Background: Traumatic brain injury (TBI) remains a cause of lifelong disability, death, and suicide worldwide. TBI-induced near-death experience (NDE) could increase suicide risks. Objective: We investigated TBI coupled with NDE and posttraumatic stress disorder (PTSD) as a possible indicator of suicide. Methods: A 17-year-old male who sustained an acute severe TBI in a traffic collision, was comatose 14 days, had an NDE awakening from the coma, and, years after rehabilitation, suffered PTSD, clinical depression, and survived a suicide attempt. This personal experience of a TBI-induced NDE and lingering PTSD was acquired directly from the patient by interview. We discuss his case while considering relevant literature. Results: Longitudinal data from 1961 to 2021 generated from the PubMed interface revealed 4056 TBI patients committed suicide. NDE was only reported in one of those cases and, although not a suicide, in the personal experience. Neuropsychological assessment at long-term follow-ups revealed few TBI patients exhibited normal mental/physical functions compared to the general population. Unfavorable GOS scores were risk predictors for neuropsychological/physical impairments later in life, with outcomes of depression, PTSD, poor QOL, and/or suicide. Conclusions: For TBI-NDE survivors, including those with PTSD, long-term periodic neuropsychological follow-ups and psychosocial support may help decrease suicide risks.
References
[1]
Levin, H.S., Shum, D. and Chan, R.C. (2014) Understanding Traumatic Brain Injury: Current Research and Future Directions. Oxford University Press, New York.
[2]
Herman, J. (2020) Complex PTSD at National Center for PTSD. http://www.ptsd.va.gov/professional/treat/essentials/complex_ptsd.asp
Koch, C. (2020) What Near-Death Experiences Reveal about the Brain, in “Tales of the Dying Brain.” Scientific American, 322, 70-75.
[5]
Hou, Y., Huang, Q., Prakash, R. and Chaudhury, S. (2013) Infrequent near Death Experiences in Severe Brain Injury Survivors—A Quantitative and Qualitative Study. Annals of Indian Academy of Neurology, 16, 75-81. https://doi.org/10.4103/0972-2327.107715
[6]
Greyson, B. (1983) The Near-Death Experience Scale: Construction, Reliability, and Validity. The Journal of Nervous and Mental Disease, 171, 369-375. https://doi.org/10.1097/00005053-198306000-00007
[7]
Threlkeld, Z.D., Bodien, Y.G., Rosenthal, E.S., Giacino, J.T., Nieto-Castanon, A., Wu, O., Whitfield-Gabrieli, S. and Edlow, B.L. (2018) Functional Networks Reemerge during Recovery of Consciousness after Acute Severe Traumatic Brain Injury. Cortex, 106, 299-308. https://doi.org/10.1016/j.cortex.2018.05.004
[8]
None (1998) Rehabilitation of Persons with Traumatic Brain Injury. NIH Consensus Statement, 16, 1-41.
[9]
Brooks, J.C., Shavelle, R.M., Strauss, D.J., Hammond, F.M. and Harrison-Felix, C.L. (2015) Long-Term Survival after Traumatic Brain Injury Part I: External Validity of Prognostic Models. Archives of Physical Medicine and Rehabilitation, 96, 994-999.E2. https://doi.org/10.1016/j.apmr.2015.02.003
[10]
Brooks, J.C., Shavelle, R.M., Strauss, D.J., Hammond, F.M. and Harrison-Felix, C.L. (2015) Long-Term Survival after Traumatic Brain Injury Part II: Life Expectancy. Archives of Physical Medicine and Rehabilitation, 96, 1000-1005. https://doi.org/10.1016/j.apmr.2015.02.002
[11]
Himanen, L., Portin, R., Isoniemi, H., Helenius, H., Kurki, T. and Tenovuo, O. (2006) Longitudinal Cognitive Changes in Traumatic Brain Injury: A 30-Year Follow-Up Study. Neurology, 66, 187-192. https://doi.org/10.1212/01.wnl.0000194264.60150.d3
[12]
Dahm, J. and Ponsford, J. (2015) Comparison of Long-Term Outcomes Following Traumatic Injury: What Is the Unique Experience for Those with Brain Injury Compared with Orthopaedic Injury? Injury, 46, 142-149. https://doi.org/10.1016/j.injury.2014.07.012
[13]
Gautschi, O.P., Huser, M.C., Smoll, N.R., Maedler, S., Bednarz, S., von Hessling, A., Lussmann, R., Hildebrandt, G. and Seule, M.A. (2013) Long-Term Neurological and Neuropsychological Outcome in Patients with Severe Traumatic Brain Injury. Clinical Neurology and Neurosurgery, 115, 2482-2488. https://doi.org/10.1016/j.clineuro.2013.09.038
[14]
Andelic, N., Howe, E.I., Hellstrøm, T., Sanchez, M.F., Lu, J., Løvstad, M. and Røe, C. (2018) Disability and Quality of Life 20 Years after Traumatic Brain Injury. Brain and Behavior, 8, e01018. https://doi.org/10.1002/brb3.1018
[15]
Rassovsky, Y., Levi, Y., Agranov, E., Sela-Kaufman, M., Sverdlik, A. and Vakil, E. (2015) Predicting Long-Term Outcome Following Traumatic Brain Injury (TBI). Journal of Clinical and Experimental Neuropsychology, 37, 354-366. https://doi.org/10.1080/13803395.2015.1015498
[16]
Schwab, K.A., Gudmudsson, L.S. and Lew, H.L. (2015) Long-Term Functional Outcomes of Traumatic Brain Injury. Handbook of Clinical Neurology, 128, 649-659. https://doi.org/10.1016/B978-0-444-63521-1.00040-6
[17]
Brooks, J.C., Strauss, D.J., Shavelle, R.M., Paculdo, D.R., Hammond, F.M. and Harrison-Felix, C.L. (2013) Long-Term Disability and Survival in Traumatic Brain Injury: Results from the National Institute on Disability and Rehabilitation Research Model Systems. Archives of Physical Medicine and Rehabilitation, 94, 2203-2209. https://doi.org/10.1016/j.apmr.2013.07.005
[18]
Vasterling, J.J., Aslan, M., Lee, L.O., Proctor, S.P., Ko, J., Jacob, S. and Concato, J. (2018) Longitudinal Associations among Posttraumatic Stress Disorder Symptoms, Traumatic Brain Injury, and Neurocognitive Functioning in Army Soldiers Deployed to the Iraq War. Journal of the International Neuropsychological Society, 24, 311-323. https://doi.org/10.1017/S1355617717001059
[19]
Stålnacke, B.M., Saveman, B.I. and Stenberg, M. (2019) Long-Term Follow-Up of Disability, Cognitive, and Emotional Impairments after Severe Traumatic Brain Injury. Behavioural Neurology, 2019, Article ID: 9216931. https://doi.org/10.1155/2019/9216931
[20]
D'Arcy, R.C., Lindsay, D.S., Song, X., Gawryluk, J.R., Greene, D., Mayo, C., Hajra, S.G., Mandziuk, L., Mathieson, J. and Greene, T. (2016) Long-Term Motor Recovery after Severe Traumatic Brain Injury: Beyond Established Limits. The Journal of Head Trauma Rehabilitation, 31, E50-E58. https://doi.org/10.1097/HTR.0000000000000185
[21]
Sutherland, C. (1992) Reborn in the Light: Life after Near-Death Experiences. Bantam Books, New York.
[22]
Erminia, C. and Graham, M. (2008) Religion and Spirituality along the Suicidal Path. Suicide and Life-Threatening Behavior, 38, 229-244. https://doi.org/10.1521/suli.2008.38.2.229
[23]
Rasic, D.T., Belik, S.L., Elias, B., Katz, L.Y., Enns, M., Sareen, J. and Swampy Cree Suicide Prevention Team. (2009) Spirituality, Religion and Suicidal Behavior in a Nationally Representative Sample. Journal of Affective Disorders, 114, 32-40. https://doi.org/10.1016/j.jad.2008.08.007
[24]
Harrison-Felix, C.L., Whiteneck, G.G., Jha, A., DeVivo, M.J., Hammond, F.M. and Hart, D.M. (2009) Mortality Over Four Decades after Traumatic Brain Injury Rehabilitation: A Retrospective Cohort Study. Archives of Physical Medicine and Rehabilitation, 90, 1506-1513. https://doi.org/10.1016/j.apmr.2009.03.015
[25]
Brenner, L.A., Ignacio, R.V. and Blow, F.C. (2011) Suicide and Traumatic Brain Injury among Individuals Seeking Veterans Health Administration Services. The Journal of Head Trauma Rehabilitation, 26, 257-264. https://doi.org/10.1097/HTR.0b013e31821fdb6e
[26]
Hostetter, T.A., Hoffmire, C.A., Forster, J.E., Adams, R.S., Stearns-Yoder, K.A. and Brenner, L.A. (2019) Suicide and Traumatic Brain Injury Among Individuals Seeking Veterans Health Administration Services Between Fiscal Years 2006 and 2015. The Journal of Head Trauma Rehabilitation, 34, E1-E9. https://doi.org/10.1097/HTR.0000000000000489
[27]
Madsen, T., Erlangsen, A., Orlovska, S., Mofaddy, R., Nordentoft, M. and Benros, M.E. (2018) Association between Traumatic Brain Injury and Risk of Suicide. Journal of the American Medical Association, 320, 580-588. https://doi.org/10.1001/jama.2018.10211
[28]
Humphrey, N. (2018) The Lure of Death: Suicide and Human. Philosophical Transactions of the Royal Society B, 373, Article ID: 20170269. https://doi.org/10.1098/rstb.2017.0269
[29]
Farrar, J.T. (2019) Pain Interference on Quality of Life Is Not Just about Physical Function. Pain Medicine, 20, 211-212. https://doi.org/10.1093/pm/pny147_2
[30]
Fann, J.R., Ribe, A.R., Pedersen, H.S., Fenger-Grøn, M., Christensen, J., Benros, M.E. and Vestergaard, M. (2018) Long-Term Risk of Dementia among People with Traumatic Brain Injury in Denmark: A Population-Based Observational Cohort Study. The Lancet Psychiatry, 5, 424-431. https://doi.org/10.1016/S2215-0366(18)30065-8
[31]
Bethune, A., da Costa, L., van Niftrik, C.H.B., and Feinstein, A. (2017) Suicidal Ideation after Mild Traumatic Brain Injury: A Consecutive Canadian Sample. Archives of Suicide Research, 21, 392-402. https://doi.org/10.1080/13811118.2016.1199990
[32]
Dammann, G. and Gerisch, B. (2005) [Narcissistic Personality Disorders and Suicidal Behaviour. A Psychodynamic Perspective on Treatment Difficulties.] Schweizer Archiv für Neurologie und Psychiatrie, 156, 299-309. https://doi.org/10.4414/sanp.2005.01625
[33]
Satcher, D. (1999) Mental Health: A Report of the Surgeon General. US Public Health Service, Bethesda, MD.
[34]
Smith, D. (2001) Shock and Disbelief. Atlantic Monthly, 287, 79-90.
[35]
Brean, J. (2019) Before Ernest Hemingway’s Suicide, Nine Concussions Incapacitated His Brain, Forensic Psychiatrist Concludes. National Post. http://nationalpost.com/entertainment/hemingways-depession-was-spurred-on-by-cte-blows-to-the-head-new-book-argues
[36]
Byers, A.L., Li, Y., Barnes, D.E., Seal, K.H., Boscardin, W.J. and Yaffe, K. (2020) A National Study of TBI and Risk of Suicide and Unintended Death by Overdose and Firearms. Brain Injury, 34, 328-334. https://doi.org/10.1080/02699052.2019.1701708
[37]
Hotchner, A.E. (1967) Papa Hemingway: A Personal Memoir. Bantam Books, New York.
[38]
Hemingway, E. (1932) Death in the Afternoon. Scribner, New York, 517 p.