Those who recover from Acquired Brain Injury (ABI) are at a greater risk of suicide than the general population. The following factors contribute to increased risk:
- Neurological sequelae of brain injury resulting in ongoing disability (e.g. physical, cognitive and communicative impairments, seizures, pain and other medical issues).
- Psychological and psychiatric difficulties including adjustment reactions, depression, anxiety, personality change and occasionally psychosis.
- Difficulty coping with significant changes to personal circumstances resulting in high levels of stress and anxiety.
- Pre-injury history of psychiatric problems.
Social issues such as breakdown of relationships, loss of employment and financial difficulties can lead to isolation and feelings of loneliness and worthlessness. Physical disabilities, chronic pain, epilepsy and other medical problems can aggravate these feelings leading to thoughts that life is not worth living.
In addition there may be a pre-injury history of depression, other mental health disorder or difficulties with alcohol and/or substance misuse which are of themselves risk factors for suicide attempt. Any pre-existing psychiatric problems are likely to re-emerge following brain injury and may be exacerbated by the contributory factors described above.
These issues are often combined with cognitive and behavioural changes after brain injury such as impaired judgement, impulsivity, anger (at oneself or with others) and the inability to experience pleasure (anhedonia). This toxic mixture can lead to impulsive, life threatening acts or purposeful suicide.
It is important that all the above danger signs are heeded as the risk of suicide persists for years post injury. Appropriate measures such as treatment of depression, psychiatric referral, support and counselling are necessary. Family members should also be offered support and advice. Contact details for agencies such as Samaritans can also be useful.