Suicide Risk in Homeless Veterans with Traumatic Brain Injury

ABSTRACT SUICIDE RISK IN HOMELESS VETERANS WITH TRAUMATIC BRAIN INJURY Dr. Briana Lafferty Dr. Marilynn Sommers Every sixty-five minutes a veteran takes his or her own life. Suicide is now the second leading cause of death among United States (US) military service members, with rates almost three times that of the general population. An association may exist between suicide and traumatic brain injury (TBI). One in six military service members involved in the wars in Iraq and Afghanistan are said to have been subjected to at least one TBI. With the growing number of service members exposed to blast injuries, the consequences of TBI, such as changes in mood, personality, cognition, and behavior, expose them to the risk of suicide. Veterans are also 50% more likely than other Americans to become homeless, and homelessness is another problem contributing to a greater risk for suicide in this population. Rates of suicide among individuals experiencing homelessness are reported to be approximately ten times higher than the annual percentage of suicides within the housed population. Currently, there is no existing literature that examines suicide risk in veterans affected by both TBI and homelessness. The aim of my study was to examine the associations among suicide risk and specific physical, psychological, social, and military factors, as well as to describe the association of suicide risk and utilization of Veterans Affairs (VA) healthcare services, in a sample of homeless US Veterans who have experienced at least one TBI. I conducted a cross-sectional study using secondary data from the National Center for Homelessness Among Veterans, in addition to performing retrospective chart reviews. My findings demonstrated strong associations between high risk for suicide and marital status, PTSD, issues with memory/problem solving, seizures, and inpatient admissions for mental health treatment. My findings have implications for health care and policy change related to decreasing stigmatization of mental health issues, overcoming barriers and increasing eligibility to VA healthcare benefits, and mandating more aggressive screening and prevention efforts. These changes are needed particularly during the transition to civilian life. Degree Type Dissertation Degree Name Doctor of Philosophy (PhD) Graduate Group Nursing First Advisor Marilynn Sommers This dissertation is available at ScholarlyCommons: http://repository.upenn. edu/edissertations/1335 Subject Categories Nursing This dissertation is available at ScholarlyCommons: http://repository.upenn. edu/edissertations/1335 SUICIDE RISK IN HOMELESS VETERANS WITH TRAUMATIC BRAIN INJURY Briana Lafferty A DISSERTATION in Nursing Presented to the Faculties of the University of Pennsylvania in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy 2014 Supervisor of Dissertation ________________________________ Dr. Marilynn Sommers, PhD, RN, FAAN Lillian S. Brunner Professor of Medical Surgical Nursing Director of Center for Global Women's Health Graduate Group Chairperson _________________________________ Dr. Connie Ulrich, PhD, RN, FAAN Associate Professor of Nursing Associate Professor of Bioethics, Department of Medical Ethics, School of Medicine Chair, Graduate Group in Nursing Dissertation Committee Dr. Jamison Fargo, PhD. Associate Professor at Utah State University Dr. Nancy Hanrahan, PhD, RN, CS, FAAN Associate Professor at the University of Pennsylvania School of Nursing Dr. Ann Elizabeth Montgomery, PhD Associate Researcher at the National Center on Homelessness Among Veterans ii Dedication page I would like to dedicate this work to Ricky Palladino, my best friend, whom none of this would have been possible without. You’ve held my hand through this entire process. At times when I felt I wanted to give up, you gave me the motivating words I needed to continue. I love you. I would also like to dedicate this to Carolyn Peluso. Your friendship and support have influenced me in ways that you will never know. You will always be loved and