Evaluating the Cross-Sectional and Longitudinal Relationships Predicting Suicidal Ideation Following Traumatic Brain Injury
Open accessAbstract
Objective: Characterize relationships among substance misuse, depression, employment, and suicidal ideation (SI) following moderate to severe traumatic brain injury (TBI). Design: Prospective cohort study. Setting: Inpatient rehabilitation centers with telephone follow-up; level I/II trauma centers in the United States. Participants: Individuals with moderate to severe TBI with data in both the National Trauma Data Bank and the Traumatic Brain Injury Model Systems National Database, aged 18 to 59 years, with SI data at year 1 or year 2 postinjury (N = 1377). Main Outcome Measure: Primary outcome of SI, with secondary employment, substance misuse, and depression outcomes at years 1 and 2 postinjury. Results: Cross-lagged structural equation modeling analysis showed that year 1 unemployment and substance misuse were associated with a higher prevalence of year 1 depression. Depression was associated with concurrent SI at years 1 and 2. Older adults and women had a greater likelihood of year 1 depression. More severe overall injury (injury severity score) was associated with a greater likelihood of year 1 SI, and year 1 SI was associated with a greater likelihood of year 2 SI. Conclusions: Substance misuse, unemployment, depression, and greater extracranial injury burden independently contributed to year 1 SI; in turn, year 1 SI and year 2 depression contributed to year 2 SI. Older age and female sex were associated with year 1 depression. Understanding and mitigating these risk factors are crucial for effectively managing post-TBI SI to prevent postinjury suicide.
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Those with impulsivity likely struggle with functional deficits.
“TBI predisposes individuals to functional deficits [14,15] and impulsivity [16], and those with impulsivity likely struggle with functional deficits [17].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [17]
The Discussion (page unavailable) says executive dysfunction after TBI is often characterized by impulsive behaviors, linking impulsivity to one kind of deficit. It does not establish that people with impulsivity generally struggle with broader functional deficits, such as limitations in employment or daily functioning. (LLM, conf=0.76)
Experimental — accuracy not yet measuredAmong individuals with TBI, those who were unemployed in the past year were at the highest risk for SI when compared to individuals who had been employed.
“Among individuals with TBI, those who were unemployed in the past year were at the highest risk for SI when compared to individuals who had been employed [17].”
From Frontal Pole Neuromodulation for Impulsivity and Suicidality in Veterans With Mild Traumatic Brain Injury and Common Co-Occurring Mental Health Conditions: Protocol for a Pilot Randomized Controlled Trial (2024) · cites this paper as [17]
The Results (Participant characteristics; page not provided) report that participants with suicidal ideation at year 1 were more often unemployed at year 1. The Results (Modeling results; page not provided) also associate employment with a lower likelihood of suicidal ideation at year 2. But the paper measures employment status at follow-up, not whether someone was unemployed during the past year, and it does not establish that unemployed participants had the highest risk. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Nowrangi, M. A., Kortte, K. B., & Rao, V. (2013) · Psychosomatics · doi:10.1016/j.psym.2013.11.006 · Cited by 10 · see citing works
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Self-citationA Guide to the Traumatic Brain Injury Model Systems National Database
Karpur, A. (2013) · eCommons (Cornell University) · Cited by 4 · see citing works
Assessing Suicide Ideation in Patients With Traumatic Brain Injury (TBI) by Using Depression Scales
Gosselin, N., & Perroud, N. A. (2013) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0b013e3182527138 · Cited by 4 · see citing works
Table A-1, Classification of TBI Severity
O'Neil, M. E., Carlson, K. F., Storzbach, D. M., Brenner, L. A., Freeman, M., Quiñones, A. R., Motu’apuaka, M. L., Ensley, M., & Kansagara, D. L. (2013) · Cited by 3 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
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Risbrough, V. B., Vaughn, M. N., & Friend, S. F. (2021) · Biological Psychiatry · doi:10.1016/j.biopsych.2021.11.012 · Cited by 75 · see citing works
Perrin, P. B., Klyce, D. W., Fisher, L. B., Juengst, S. B., Hammond, F. M., Gary, K. W., Niemeier, J. P., Bergquist, T. F., Bombardier, C. H., Rabinowitz, A. R., et al. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.07.790 · Cited by 14 · see citing works
Self-citationUsing Machine Learning to Examine Suicidal Ideation After Traumatic Brain Injury
Fisher, L. B., Curtiss, J. E., Klyce, D. W., Perrin, P. B., Juengst, S. B., Gary, K. W., Niemeier, J. P., Hammond, F. M., Bergquist, T. F., Wagner, A. K., et al. (2022) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000002054 · Cited by 13 · see citing works
Self-citationKlyce, D. W., Perrin, P. B., Fisher, L. B., Hammond, F. M., Juengst, S. B., Bergquist, T. F., Rabinowitz, A. R., Wagner, A. K., Bombardier, C. H., Niemeier, J. P., et al. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23282 · Cited by 12 · see citing works
Self-citationKlyce, D. W., Perrin, P. B., Ketchum, J. M., Finn, J. A., Juengst, S. B., Gary, K. W., Fisher, L. B., Pasipanodya, E., Niemeier, J. P., Vargas, T. A., et al. (2024) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000000902 · Cited by 9 · see citing works
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Boylan, L. E., Karmarkar, A. M., Malhotra, B., Kanani, C., Ketchum, J. M., Abassi, K., Agtarap, S., Martin, A. M., Dams-O’Connor, K., Walker, W. C., et al. (2025) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001070 · Cited by 3 · see citing works
Bernanke, A., Hasley, R., Sabetfakhri, N., de Wit, H., Smith, B. M., Wang, L., Brenner, L. A., Hanlon, C., Philip, N. S., Ajilore, O., et al. (2024) · JMIR Research Protocols · doi:10.2196/58206 · Cited by 2 · see citing works
Sharma, B., Monteiro, L., Changoor, A. T., Colella, B., & Green, R. (2025) · Annals of Neurology · doi:10.1002/ana.27279 · Cited by 2 · see citing works
Psychological and cognitive correlates of suicidal ideation following traumatic brain injury
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Prevalence of depression and suicidal ideation in trauma patients in western Rajasthan
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WITHDRAWNPreprint
(2025) · doi:10.31234/osf.io/48p6b_v2
Psychological and Cognitive Correlates of Suicidal Ideation Following Traumatic Brain InjuryPreprint
Carmichael, J. J., Samiotis, A., Andrews, K., Carminati, J.-Y. J., Johnston, L., Spitz, G., Gould, K. R., & Ponsford, J. L. (2025) · doi:10.31234/osf.io/48p6b_v3
Malhotra, B., Arango‐Lasprilla, J. C., Agtarap, S., Klyce, D. W., Starosta, A. J., Chapman, O., Chung, J. S., Venkatesan, U. M., Dini, M. E., Xia, B., et al. (2026) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0000000000001178
Lall, S., de Souza, N. L., Watson, E. M., Klyce, D. W., Brenner, L. A., Power, M. C., Dams-O’Connor, K., & Kumar, R. G. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.122348
Self-citation
- Authors
- Awan, N., DiSanto, D., Juengst, S. B., Kumar, R. G., Bertisch, H., Niemeier, J., Fann, J. R., Kesinger, M. R., Sperry, J., & Wagner, A. K.
- Affiliations
- University of Pittsburgh (US)
- ORCID
- Venue
- Journal of Head Trauma Rehabilitation
- Published
- 2020-07-27
- Volume
- 36
- Issue
- 1
- Pages
- E18-E29
- ISSN
- 0885-9701 (ISSN-L)
- PMC
- PMC10280901
- OpenAlex
- W3048338611
- Cited by
- 18
- References
- 92
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 2 · 2023: 2 · 2022: 3 · 2021: 4
- FWCI
- 1.61
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Head Trauma Rehabilitation (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (TL1 TR0001858, HD065702, TL1TR001858)
- National Center for Advancing Translational Sciences
- National Institute on Disability, Independent Living, and Rehabilitation Research
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD065702, R21HD089075, P2CHD065702)
- Topics
- Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- suicidal ideation, traumatic brain injury, substance abuse, depression, unemployment, employment, injury severity, extracranial injuries, risk factors, sex differences, age differences
- MeSH terms
- Brain Injuries, Traumatic, Aged, Cross-Sectional Studies, Employment, Female, Humans, Prospective Studies, United States, Suicidal Ideation
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 ›
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