Suicidality and Self-Harm Among Individuals With Traumatic Brain Injury: Risk and Protective Factors and Coping Mechanisms.

Objective: The authors examined lived experience perspectives of suicidality and nonsuicidal self-injury (NSSI) after moderate-to-severe traumatic brain injury (TBI), risk and protective factors, and methods of coping.

Methods: A record review of suicide risk assessments was completed as part of routine clinical risk management for a research study. The authors used a semistructured interview approach developed from existing clinical tools and extracted data from assessment records by using content analysis to categorize common responses.

Results: Data were extracted from records of 68 participants (mean±SD age=45.9±14.4 years; 82% male) with a history of moderate-to-severe TBI (mean=10.7±9.1 years after TBI). Most participants (86%) were currently experiencing suicidal thoughts, and 50% had experienced NSSI thoughts in their lifetime. Fifteen participants (28%) reported a lifetime suicide attempt. The most common protective factors for suicidal ideation reported by participants were support from family (59%) and the personal attributes of openness and being optimistic (49%). The most common risk factors were emotional distress or presence of a psychiatric diagnosis (62%), TBI sequelae (such as fatigue; 49%), work-related stress (43%), and lack of family support (34%). Engaging with health professionals (62%) and seeking support from family (57%) were the most common healthy coping strategies, whereas substance use (38%) and social withdrawal (32%) were the most common unhealthy coping strategies.

Conclusions: The findings of this study provide detailed insights into the lived experiences of suicidality and NSSI after moderate-to-severe TBI, how survivors conceptualize factors that may increase or attenuate risk, and common coping strategies.