To the Editor The article by Bryan and Clemans1 about the relationships between episodes of combat mild traumatic brain injury (mTBI) and suicide augments information on the role of repeated traumatic brain injury episodes in the genesis of brain injury and altered behavior.2,3 The finding of a relationship between number of mTBI episodes and the likelihood of suicidality is consistent with prior observations demonstrating that the likelihood of an individual developing posttraumatic stress disorder increased with the number of episodes of combat mTBI that were associated with loss of consciousness (LOC).4 We found that the relationship between posttraumatic stress disorder and the number of mTBI episodes was stronger for mTBI associated with LOC compared with the number of mTBI events that were not accompanied by LOC. We wonder if Bryan and Clemans1 can comment on whether suicidality was related more strongly to episodes of mTBI with LOC compared with episodes without LOC.
Riechers RG, Ruff SE, Ruff RL. Suicidality and Injury of the Prefrontal Cortex in Multiple Incidents of Mild Traumatic Brain Injury. JAMA Psychiatry. 2014;71(1):94. doi:10.1001/jamapsychiatry.2013.2989