Suicide Risk in Homeless Veterans With TBI

Posted on August 9, 2022

Suicide is now the second principal cause of death among the United States (U.S.) military service persons, with rates almost three times higher than the general population. Every sixty-five minutes, one veteran takes his/her own life. A connection exists between traumatic brain injury (TBI) and suicide. 

One in six military service members who fought in the wars in Afghanistan and Iraq have been subjected to at least one TBI. With the large number of service members exposed to blast injuries, the consequences of TBI, such as changes in personality, mood, behavior, and cognition, expose them to the risk of suicide. 

Veterans are 50% more probable than other Americans to become homeless, and homelessness is another problem contributing to a greater risk for suicide among this population. Rates of suicide among individuals facing homelessness are reported to be approx. ten times higher than the yearly percentage of suicides in the housed population. Not enough studies have been conducted to determine the suicide risk in veterans affected by both homelessness and TBI. 

A study was conducted to examine the association between suicide risk and specific physical, psychological, social, and military factors and to describe the association between suicide risk and utilization of VeteransAffairs (V.A.) healthcare services in a sample of homeless U.S. Veterans who have suffered at least one TBI. In addition to performing retrospective chart reviews, the study used secondary data from the National Center for Homelessness Among Veterans. 

The findings demonstrated strong associations between high risk for suicide and PTSD, seizures, marital status, memory/problem-solving issues, and inpatient mental health treatment admissions. These findingshave implications for health care and policy change related to decreasing discrimination against mental health issues, overcoming barriers, and increasing eligibility for V.A. healthcare benefits. As also authorizing more aggressive screening and prevention efforts. These modifications are necessary, mostly during the transition from veteran to civilian life.

Homelessness and the Military

In addition to the high prevalence of TBI within the homeless population, there is also a high prevalence of veterans within the homeless population. Veterans are 50% more likely than other Americans to become homeless. A report presented to the Congress showed that approximately 57,849 veterans were homeless in the U.S. on one particular night in January.

Unemployment rates are higher for veterans compared to non-veterans, which also puts them at an increased risk for homelessness. The U.S. Department of Labor, in 2010, found that more than 20% of veterans who served in Iraq or Afghanistan were unemployed for the past five years. Approximately 12% of post-9/11 veterans were unemployed as of October 2011, compared to 9% of the general population. 

A study in 2007 showed that 18% of veterans who searched for jobs one to three years after discharge from the military were unemployed. Some studies show that lower-income and unemployment can contribute to suicidal behavior. 

Investigators found that individuals within the general population earning less than $17,000 per year have over two times higher rates of suicide attempts than individuals earning more than $17,000 when adjusting for age, marital status, race, gender, and employment.

Employment difficulties are only one factor contributing to a veteran being at risk for homelessness. Other factors may include psychological conditions, adaptation issues, or, as mentioned above, TBI.

Homelessness and Suicide Risk 

Veterans who are homeless may also be at a greater risk for suicide. Compared to a single TBI, a repeat brain injury has devastating effects for the individual, prolongs time to recovery, increases symptoms, and makes the risk for suicide even greater.

Brain scans of veterans with known blast exposure and/or concussive injury was compared to four athletes with repetitive concussions. The study found similar neuropathological changes in brain tissue in both. 

CTE (Chronic Traummatic Encephalopathy) can begin to manifest immediately, or years after the last TBI, and typically begins with cognitive and emotional disturbances, including impulsivity, aggression, depression, memory loss, confusion, impaired judgment, and in some cases progressive dementia. These symptoms can lead to an increased risk for suicidal behavior.