Suicidal thoughts and behaviors are a serious concern after traumatic brain injury (TBI). Research based on the Traumatic Brain Injury Model System National Database—a large database of long-term outcomes after moderate-to-severe TBI including over 1,500 patients recruited from Jefferson Moss-Magee Rehabilitation Hospital—has shown that approximately 3% of individuals report at least one suicide attempt, and over 8% report suicidal thoughts in the first five years after injury. There is an urgent need to identify the risk factors that are associated with these thoughts and behaviors, so clinicians know who needs intervention and how best to intervene.
Amanda Rabinowitz, PhD, is involved in a research project designed to meet this need. Jefferson Moss Rehabilitation Research Institute is enthusiastic to be one of the sites participating in The Leveraging Nationwide Research Infrastructure to Enrich Brain Health after TBI study, or ENRICH Brain Health for short. This multicenter study, funded by an $8 million Focused Program Award from the Department of Defense to Kristen Dams-O’Connor, PhD, of Mount Sinai, aims to understand and improve long-term cognitive and psychological health after TBI. The Institute is participating in one of the five separate projects supported by this award, designed to address a critical gap in understanding risk, resilience, and protective factors associated with cognitive and psychological outcomes among civilians and Veterans with TBI.
This project leverages existing infrastructure of the National Institute of Disability, Independent Living and Rehabilitation Research (NIDILRR)-funded longitudinal civilian and Veteran TBI Model Systems of Care—a longitudinal network tracking outcomes in both civilian and Veteran populations—to investigate factors associated with changes in cognitive function and suicidal thoughts and behaviors over time in individuals with chronic TBI. Researchers at our Institute identified Model Systems participants who had shown changes in cognitive performance or had previously endorsed high-risk suicidal ideation or a suicide attempt, and re-contacted them to collect data on modifiable risk and protective factors.
Data collection is now complete, with over 630 interviews conducted across all sites including 58 participants recruited through our Institute. Dr. Rabinowitz is currently collaborating with investigators at Mt. Sinai on a qualitative analysis examining triggers and reasons for living among participants who had previously endorsed suicidality. This work has the potential to yield rich insights into the lived experiences of individuals with TBI who have contemplated self-harm, with important implications for the development of targeted intervention and prevention strategies.
The other projects supported by the award establish a community-based advisory group and broadened recruitment efforts of Veterans with TBI for post-mortem brain donation, histopathological study of post-mortem brain tissue, and brain imaging studies to understand the network-based structural and functional alterations underlying neurobehavioral health deterioration following TBI. Collectively, these projects will contribute to the development of tools for diagnosis and treatment throughout the lives of patients with TBI.