Traumatic Brain Injury (TBI) has emerged as a significant concern, particularly among veterans of wars in Iraq and Afghanistan. Studies have shown that TBI is linked to various psychiatric conditions, including an increased risk of suicide attempts. However, there is hope on the horizon in the form of Hyperbaric Oxygen Therapy (HBOT), which shows promise in alleviating the effects of TBI and reducing suicidal ideation.

Understanding the Link Between TBI and Suicide

Mild Traumatic Brain Injury (mTBI) has become one of the signature injuries among veterans, with up to 23% of US veterans who served in Iraq and Afghanistan reporting at least one mTBI during their service. Among these veterans, psychiatric conditions are more common among those with TBI than those without. This includes posttraumatic stress disorder (PTSD) and depression, which often co-occur with TBI.

Recent studies have explored the connection between TBI and suicide attempts. While some research has shown an association between TBI and an increased risk of suicide attempts, the results have been mixed. However, one common thread in these studies is the role of psychiatric comorbidity, particularly PTSD, in mediating the relationship between TBI and suicidal behavior.

The Fonda study, titled “Traumatic Brain Injury and Attempted Suicide Among Veterans of the Wars in Iraq and Afghanistan,” utilized Veterans Affairs (VA) registry data to examine the associations between deployment-related TBI, psychiatric diagnoses, and attempted suicide among 273,591 veterans deployed in support of Operations Enduring Freedom, Iraqi Freedom, and New Dawn. The study spanned from 2007 to 2012, providing a comprehensive perspective on this critical issue.

Key Findings:
  1. Higher Suicide Risk Among TBI Veterans: The study found that veterans with TBI were significantly more likely to attempt suicide than those without TBI. Specifically, the adjusted hazard ratio was 3.76, meaning that veterans with TBI had a nearly fourfold higher risk of suicide attempts.
  2. Psychiatric Conditions as Mediators: An intriguing aspect of the study was the investigation into the role of psychiatric conditions in mediating the association between TBI and suicide attempts. The findings indicated that 83% of the association between TBI and attempted suicide was mediated by co-occurring psychiatric conditions.
  3. PTSD’s Significant Impact: Among the various psychiatric conditions, posttraumatic stress disorder (PTSD) had the most substantial impact on mediating the link between TBI and suicide attempts. PTSD alone mediated 73% of the association between TBI and suicide attempts.
  4. Severity and Mechanism of TBI: The study also categorized TBI by severity, with the majority being classified as mild. It found no meaningful differences in associations by TBI severity, suggesting that even mild TBIs can significantly increase suicide risk.
Implications and Healing Strategies

Understanding the complex relationship between TBI, psychiatric conditions, and suicide risk is crucial for developing effective strategies to support veterans dealing with these challenges. Here are some key takeaways and potential approaches:

  1. Early Detection and Intervention: Identifying TBI and psychiatric conditions in veterans is paramount. Routine screenings for TBI and mental health issues during and after deployment can help with early detection and timely intervention.
  2. Comprehensive Mental Health Care: Providing veterans with access to comprehensive mental health care, including evidence-based treatments for TBI and psychiatric conditions like PTSD and depression, is essential.
  3. Holistic Support: Veterans’ well-being should be addressed holistically, including their physical, mental, and social needs. Supportive networks, peer counseling, and community involvement can play pivotal roles in recovery.
  4. Raising Awareness: Public awareness campaigns and educational initiatives can help destigmatize mental health issues, encouraging veterans to seek help when needed.
  5. Research and Innovation: Ongoing research into the interaction between TBI and psychiatric conditions is crucial. Developing innovative treatments and interventions based on scientific advancements can improve outcomes for veterans.

The Role of HBOT in TBI Treatment

Hyperbaric Oxygen Therapy (HBOT) is a medical treatment that involves breathing pure oxygen in a pressurized environment. It is widely recognized for its effectiveness in treating conditions such as decompression sickness in divers and non-healing wounds. In recent years, HBOT has garnered attention for its potential in TBI treatment. HBOT works by increasing the amount of oxygen that the blood can carry to the brain. This helps to reduce inflammation, promote the growth of new blood vessels, and enhance the brain’s ability to heal itself. Given that one of the primary consequences of TBI is reduced oxygen supply to brain tissues, HBOT offers a logical holistic and theraputic approach.

How HBOT May Help TBI Patients
  1. **Reducing Inflammation:** TBI often triggers an inflammatory response in the brain. HBOT has been shown to reduce this inflammation, potentially preventing further damage.
  2. **Enhancing Neuroplasticity:** HBOT may promote neuroplasticity, the brain’s ability to reorganize itself by forming new neural connections. This can aid in cognitive and functional recovery.
  3.  **Improving Cognitive Function:** Some studies suggest that HBOT can enhance cognitive function in TBI patients, including memory and attention.
HBOT and Suicide Prevention

One of the most promising aspects of HBOT is its potential to reduce suicidal ideation in TBI patients. By addressing the underlying brain damage and associated psychiatric conditions, HBOT may provide individuals with newfound hope and mental stability.


The Fonda study highlights the concerning link between TBI and suicide risk among veterans, with psychiatric conditions acting as significant mediators. To support veterans who have experienced TBI, a multifaceted approach that combines early detection, comprehensive mental health care, holistic support, awareness campaigns, and ongoing research is essential. By addressing these complex issues head-on, we can strive to reduce the alarming suicide rates among veterans and improve their overall well-being.

Traumatic Brain Injury continues to be a serious concern, especially among veterans who have served in combat zones. The increased risk of psychiatric conditions and suicide attempts in TBI patients underscores the urgent need for effective treatments. Hyperbaric Oxygen Therapy (HBOT) is emerging as a promising option, offering hope for those who have struggled with the aftermath of TBI. As research in this area continues, HBOT may become an integral part of TBI treatment and suicide prevention strategies, providing a brighter future for affected individuals.


Fonda JR, Fredman L, Brogly SB, McGlinchey RE, Milberg WP, Gradus JL. Traumatic Brain Injury and Attempted Suicide Among Veterans of the Wars in Iraq and Afghanistan. Am J Epidemiol. 2017 Jul 15;186(2):220-226. doi: 10.1093/aje/kwx044. PMID: 28472407.