Suicidality and Suicide Prevention Among War Veterans with Traumatic Brain Injury
Grahame Simpson and Robyn Tate
Liverpool Hospital, Sydney, Australia; Faculty of Medicine, University of Sydney, Australia
Suicide in the Military. Hauppauge, New York: Nova Science Publishers, 2009, 210 pages.
Traumatic brain injury (TBI) is a common injury sustained by soldiers in war, with rates ranging from 14 to 20% among wounded veterans from both 20th and 21st century conflicts. To date little is known about the frequency of lethal and nonlethal suicidal behaviours among these veterans. In the only suicide prevalence estimate to date, World War 2 veterans with TBI from Finland had a suicide rate ranging between 70-80 per 100,000, double the rate for the general Finnish population. Turning to suicide risk factors, research to date suggests that factors including sex, injury severity, post-injury psychiatric morbidity and occupational status may modulate the level of suicide risk among veterans with TBI. Suicide prevention efforts can be organised hierarchically, to focus at three levels: Universal interventions (such as suicide screening) that target all veterans with TBI; Selected interventions (such as pharmacotherapy) that target veterans in at-risk groups (e.g., depressed veterans); and Indicated interventions (such as crisis intervention) that target veterans who have displayed suicidal behaviour. The future challenge is to combine research and clinical practice efforts to reduce the overall levels of suicide.