BACKGROUND: Traumatic brain injury (TBI) and suicidal behavior lead to serious morbidity and premature mortality. TBI in adulthood is associated with a higher incidence of suicide, but the risk in adolescents and young adults is not clear.METHODS: Longitudinal follow-up data were extracted from a National Health Insurance Research Database. Adolescents and young adults (12-29 years old) with and without TBI (1:4) were included, and the incidences of following attempted suicide were analyzed. The association of TBI severity, repeated TBI, and comorbid psychiatric disorders with attempted suicide were also investigated.RESULTS: Overall, 31,599 and 126,396 subjects were enrolled in the TBI and control cohorts, respectively. The overall incidence of attempted suicide was significantly higher in the TBI cohort than in the control cohort (4.6% versus 1.0%, P < 0.001). The age at first suicide attempt was also lower in the TBI cohort (25.71 ± 5.25 versus 28.99 ± 5.26 years, P < 0.001). After adjusting for confounding factors, severe TBI, repeated TBI, female, younger age at TBI, and comorbid psychiatric conditions (unipolar depression, bipolar disorder, alcohol and substance use disorders) were associated with higher risks of attempted suicide. Long-term cumulative risks of attempted suicide were significantly elevated in the TBI cohort (P < 0.001).LIMITATION: Access to individual's detailed medical record was not available.CONCLUSION: TBI is associated with an elevated risk of attempted suicide in adolescents and young adults. TBI severity, repetitive injury, female, younger age at injury, and certain psychiatric comorbidities are independent risk factors.
Adolescent Adult