Identifying group-based patterns of suicidal ideation over the first 10 years after moderate-to-severe TBI

Daniel W. Klyce, Paul B. Perrin, Lauren B. Fisher, Flora M. Hammond, Shannon B. Juengst, Thomas F. Bergquist, Amanda R. Rabinowitz, Amy K. Wagner, Charles H. Bombardier, Janet P. Niemeier, Kelli W. Gary, Joseph T. Giacino, Ross D. Zafonte

Research output: Contribution to journalArticlepeer-review


Objective: To identify group-based patterns in suicidal ideation (SI) over the first 10 years after traumatic brain injury (TBI). Methods: Participants included 9539 individuals in the TBI Model Systems National Database who responded to Patient Health Questionnaire-9 Item 9 assessing SI at 1, 2, 5, and/or 10 years post-injury. A k-means cluster analysis was conducted to determine group-based patterns of SI, and pre-injury variables were compared with ANOVAs and chi-square tests. Results: SI and attempts decreased over time. Four group-based patterns emerged: Low, increasing, moderate, and decreasing SI. The low SI group comprised 89% of the sample, had the highest pre-injury employment, fewer mental health vulnerabilities, least severe injuries, and were oldest. The increasing SI group had the most severe TBIs, were youngest, and disproportionately Black or Asian/Pacific Islander. Conclusion: These findings reinforce the importance of mental health and suicide risk assessment during chronic recovery from TBI.

Original languageEnglish (US)
Pages (from-to)877-891
Number of pages15
JournalJournal of Clinical Psychology
Issue number5
StatePublished - May 2022


  • TBI Model Systems
  • cluster analysis
  • suicidal ideation
  • suicide
  • traumatic brain injury

ASJC Scopus subject areas

  • Clinical Psychology
  • Arts and Humanities (miscellaneous)


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