COMPLETED SUICIDE AFTER TRAUMATIC BRAIN INJURY

Suicide ideation and behaviors after traumatic brain injury (TBI) pose a dire, albeit infrequent, clinical emergency. The literature on suic ide after TBI is sparse, but that on suicide in the general population may have limited applicability. Persons with TBI frequently experienc e impairments and disabilities that introduce additional complexities to the management of suicidality in this population. The current study examines in detail the premorbid psychosocial variables, injury detai ls, and posttraumatic sequelae of eight completed suicides after TBI. The eight suicides were among 50 deaths occurring in 896 admissions to a regional brain injury rehabilitation service over a period of 18 ye ars. The most notable feature of the group was the presence of psychia tric and emotional symptomatology in most cases, superimposed on a ran ge of neuropsychological impairments. This combination imposed major l imitations on the subjects' psychosocial reintegration, and we propose that it was in this context that they were vulnerable to suicide. The article concludes with recommendations for clinical management of peo ple who exhibit suicide ideation or make suicide attempts after TBI.