Brain Impairment

  • Brain Impairment / Volume 14 / Special Issue 01 / May 2013, pp 92-112
  • Copyright © The Author(s), published by Cambridge University Press on behalf of Australian Academic Press Pty Ltd 2013 This is a work of the U.S. Government and is not subject to copyright protection in the United States.
  • DOI: (About DOI), Published online: 02 May 2013

State of the Art Reviews

Suicidal Ideation and Behaviours after Traumatic Brain Injury: A Systematic Review

Nazanin H. Bahrainia1a2 c1, Grahame K. Simpsona3a4, Lisa A. Brennera1a2, Adam S. Hoffberga1 and Alexandra L. Schneidera1

a1 Veterans Integrated Service Network (VISN) 19 Mental Illness Research Education and Clinical Center (MIRECC), Denver, Colorado, USA

a2 University of Colorado, School of Medicine, Aurora, Colorado, USA

a3 Liverpool Brain Injury Rehabilitation Unit, Liverpool Hospital, Sydney, Australia

a4 Rehabilitation Studies Unit, Sydney School of Medicine, University of Sydney, Australia


Traumatic brain injury (TBI) is prevalent among many populations and existing data suggest that those with TBI are at increased risk for death by suicide. This systematic review serves as an update to a previous review, with the aim of evaluating the current state of evidence regarding prevalence and risk of suicide deaths, post-TBI suicidal ideation and suicide attempts, and treatments to reduce suicide-related outcomes among TBI survivors. Review procedures followed the PRISMA statement guidelines. In all, 1014 abstracts and 83 full-text articles were reviewed to identify 16 studies meeting inclusion criteria. Risk of bias for individual studies ranged from low to high, and very few studies were designed to examine a priori hypotheses related to suicide outcomes of interest. Overall, findings from this systematic review supported an increased risk of suicide among TBI survivors compared to those with no history of TBI. Evidence pertaining to suicidal thoughts and attempts was less clear, mainly due to heterogeneity of methodological quality across studies. One small randomised controlled trial was identified that targeted suicide prevention in TBI survivors. Further research is needed to identify the prevalence of post-TBI ideation and attempts, and to establish evidence-based suicide prevention practices among TBI survivors.


  • suicide;
  • suicide attempt;
  • suicide ideation;
  • traumatic brain injury;
  • systematic review


c1 Address for correspondence: Nazanin H. Bahraini, VISN 19 MIRECC, 1055 Clermont Street, Denver, Colorado, 80220, USA. E-mail:


  Disclaimer: This article is based on work supported, in part, by the Department of Veterans Affairs, but does not necessarily represent the views of the Department of Veterans Affairs or the United States Government. Drs Brenner and Simpson would also like to acknowledge that they are authors on 6 of the 16 papers reviewed. Efforts were made to reduce conflicts (i.e., other members of the team reviewed their articles in terms of risk of bias).