A New Link Between Traumatic Brain Injury and Suicide

In this photo taken Monday, Feb. 15, 2010, U.S. Army soldiers from 1st Battalion, 30th Infantry Regiment are seen at a ceremony launching the Combined Security Force on Kirkuk, north of Baghdad, Iraq. (AP Photo/Maya Alleruzzo)

In this photo taken Monday, Feb. 15, 2010, U.S. Army soldiers from 1st Battalion, 30th Infantry Regiment are seen at a ceremony launching the Combined Security Force on Kirkuk, north of Baghdad, Iraq. (AP Photo/Maya Alleruzzo)

May 15, 2013

A new study finds for the first time that military members with multiple traumatic brain injuries are more likely to be at risk for suicide, not only in the short term, but throughout their lifetime.

The study found that often they sustained some of those head injuries earlier in life — usually while playing sports like football — the impact of which are then compounded by injuries sustained in combat.

The study was conducted by Craig Bryan, assistant professor of psychology at the University of Utah and associate director of the National Center for Veterans Studies.

Bryan studied active-duty soldiers in Iraq in 2009, gathering data about service members’ suicidal thoughts after they returned to base with traumatic brain injuries, one of the more common injuries in these recent wars. It’s being published in the medical journal JAMA Psychiatry today.

He found that one in five patients — nearly 22 percent — who experienced more than one TBI in their lifetime reported thoughts or preoccupation with suicide, compared to 6 percent of patients with only one TBI. Those with no history of TBI reported no suicidal thoughts.

The Sports Connection

The study found that those with multiple TBIs often first got hurt before they joined up.

“A lot of these guys are coming in with histories of head injuries, and a lot of times they’re sports related,” he said. “They played sports in high school, got knocked out a couple of times, and (later) joined the military.”

Some of these military members reported having had as many as six head injuries before they entered the service, he said. And he said the data also shows an estimated 20 percent of service members sustained concussions during basic training.

The implication, Bryan said, is that these earlier injuries can create a “preexisting vulnerability that gets activated” by another head injury sustained in combat. Bryan screened these military members when they came back from missions having sustained some kind of head trauma, usually in an IED attack. Some service members sustained as many as 15 traumatic brain injuries while deployed, according to his research.

Those with multiple TBIs were also at higher risk for PTSD and depression, the study found.

Craig focused only on active-duty military members and stressed that this study is too narrow to draw conclusions about any implications for other groups, including athletes. But it’s a significant new development in the study of TBI, as researchers also probe potential links to brain damage among professional football players who sustain concussions during their careers.

The Army last year teamed up with the National Football League to share research on TBI and conduct joint research projects, such as putting sensors in the helmets of both players and soldiers to detect concussions.

The Most Dangerous Injury

The Defense Department estimates that 266,810 of the 1.6 million service members who served in Iraq and Afghanistan received a traumatic brain injury between 2000 and 2012, although the military and other researchers believe many more remain undiagnosed. (A 2008 RAND Corp. study estimated the number of TBIs was far higher, at 400,000.)

The vast majority of head injuries were sustained by Army soldiers — and almost all were mild. But it turns out that might be the most dangerous kind. Bryan said his data and other studies suggest that mild head injuries tend to be more likely to lead to suicidal thoughts than more severe ones.

Researchers don’t yet know why. One theory is that it could be psychological, Bryan said. People — or the patient himself — might expect a quicker recovery from a mild concussion, and unwittingly impose more stress as a result.

“Or maybe there’s something about the milder injuries that is disrupting brain structure and functioning in ways we aren’t able to fully understand or capture yet,” he said.

The military screens all at-risk service members for concussions in dedicated centers, according to new guidance issued by the Defense Department last year. According to its protocol for handling TBI, those with mild head injuries return to the field within five days.

A spokeswoman for the department didn’t respond to an email seeking a comment.

The Military’s Suicide Problem

The Pentagon has been struggling to deal with the high rate of suicide that has plagued all five branches of the service in recent years. In 2011, 303 active-duty service members killed themselves — nearly one per day. Last year, the number reached 349.

In March, 53 members of Congress sent a letter to Defense Secretary Chuck Hagel and Eric Shinseki, the secretary of Veterans Affairs, requesting more data on the link between suicide and TBI.

Noting that suicide among service members and veterans “continue at unacceptably high levels,” the officials said that “by collecting information about the psychical injuries sustained by suicide victims, we can get a better sense of the root causes of military and veteran suicide.”

The reasons for suicide are complex and unique to each individual. Hardly any service members who killed themselves in the past few years told anyone what they were planning, according to the latest Defense Department data on suicide (pdf).

What is known is that most share a common profile. An overwhelming majority of service members who take their lives are young, white males at the enlisted rank. Most have graduated from high school but have no higher education. Most die on U.S. soil, at home or in their barracks on base, shot by their own personal firearm.

About 85 percent of service members who take their lives haven’t seen combat or even been deployed in war.

But Bryan’s study suggests that traumatic brain injury may be one factor for those in the remaining 15 percent who have been exposed to fighting.

If his research shows anything, Bryan said, it underscores the importance for the Pentagon of targeting small subgroups of service members for their personal risk factors rather than trying to find a catch-all solution to suicide.

Bryan also asked FRONTLINE to stress that although TBI can put some service members at greater risk for suicide, the data also shows that a vast majority of troops with head injuries don’t take their lives.

“Resiliency is the rule,” he said. “Most service members sustaining TBI do recover, do get better, do move on. I don’t want to induce hopelessness in people who have been blasted multiple times in the line of duty.”

Sarah Childress

Sarah Childress, Former Series Senior Editor, FRONTLINE

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