Suicide in Veterans with Post-Traumatic Headache: An Analysis of Health Systems Data (P14-12.001) (2023)

<h3>Objective:</h3> Evaluate the association of post-traumatic headache (PTH) with suicide-related behaviors (SRBs) compared to matched controls and explore psychiatric diagnoses and headache disease severity as mediators. <h3>Background:</h3> While PTH and SRB risk factors are prevalent among Veterans, whether PTH is associated with increased risk of SRBs is unclear. <h3>Design/Methods:</h3> This study extracted data from Veterans Health Administration (VHA) electronic health record data sources. Veterans diagnosed with PTH by a physician or APRN during the study period (fiscal years 2008–2020) were included. Non-headache controls were matched on gender, race/ethnicity, age (+/− 5 years), and year and point of care. Logistic regression evaluated differences in SRBs between the PTH group and matched controls. Diagnoses of major depressive disorder (MDD), post-traumatic stress disorder (PTSD), and insomnia, and headache disease severity (operationalized as neurology consultation), were explored separately as potential mediators between PTH and SRBs. <h3>Results:</h3> Out of 51,755 Veterans diagnosed with PTH, 6,447 (12.5%) reported any SRB compared to 5,150 matched controls (5%). The PTH group was predominantly White, Non-Hispanic (64.5%) male (89.4%) with an average age of 41 (interquartile Range= 30 – 56). Veterans with PTH had increased odds of any SRB (OR = 2.72, 95% confidence interval [CI] 2.62, 2.82) compared to controls. Results remained significant (OR= 1.80, 95% CI 1.72, 1.87) after adjusting for age, substance use disorders, and the Charlson Comorbidity Index. Significant mediation was observed; the percentages mediated were as follows: MDD (49.4%), PTSD (41.0%), headache disease severity (15.8%), and insomnia (11.8%). <h3>Conclusions:</h3> PTH was significantly associated with SRBs; mental health diagnoses and headache disease severity contributed to this relationship. Suicide risk mitigation strategies must be integrated into clinical practice for clinicians treating PTH patients, including addressing headache disease severity and comorbid mental health concerns, particularly MDD and PTSD. <b>Disclosure:</b> Ms. Anthony has nothing to disclose. Manali Phadke has nothing to disclose. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Amgen. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Biohaven. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Lundbeck. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for GlaxoSmithKline. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Teva. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vedanta. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Merck. Dr. Lipton has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Satsuma. Dr. Lipton has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Grifols. Dr. Lipton has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Allergan/Abbvie. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Lipton has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Lundbeck. Dr. Lipton has stock in Biohaven. Dr. Lipton has stock in Manistee. The institution of Dr. Lipton has received research support from Teva. The institution of Dr. Lipton has received research support from Amgen. The institution of Dr. Lipton has received research support from Allergan/Abbvie. The institution of Dr. Lipton has received research support from Gammacore. The institution of Dr. Lipton has received research support from Axsome. The institution of Dr. Lipton has received research support from Charleston Labs. The institution of Dr. Lipton has received research support from Eli Lilly. The institution of Dr. Lipton has received research support from Satsuma. The institution of Dr. Lipton has received research support from NIH . The institution of Dr. Lipton has received research support from NIH. The institution of Dr. Lipton has received research support from NINDS. The institution of Dr. Lipton has received research support from NIH. The institution of Dr. Lipton has received research support from NIA. The institution of Dr. Lipton has received research support from NIH. The institution of Dr. Lipton has received research support from NIA. The institution of Dr. Lipton has received research support from NIH. The institution of Dr. Lipton has received research support from Veterans Administration. The institution of Dr. Lipton has received research support from NIH. Dr. Lipton has received publishing royalties from a publication relating to health care. The institution of Dr. Androulakis has received research support from VA rehabilitation research . The institution of Dr. Altalib has received research support from UCB. The institution of Dr. Altalib has received research support from Eisai. The institution of Dr. Altalib has received research support from Sunovian. The institution of Dr. Altalib has received research support from DEPARTMENT OF DEFENSE - CONGRESSIONALLY DIRECTED MEDICAL RESEARCH PROGRAMS. Brenda Fenton has nothing to disclose. Dr. Sico has nothing to disclose. Dr. Seng has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for GlaxoSmithKline. Dr. Seng has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Click Therapeutics. The institution of Dr. Seng has received research support from NINDS.