Living with suicidality following traumatic brain injury: a qualitative study

The impact of different neurobehavioral symptoms on suicidal ideation and perceived likelihood of future suicidality

Existing literature suggests that psychological and functional impairment, independent of head injury severity, can increase suicide risk. This study explores the impacts of self-perceived dysfunction within four neurobehavioral symptom clusters-vestibular (e.g., dizziness, balance), somatosensory (e.g., headaches, nausea, vision), affective (e.g., anxious, irritable mood), and cognitive (e.g., concentration, memory, indecision)-on current suicidal ideation and the perceived likelihood of future suicidal ideation and attempts. Community participants (n = 309; Mage = 36.88; 51.6% female; 79.6% White) completed the Neurobehavioral Symptom Inventory (NSI) and the Self-Injurious Thoughts and Behaviors-Short Form (SITBI-SF). Quantile regression analysis was used to explore the effects of the four neurobehavioral symptom clusters at different levels of suicidal ideation intensity, perceived likelihood of future suicidal ideation, and self-perceived likelihood of future suicide attempt. Controlling for past head injuries and suicide attempts, affective symptoms were significantly associated with a moderate and high average intensity of current suicidal ideation. Somatosensory symptoms were significantly associated with a moderate perceived likelihood of future suicidal ideation. Finally, vestibular symptoms were significantly associated with a moderate perceived likelihood of a future suicide attempt. These findings highlight the critical need to consider a broader spectrum of symptoms, including chronic physical symptoms, when assessing suicide risk. Furthermore, they underscore the need to expand beyond affective symptoms as an explanation for increased suicidality and examine additional mechanisms through which chronic physical symptoms can increase suicide risk.

The role of spirituality and identity formation in personal recovery from traumatic brain injury: A qualitative analysis through the personal experiences of survivors

Traumatic brain injury (TBI) is a type of acquired brain injury (ABI) that happens when a sudden, external, physical assault damages the brain. TBI can cause long-term cognitive impairments and other lifestyle changes that may affect psychological wellbeing. Among the psychological challenges people recovering from TBI often face is the subjective loss of their pre-injury identity. Quantitative and qualitative research suggests that spirituality can play a positive role in recovery from TBI, increasing the quality of life and overall mental health. However, thus far, the research into this topic has not directly addressed the relationship between identity and spirituality after TBI. The present study sought to do this by thematically analyzing 22 public podcasts featuring interviews of people recovering from TBI telling their stories. The authors review the spiritual themes discussed in the podcasts and then propose a hypothesis about how, through a sense of connection to something self-transcendent, spirituality may enable people to test new meanings and identities, relatively free from the consequences of discrepancy in meaning and identity after TBI.

Self-Perception of Cognitive-Communication Functions After Mild Traumatic Brain Injury

PURPOSE

A mixed-method approach was used to investigate the lived experiences of adults with mild traumatic brain injury (mTBI). The study aimed to understand the perceived relationship between cognitive-communication problems, thinking and communication concerns, and neurobehavioral symptoms. We hypothesized that individuals with cognitive-communication problems would attribute their problems with communication to their mTBI history and their self-perceived problems would be correlated with symptomatology.

METHOD

The Neurobehavioral Symptom Inventory (NSI) and an online cognitive-communication survey was used to conduct a study of 30 adults with mTBI history. Quantitative survey and NSI scores were analyzed with content analysis and correlational statistics.

RESULTS

The average NSI Total score was 17 with the following subscale scores: somatic (5), affective (8), and cognitive (3.9). Participants reported problems with expressive communication (56%), comprehension (80%), thinking (63%), and social skills (60%). Content analysis revealed problems in the following areas: expression (e.g., verbal, and written language), comprehension (reading and verbal comprehension), cognition (e.g., attention, memory and speed of processing, error regulation), and functional consequences (e.g., academic work, social problems, and anxiety and stress). A Pearson correlation indicated a statistically significant relationship (p < .01) between the Communication Survey Total and the Total, Somatic, Affective, and Cognitive subscales.

CONCLUSIONS

This study highlights a multifactorial basis of cognitive-communication impairment in adults with mTBI. We show that those with mTBI history perceive difficulties with cognitive-communication skills: conversations, writing, and short-term memory/attention. Furthermore, those with mTBI perceive their cognitive-communication problems after injury have impacted their vocational, social, and academic success.

Living with suicidal thoughts: A scoping review

BACKGROUND

There is a significantly higher number of people experiencing severe levels of suicidal thoughts compared to that of suicidal deaths and suicide attempts. In suicide prevention research, there is a shift towards greater emphasis on people's experiences of living with suicidal thoughts. This can expand the existing evidence base, which is dominated by a biomedical approach. The aim of this review was to summarise and disseminate existing research on the lived experiences of living with suicidal thoughts.

METHODS

A scoping review by Arksey & O'Malley consisting of six stages: (1) formulating the research question, (2) identifying relevant studies, (3) selecting studies, (4) mapping data, (5) summarising the results and (6) consulting stakeholders. PubMed, PsycINFO and CINAHL were searched for studies in English, Danish, Swedish and Norwegian. Peer-reviewed articles examining people's experiences of living with suicidal thoughts using qualitative methods were included. The search was supplemented with a citation pearl search in the Web of Science database. Twenty-eight studies were included.

RESULTS

The findings were organised under two thematic headings: (a) the significance of social connections and (b) a loss of the personal self.

CONCLUSION

There is a need for further qualitative research of people's experiences of living with suicidal thoughts from an everyday life perspective. Awareness about social connections and attachment in mental health prevention and governance is crucial. Trauma-informed care could be a useful approach to prevent suicidal thoughts as the review found that many participants had traumatic experiences in both childhood and adulthood. As part of the treatment of suicidal thoughts, it might be useful to have a focus on narrative and communicative methods and their clinical application.

Identifying group-based patterns of suicidal ideation over the first 10 years after moderate-to-severe TBI

OBJECTIVE

To identify group-based patterns in suicidal ideation (SI) over the first 10 years after traumatic brain injury (TBI).

METHODS

Participants included 9539 individuals in the TBI Model Systems National Database who responded to Patient Health Questionnaire-9 Item 9 assessing SI at 1, 2, 5, and/or 10 years post-injury. A k-means cluster analysis was conducted to determine group-based patterns of SI, and pre-injury variables were compared with ANOVAs and chi-square tests.

RESULTS

SI and attempts decreased over time. Four group-based patterns emerged: Low, increasing, moderate, and decreasing SI. The low SI group comprised 89% of the sample, had the highest pre-injury employment, fewer mental health vulnerabilities, least severe injuries, and were oldest. The increasing SI group had the most severe TBIs, were youngest, and disproportionately Black or Asian/Pacific Islander.

CONCLUSION

These findings reinforce the importance of mental health and suicide risk assessment during chronic recovery from TBI.