Research Reports - Suicide, fatal injuries, and other causes of premature mortality in patients with traumatic brain injury

JAMA Psychiatry. 2014 Jan 15

Fazel S(1), Wolf A(1), Pillas D(2), Lichtenstein P(3), Långström N(3)

IMPORTANCE Longer-term mortality in individuals who have survived a traumatic
brain injury (TBI) is not known. OBJECTIVES To examine the relationship between
TBI and premature mortality, particularly by external causes, and determine the
role of psychiatric comorbidity. DESIGN, SETTING, AND PATIENTS We studied all
persons born in 1954 or later in Sweden who received inpatient and outpatient
International Classification of Diseases-based diagnoses of TBI from 1969 to 2009
(n = 218 300). We compared mortality rates 6 months or more after TBI to general
population controls matched on age and sex (n = 2 163 190) and to unaffected
siblings of patients with TBI (n = 150 513). Furthermore, we specifically
examined external causes of death (suicide, injury, or assault). We conducted
sensitivity analyses to investigate whether mortality rates differed by sex, age
at death, severity (including concussion), and different follow-up times after
diagnosis. MAIN OUTCOMES AND MEASURES Adjusted odds ratios (AORs) of premature
death by external causes in patients with TBI compared with general population
controls. RESULTS Among those who survived 6 months after TBI, we found a 3-fold
increased odds of mortality (AOR, 3.2; 95% CI, 3.0-3.4) compared with general
population controls and an adjusted increased odds of mortality of 2.6 (95% CI,
2.3-2.8) compared with unaffected siblings. Risks of mortality from external
causes were elevated, including for suicide (AOR, 3.3; 95% CI, 2.9-3.7), injuries
(AOR, 4.3; 95% CI, 3.8-4.8), and assault (AOR, 3.9; 95% CI, 2.7-5.7). Among those
with TBI, absolute rates of death were high in those with any psychiatric or
substance abuse comorbidity (3.8% died prematurely) and those with solely
substance abuse (6.2%) compared with those without comorbidity (0.5%).
CONCLUSIONS AND RELEVANCE Traumatic brain injury is associated with substantially
elevated risks of premature mortality, particularly for suicide, injuries, and
assaults, even after adjustment for sociodemographic and familial factors.
Current clinical guidelines may need revision to reduce mortality risks beyond
the first few months after injury and address high rates of psychiatric
comorbidity and substance abuse.

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