Responses to Traumatic Brain Injury Screening Questions and Suicide Attempts among Those Seeking Veterans Health Administration Mental Health Services.

Alexandra L Schneider,Lisa A Brenner,Trisha A Hostetter,Joe Huggins,Bridget B Matarazzo,Beeta Y Homaifar,Jeri E Forster,Jennifer H Olson-Madden

doi:10.3389/fpsyt.2016.00059

Abstract

Psychometrically sound screening tools available to aid in the identification of lifetime history of traumatic brain injury (TBI) are limited. As such, the Traumatic Brain Injury-4 (TBI-4) was developed and implemented in a Veterans Health Administration (VHA) mental health clinic. To provide information regarding both the predictive validity and clinical utility of the TBI-4, the relationship between screening results and future suicide attempts was evaluated. The aim of this study was to determine whether a positive screen on the TBI-4 was associated with increased risk for suicide attempt within 1-year post screening. The TBI-4 was administered to 1,097 Veterans at the time of mental health intake. Follow-up data regarding suicide attempts for the year post-mental health intake were obtained from suicide behavior reports (SBRs) in Veteran electronic medical records (EMRs). Fisher's exact tests were used to determine the proportion of suicide attempts by TBI-4 status. In the year post TBI-4 screening, significantly more Veterans who screened positive had a documented suicide attempt as compared to those who screened negative (p = 0.003). Those with a positive TBI screen at mental health intake had a higher proportion of SBRs than those who screened negative for TBI. Findings provided further psychometric support for the TBI-4. Moreover, results suggest the inclusion of this screen could prove to be helpful in identifying those who may be at risk for future suicide attempt within 1-year post screening.

Highlights

Traumatic brain injury (TBI) is a frequently noted health condition among individuals seeking Veteran’s Health Administration (VHA) services
Recent attention has been focused on developing a screening tool for deploymentrelated TBI for Service Members returning from the conflicts in Iraq and Afghanistan [3], there remains a lack of psychometrically sound screening tools for lifetime history of TBI that could be used across Veteran cohorts
In a 2013 publication, Bahraini and Brenner suggested that the costs versus benefits of TBI screening should be evaluated empirically [8]

Summary

Introduction

Traumatic brain injury (TBI) is a frequently noted health condition among individuals seeking Veteran’s Health Administration (VHA) services. The Traumatic Brain Injury-4 (TBI-4) was developed to address this need and was implemented as part of the mental health intake process in a Veterans Affairs Medical Center Mental Health Clinic [1]. It is composed of the following four questions: [1] Have you ever been hospitalized or treated in an emergency room following a head or neck injury?; [2] Have you ever been knocked out or unconscious following an accident or injury?; [3] Have you ever injured your head or neck in a car accident or from some other moving vehicle accident?; and [4] Have you ever injured your head or neck in a fight or fall? To provide information regarding both the predictive validity and clinical utility of the TBI-4, the relationship between screening results and future suicide attempts was evaluated

Methods

Results

Conclusion