to general population controls matched on age and sex (n = 2,163,190) and to unaffected siblings of patients with TBI (n = 150,513). Furthermore, we specifically examined external causes of death (suicide, injury, or assault). We conducted sensitivity analyses to investigate whether mortality rates differed by sex, age at death, severity (including concussion), and different follow-up times after diagnosis. MAIN OUTCOMES AND MEASURES: Adjusted odds ratios (AORs) of premature death by external causes in patients with TBI compared with general population controls. RESULTS: Among those who survived 6 months after TBI, we found a 3-fold increased odds of mortality (AOR, 3.2; 95% CI, 3.0-3.4) compared with general population controls and an adjusted increased odds of mortality of 2.6 (95% CI, 2.3-2.8) compared with unaffected siblings. Risks of mortality from external causes were elevated, including for suicide (AOR, 3.3; 95% CI, 2.9-3.7), injuries (AOR, 4.3; 95% CI, 3.8-4.8), and assault (AOR, 3.9; 95% CI, 2.7-5.7). Among those with TBI, absolute rates of death were high in those with any psychiatric or substance abuse comorbidity (3.8% died prematurely) and those with solely substance abuse (6.2%) compared with those without comorbidity (0.5%). CONCLUSIONS AND RELEVANCE: Traumatic brain injury is associated with substantially elevated risks of premature mortality, particularly for suicide, injuries, and assaults, even after adjustment for sociodemographic and familial factors. Current clinical guidelines may need revision to reduce mortality risks beyond the first few months after injury and address high rates of psychiatric comorbidity and substance abuse.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1001/jamapsychiatry.2013.3935

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • The sibling-comparison design accounts for unobserved familial confounders shared by siblings, including half of their genes.

    “A unique feature of this study is the use of the sibling-comparison design [25]. This has been adopted in previous Swedish studies [8,16] and allows one to account for unobserved familial (e.g., genetic and environmental) confounders.”

    From Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes (2016) · cites this paper as [16]

    The Methods (Sibling Control Studies) compare patients with unaffected full siblings, and the Discussion says this partly addressed residual confounding from genetic and early environmental factors. The paper does not state that siblings share half their genes, and it cautions that other residual confounding remains; thus the claim is supported as a description of partial control, not complete accounting. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Epidemiological studies have consistently found higher rates of adverse outcomes in adults who have sustained a TBI compared to the general population.

    “Epidemiological studies have consistently found higher rates of adverse outcomes in adults who have sustained a TBI when compared to the general population [7–16].”

    From Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes (2016) · cites this paper as [16]

  • Using the National Patient Register to ascertain TBI cases allowed comprehensive information on all individuals who sought medical treatment, but will have underestimated milder forms of TBI, such as sports-related injuries.

    “We used the National Patient Register, as adopted by previous studies [8,15,16], to ascertain TBI cases. This allowed comprehensive information on all individuals who sought medical treatment for their injuries, but will have underestimated milder forms of TBI, for example of the type prevalent in sports-related injuries [53–56].”

    From Long-Term Outcomes Associated with Traumatic Brain Injury in Childhood and Adolescence: A Nationwide Swedish Cohort Study of a Wide Range of Medical and Social Outcomes (2016) · cites this paper as [16]

  • Depression, bipolar disorder, schizophrenia-spectrum disorders, substance use disorders, epilepsy, and traumatic brain injury each raise the odds of completed suicide by more than threefold.

    “Depression, bipolar disorder, schizophrenia-spectrum disorders, substance use disorders, epilepsy,13 and traumatic brain injury14 each increases the odds of completed suicide by a factor of more than 3.”

    From Suicide (2020) · cites this paper as [14]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. [40]National Institute for Health and Clinical Excellence Self-Harm: The Short-term Physical and Psychological Management of Secondary Prevention of Self-harm in Primary and Secondary Care: Clinical Guideline CG16 2004 National Institute for Health and Clinical Excellence London, England 21834185

Cited by

Sorted by citations

Related

Authors
Fazel, S., Wolf, A., Pillas, D., Lichtenstein, P., & Långström, N.
Affiliations
  • Warneford Hospital (GB)
  • University College London (GB)
  • Karolinska Institutet (SE)
ORCID
Venue
JAMA Psychiatry
Publisher
American Medical Association (AMA)
Published
2014-03-01
Volume
71
Issue
3
Pages
326
ISSN
2168-622X (ISSN-L)
DOI
10.1001/jamapsychiatry.2013.3935
PMC
PMC4058552
OpenAlex
W2013113465
Cited by
159
References
48
Citations by year
2026: 8 · 2025: 13 · 2024: 9 · 2023: 10 · 2022: 11 · 2021: 17 · 2020: 14 · 2019: 11 · 2018: 14 · 2017: 10 · 2016: 15 · 2015: 17 · 2014: 10
FWCI
13.13
Type
journal article
Language
en
Open access
Locations
  • JAMA Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
Wellcome Trust (095806)
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
Keywords
traumatic brain injury, premature mortality, suicide, fatal injuries, assault, external causes of death, psychiatric comorbidity, substance abuse, long-term survival, concussion, siblings as controls, sex differences, age at death, injury severity, mortality risk factors
MeSH terms
Adolescent, Adult, Mental Disorders, Brain Injuries, Cause of Death, Child, Female, Follow-Up Studies, Humans, Male, Middle Aged, Severity of Illness Index, Suicide, Sweden, Time Factors, Wounds and Injuries, Comorbidity, Substance-Related Disorders, Young Adult, Mortality, Premature

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review