Arja Mainio
Oulu University Hospital, Oulu, Finland
War and Suicide. Hauppauge, New York: Nova Science Publishers, 2009, 306 pages.

TBI has a negative impact on somatic, cognitive and emotional/behavioral functions. To the victims and their families, psychosocial deficits and psychiatric disorders are commonly the major source of disability in their rehabilitation process. Pre-injury problems of TBI patients i.e. psychiatric disorders, pre-traumatic background in family circumstances, alcohol abuse, younger age, and lower socioeconomic status, have found to be associated with increased post-injury suicidality. TBI increases a risk for life-time psychiatric disturbances such as depression, anxiety and aggressive behavior. Aggressiveness, history of psychiatric disorder and executive dysfunction are risk factors for suicidal behavior among TBI subjects. Traumatic brain injury per se has been found to be associated with elevated suicidal behavior, i.e. suicidal ideation, suicide attempts as well as completed suicide. Previous literature indicates that there is no direct causality between TBI and suicide; the relation is more complex. The background of linking TBI to suicide has been hypothesized to be in a stress-diathesis model, or suicidality is suggested to be mediated via disinhibition and impulsivity in frontal lobe lesion. The seriousness of injury is one of the most important risk factors for suicide at all ages for males and females alike. The other risk factors are substance abuse, psychiatric morbidity and aggressiveness, temporary or permanent cognitive and behavioral impairments, long-term psychosocial consequences such as unemployment, relationship breakdown and social isolation. Studies among TBI patients have not been able to evaluate the temporally specific risk period for suicide after TBI. There are no specific guidelines available for suicide prevention in patients suffering from the post-injury consequences of TBI. General practitioners have a central role following up people with TBI in suicide prevention. An important component for suicide prevention in general is training frontline staff knowledge and skills in suicide assessment and management. The major challenge in suicide prevention is treatment of post-TBI depression. Psychiatric consultation is recommended especially for those with unsuccessful adaptation process due to TBI. Crisis intervention, problem-solving therapies, and cognitive behavior therapy (CBT) are therapies for choice in psychiatric treatment.