创伤性脑损伤(TBI)每年影响全球超过4800万人。自杀在TBI中很常见,有几个已知的因素,包括严重的TBI,抑郁症,酒精使用,和男性。冲动性,或者倾向于用很少的想法迅速采取行动,可能是TBI后自杀的早期预测指标。这项研究的目的是评估在创伤性脑损伤(TBI)后有冲动史的患者自杀的风险。使用来自TriNetX美国自然语言处理协作网络的去识别电子健康记录,产生3个队列:冲动性TBI队列(I+TBI+)包括在诊断TBI前诊断为冲动性的受试者;无冲动性TBI队列(I-TBI+)包括有TBI但无冲动性的患者;无冲动性TBI队列(I+TBI-)包括有冲动性但有TBI的患者.进行了两项分析,包括分析1(冲动性TBI与无冲动性TBI)和分析2(冲动性TBI与冲动无TBI)。患者的倾向评分为1:1,按年龄匹配,性别,种族,种族,精神病诊断,和抗抑郁药的使用。结果包括自我伤害的诊断,自杀意念,或在指数事件后一年内自杀未遂。在不同的年龄类别中评估每个结果的所有时间发生率。卡方检验(分类变量)和t检验(数值变量)用于评估组间差异。在研究中确定了总共1,292,776名TBI患者。1:1倾向得分匹配后,有20,694例患者(平均[SD]年龄,48.1[21.8];8,424名女性[40.7%])具有冲动性和TBI(ITBI),1,272,082例患者(平均[SD]年龄,46.0[23.1];562,705名女性[44.2%])单独患有TBI(I-TBI+),和90,669名患者(平均[SD]年龄,43.7[22.6];45,188名女性[49.8%])仅有冲动性(ITBI-)。在TBI后的第一年内,有冲动的患者更容易表现出自我伤害(P<0.001),自杀意念(P<0.001)或自杀未遂(P<0.001)。与没有冲动的TBI患者相比,那些有冲动的人自我伤害的发生率增加了四倍(2.81%vs.0.63%),自杀意念增加了八倍(52.42%vs.6.41%),自杀企图增加了21倍(32.02%vs.1.50%)。这项研究表明,在TBI之前诊断的冲动可能会增加创伤后自杀的风险,自我伤害的风险增加了四倍,自杀意念的风险增加8倍,自杀未遂的风险增加21倍。这表征了一组可能从TBI后的早期精神病支持和有针对性的干预措施中受益的高危个体。
Traumatic brain injury (TBI) affects over 48 million people worldwide each year. Suicide is common in TBI, and there are several known contributing factors, including severe TBI, depression, alcohol use, and male sex. Impulsivity, or the tendency to act quickly with little thought, may be an early predictor of suicidality following TBI. The purpose of this study was to evaluate the risk of suicidality in patients with a prior history of impulsivity following a traumatic brain injury (TBI). Using de-identified electronic health records from the TriNetX United States Collaborative Network with Natural Language Processing, three cohorts were generated: the impulsivity TBI cohort (I+TBI+) included subjects with a diagnosis of impulsivity before a diagnosis of TBI; the no impulsivity TBI cohort (I-TBI+) included patients with TBI but no impulsivity; the impulsivity no TBI cohort (I+TBI-) included patients with impulsivity but TBI. Two analyses were conducted, including analysis 1 (impulsivity TBI vs. no impulsivity TBI) and analysis 2 (impulsivity TBI vs. impulsivity no TBI). Patients were 1:1 propensity score matched by age, sex, race, ethnicity, psychiatric diagnoses, and antidepressant use. Outcomes included a diagnosis of self-harm, suicidal ideation, or a suicide attempt within one year after the index event. The all-time incidence of each outcome was assessed across different age categories. The chi-square test (categorical variables) and t-test (numerical variables) were used to assess for differences between groups. A total of 1,292,776 TBI patients were identified in the study. After 1:1 propensity score-matching, there were 20,694 patients (mean [SD] age, 48.1 [21.8]; 8,424 females [40.7%]) with impulsivity and TBI (I+TBI+), 1,272,082 patients (mean [SD] age, 46.0 [23.1]; 562,705 females [44.2%]) with TBI alone (I-TBI+), and 90,669 patients (mean [SD] age, 43.7 [22.6]; 45,188 females [49.8%]) with impulsivity alone (I+TBI-). Within the first year after a TBI, patients with impulsivity were more likely to exhibit self-harm (P < 0.001), suicidal ideation (P < 0.001) or a suicide attempt (P < 0.001). Compared to TBI patients without impulsivity, those with impulsivity had a four-fold increase in the incidence of self-harm (2.81% vs. 0.63%), an eight-fold increase in suicidal ideation (52.42% vs. 6.41%), and a twenty-one-fold increase in suicide attempts (32.02% vs. 1.50%). This study suggests that impulsivity diagnosed before a TBI may increase the risk of post-traumatic suicidality, with a four-fold increased risk of self-harm, an eight-fold increased risk of suicidal ideation and a twenty-one-fold increased risk of suicide attempts. This characterizes a group of at-risk individuals who may benefit from early psychiatric support and targeted interventions following a TBI.