PT - JOURNAL ARTICLE AU - Gabrielle F. Miller AU - Hong Zhou AU - Alexis B. Peterson AU - Elizabeth Swedo AU - Kristin Holland AU - Marcie-jo Kresnow TI - Association between traumatic brain injury and suicidality using a mediation approach and MarketScan AID - 10.1136/ip-2022-044697 DP - 2022 Dec 05 TA - Injury Prevention PG - ip-2022-044697 4099 - http://injuryprevention.bmj.com/content/early/2022/12/04/ip-2022-044697.short 4100 - http://injuryprevention.bmj.com/content/early/2022/12/04/ip-2022-044697.full AB - Introduction Negative outcomes, including suicidal ideation/attempts, are a major public health concern, particularly among individuals who sustain a traumatic brain injury (TBI). TBI is associated with high rates of postinjury substance use, psychiatric disorders, post-traumatic stress disorder and sleep disturbances. This study examines the mediation effects of substance use, psychiatric disorder and sleep disorder on the associations between TBI and suicidal ideation/attempts.Methods A matched case–control study using data from MarketScan databases for private health insurance and Medicaid from October 2015 to December 2018 estimated the association between TBI and suicidal ideation/attempts using a mediation approach. Individuals less than 65 years of age were included.Results In the Medicaid sample, psychiatric disorders mediated 22.4% of the total effect between TBI and suicidal ideation/attempt, while substance use disorders other than opioid use disorder mediated 7.47%. In the private health insurance sample, psychiatric disorders mediated 3.97% of the total effect, opioid use disorders mediated 2.08% of the total effect and sleep disorder mediated 1.25% of the total effect.Conclusions Mediators explained less than 30% of the relationship between TBI and suicidal ideation/attempt. Findings reinforce the importance of primary prevention of TBI and monitoring patients with a TBI for risk of suicide in the first 6–12 months following injury.Data may be obtained from a third party and are not publicly available. Data are available through IBM MarketScan Research.