Group trends in posttraumatic stress disorder and suicidal ideation over the 10 years after traumatic brain injury among veterans/service members: A VA model systems study

Abstract

Abstract Objective To identify group‐based patterns in suicidal ideation (SI) and posttraumatic stress disorder (PTSD) symptoms over the first 10 years after traumatic brain injury (TBI) among Veterans and Service Members (V/SMs). Setting V/SMs enrolled in the Department of Veterans Affairs (VA) Polytrauma Rehabilitation Center (PRC) TBI Model Systems study who received inpatient rehabilitation at one of the VA's five PRCs. Participants A sample of 1057 V/SMs with TBI who completed at least one Patient Health Questionnaire‐9 (PHQ‐9) item 9 (assessing suicidal ideation) and at least one PTSD Checklist‐Civilian Version (PCL‐C) at follow‐up over the 10‐year interval. Design A k‐means cluster analysis was conducted to determine group‐based patterns of covarying PTSD and SI, and demographics, injury characteristics, and prior suicide attempt were compared with analyses of variance and chi‐squares. Main Outcomes and Measures Past 2‐week SI was assessed using PHQ‐9 item 9, and PTSD symptoms in the past month were assessed using PCL‐C. Results Three group‐based patterns emerged: low PTSD‐low SI (Cluster 1); high PTSD‐low SI (Cluster 2); and high PTSD and SI (Cluster 3). The low PTSD‐low SI group comprised 62.2% of the sample and had the lowest functional independence at discharge and higher education. The high PTSD‐low SI included the most married V/SMs preinjury. The highest risk group of V/SMs with both high PTSD and SI exhibited greater preinjury mental health vulnerabilities, including a higher proportion of preinjury and past‐year suicide attempts which persisted at 2‐, 5‐, and 10‐year follow‐ups. This cluster also had a greater history of combat deployments and a higher representation of V/SMs identifying as Asian. Conclusions Findings emphasize that PTSD plays a central role in the association with SI among V/SMs with TBI, highlighting the critical need of comprehensive mental health and suicide risk evaluation and treatment through chronic recovery after TBI.