Traumatic Brain Injury, Chronic Pain, and Associations With Suicidal Thoughts and Behaviors: A Traumatic Brain Injury Model Systems Study.

Objective: This study examined the association that chronic pain (CP) has with suicidal ideation (SI) and suicide attempt (SA) among individuals with moderate-to-severe traumatic brain injury (TBI).

Setting: Participants who completed inpatient rehabilitation at a TBI Model Systems (TBIMS) center.

Participants: In total, 2579 English-speaking participants within 10 years of moderate-to-severe TBI who completed the CP Survey at TBIMS follow-up.

Design: A multisite, cross-sectional observational cohort study.

Main outcomes and measures: Suicidal ideation and SA; experience with CP; demographic variables, injury characteristics, behavioral health, and functional characteristics.

Results: At follow-up assessment, 45.2% endorsed current CP, 14.5% reported a history of CP after TBI that had resolved, and 40.3% reported no CP since the onset of TBI. There were significant differences in prevalence of SI (P < .001) and SA (P = .018) among the pain groups, with the highest prevalence observed within the current CP group (14.8% and 2.6%, respectively). Adjusting for other covariates, multivariate logistic regression models indicated a significantly higher likelihood of SI for the current CP versus no CP group (OR = 2.05, 95% CI = 1.38, 3.06). No significant association was found between the pain groups and SA. Clinical elevated symptoms of posttraumatic stress at follow-up were associated with both SI (OR = 3.87, 95% CI = 2.76, 5.44) and SA (OR = 2.43; 95% CI = 1.25, 4.75). Those with TBI caused by violence or falls had a lower risk of SI compared to those with a vehicular-related cause of TBI. Increased SI risk was also associated with lower functional independence and participation in preinjury mental health services; risk of SA was associated with Hispanic ethnicity.

Conclusions: The current study supports further investigation on how CP and its specific attributes may influence suicide-related outcomes. These findings warrant consideration of strategies to proactively assess suicide risk and the potential development of interventions targeting suicidal behavior among individuals experiencing both CP and TBI.