Suicide Risk After Head Trauma: What You Need to Know

Spotting the Signs

illustration showing depression
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The data clearly show that after someone suffers serious head trauma there is an increased risk of suicide. The more serious the brain injury, the more likely s/he will consider or attempt suicide. Understanding the physical changes to the brain, how these changes affect mood, self-worth, and decision making helps both head trauma victims and those who love them identify when warning signs of a possible suicide attempt come up.

Research also shows us that rehabilitation programs focused on addressing suicide risk, together with medical management, can reduce the likelihood of suicide.

What Are the Statistics?

  • Up to 20 percent of individuals who have suffered a traumatic brain injury report thinking about, planning, or attempting to commit suicide within the first five years after the head trauma event.
  • Most head trauma-related suicides occur within 15 years of the accident.
  • One is considered at increased risk for suicide for the rest of one’s life, especially in the presence of long-term physical disabilities.

There are a number of additional demographic factors linked to high suicide risk. Most individuals who attempt suicide are males between the ages of 25-35. Males older than 65 are the second most likely group of head trauma survivors who attempt suicide.

Additional increased risk factors include:

  • substance abuse
  • previous underlying psychiatric problems
  • previous suicide attempts

Mental health professionals trained in understanding and treating head trauma survivors are able to piece together these risk factors and develop a therapy program designed to address each person’s suicide vulnerabilities.

Why Does Suicide Risk Go Up?

Head trauma can change one’s mental and physical abilities to complete a variety of activities.

When critical thinking and complex decision-making skills are impaired, one’s ability to complete previously mastered tasks, such as programming a computer, fixing machines, or writing research reports, may have changed. Losing the ability to do things one used to do is depressing, and some people feel their personal value has gone down.

Feelings of despair and worthlessness are common after head trauma, especially if the person suffering from the head injury can’t provide for his/her family any longer, or isn’t able to participate in previously enjoyed activities with their friends. Some individuals withdraw from society because they don’t want the disability seen by others. This in turn contributes to loneliness.

What makes this chain of events even more challenging, is that the head trauma survivor’s thinking process and ability to understand and then cope with the stressors has also changed. This means it’s harder to deal with the feelings that emerge when one can’t do the things one used to. If there were any previous psychological challenges such as depression, this usually becomes worse.

Individuals who have never thought about or tried to commit suicide, now have numerous factors known to increase one’s willingness suicide risk, and working through the challenges has become much more difficult.

The Physiology Behind TBI-Suicide Risk

Some people feel that depression is “all in your head” and with the right attitude one can easily rise above the mood disorder.

It’s important to understand there are measurable, physical changes in the brain outside of one’s personal control.

  • You can’t change the chemicals and hormones your brain produces any easier than you can force a broken leg to bear weight. You wouldn’t tell a person with a broken femur to just walk it off and get over it, so someone recovering from head trauma shouldn’t be told to just “get over” depression, isolation, and fear. It is a healing process that takes time and patience.

    There are a number of theories about what happens to the physical processes in the brain that specifically contribute to suicide risk.

    1. The brain affects mood through chemicals such as dopamine and serotonin. Hormones regulated by the brain also contribute to mood. According to one theory, changes to the central nervous system cause the brain to under-produce or over-produce specific mood regulating chemicals, which in turn increases the risk of depression.
    2. The type of stress the body goes through with traumatic brain injury may lend itself to changed neurological processes. One research study that compared persons who suffered severe trauma without head injury with those who suffered severe trauma with a head injury found that neurologic changes in the brain injury group appeared to stimulate the development of mood disorders.
    3. Other theories analyze how different lobes of the brain contribute to feelings of self-worth, effective decision making, and impulsive behavior. Damage to the frontal lobe of the brain is correlated with increased risk taking. However, some studies have shown that lobes of the brain not directly impacted in an accident can still go through physical changes. Scans of the brain after traumatic brain injury have shown that gray matter in the left prefrontal lobe shrinks. This is also a finding in those with major depression.

    Research in this area is ongoing and there are still many unanswered questions.

    How to Identify Signs

    Researchers John Cull and Wayne Gill developed a suicide probability scale, looking at four key factors:

    1. hopelessness
    2. suicide ideation
    3. negative self-evaluation
    4. hostility

    Understanding how these manifest, what they feel like, and how to recognize them can help in the early detection and prevention of suicide.

    Hopelessness: Hopelessness is usually associated with an overwhelming feeling of loneliness. There is the belief that no one else can understand what is happening or help relieve the suffering. When self-image goes through such a profound change, the head trauma survivor may feel they can’t be loved for who they have become. There is an expectation that others disapprove of them.

    When someone feels hopeless after head trauma, they may also believe they can’t change their lives for the better.

    Fatigue, listlessness, depression, and no longer being able to participate in activities that contributed to happiness may be a direct result of damage to nerve cells in the brain.

    What Helps:

    • support group with others experiencing the same issues
    • openly talking about fears with friends and family

    Suicidal Ideation: It is normal for anger to emerge when a person feels isolated and believes that s/he is letting others down and is unable to participate in life’s basic joys. This anger may be directed at the self for having the accident in the first place or losing important skills. It can also be directed at others. Sometimes the desire to punish oneself or others emerges.

    After head trauma, an accident survivor may say things like, “I should have just died in the accident” or “Dying would be less painful than living this way.”

    They may say they think about suicide and feel everything/everyone would be better off if they were dead. Suicidal ideation includes imagining how to commit suicide, how others would react, and how one’s death might solve problems.

    What Helps:

    • professional counseling to address grief and anger
    • having support people to call in an emergency

    Negative Self-Evaluation: When you don’t believe your life has much value, your drive to recover from head trauma and promote your own longevity declines. Some who suffer head trauma feel they are a burden to their loved ones. If health costs are high and they can’t earn enough money to cover those costs, the shame and sadness can be overwhelming.

    Head trauma affects everyone in the head trauma survivor’s life. Caregiver fatigue and lack of resources and emotional support for everyone involved in the recovery process can contribute to the accident survivor’s belief they are a burden. Previous relationship problems can become much worse.

    What Helps:

    • counseling that involves the entire family
    • physical and occupational therapy directed at gaining new skills
    • mapping the recovery process, so it’s clear how much has improved

    Hostility: Anger is an expression of loss, grief, and frustration. After serious head trauma, it’s more difficult for the brain to process emotions, resolve negative beliefs, and develop an appropriate response to difficulties. Factors that contribute to hostility include:

    • feeling isolated from others
    • believing that family/friends are angry and resentful
    • changes in the brain that promote impatience and impulsiveness

    When the anger translates into impulsive behaviors, and if other factors such as hopelessness, suicidal ideation, negative self-image present, it’s time to seek professional help.

    What Helps:

    • learning specific steps to manage feelings of anger
    • proactively addressing substance abuse

    Signs of Suicide Risk Masked by Brain Injury

    The above listed suicide risk factors apply to a broad range of individuals. However, these signs may not be as clear in someone who has suffered from head trauma.

    This is because brain injury affects how a person expresses their thoughts and feelings. Brain injury can also impair planning, so suicide may be more of an impulsive act than a well-planned out process that can be recognized early.

    This means it’s important to get professional help as soon as hopelessness, suicide ideation, negative self-evaluation, or hostility manifest.

    Risk-Taking Behaviors Leading Up to Suicide

    There are several key warning signs to be aware of. These include:

    • an overall increase in risk-taking behavior
    • heavy drinking
    • drug abuse
    • engaging in motor vehicle or sports activities that are dangerous

    Instead of feeling frightened, the person engaging in these behaviors may say they create a sense of “relief” from the suffering experienced secondary to the head injury. This sense of relief is a combination of energy release and desire for one’s life to end. Professional help should be sought immediately.

    What Reduces Suicide Risk?

    Finding satisfaction in one’s life can reduce risk of suicide. This doesn’t mean that all problems and challenges associated with brain injury go away. It does mean that as recovery progresses and new skills are learned a new sense of purpose and fulfillment emerges. Some life changes that increase quality of life include:

    • successfully completing new tasks
    • caring for loved ones, especially children
    • finding others who are going through head trauma recovery and developing a support system
    • completing tasks, getting a new job 
    • learning how to cope with anger and depression in healthy ways

    It takes time to develop a positive outlook, and there has to be a willingness to accept help and support from friends and family. For some, spirituality fills that void and provides a renewed sense of purpose. There is no one-size-fits-all recovery plan. Each head trauma survivor creates their own path to fulfillment with time and support from the extended medical, rehabilitation, counseling services, and their community.  


    Jorge RE, Robinson RG, Moser D, Tateno A, Crespo-Facorro B, Arndt S. Major depression following traumatic brain injury. Archives of General Psychiatry. 2004;61:42–50.

    National Institutes of Health. 1998. Consensus development conference statement, Rehabilitation of persons with traumatic brain injury. Retrieved April, 15, 2016.

    Rudd MD, Berman AL, Joiner TE Jr, et al. Warning signs for suicide: theory, research and clinical applications. Suicide and Life-Threatening Behavior. 2006;(3) 255-262.

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