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Blows to the head may triple the risk of early death, according to a new study. Researchers found that premature death in TBI survivors are often from suicide of fatal injuries.

Traumatic brain injury includes blows to the head that lead to skull fracture, internal bleeding, or loss of consciousness for longer than an hour.

The study looked at Swedish medical records going back 41 years covering 218,300 TBI survivors, 150,513 siblings of TBI survivors and over two million control cases matched by sex and age from the general population.

'We found that people who survive six months after TBI remain three times more likely to die prematurely than the control population and 2.6 times more likely to die than unaffected siblings,' said study leader Dr Seena Fazel, a Wellcome Trust Senior Research Fellow in Oxford University's Department of Psychiatry. 'Looking at siblings who did not suffer TBIs allows us to control for genetic factors and early upbringing, so it is striking to see that the effect remains strong even after controlling for these.'

Researchers added that TBI survivors who also have a history of substance abuse or mental illness are most likely to die prematurely or before the age of 56.

The study revealed that the main causes of death in TBI survivors include suicide and fatal injuries from car accidents and falls.

"TBI survivors are more than twice as likely to kill themselves as unaffected siblings, many of whom were diagnosed with psychiatric disorders after their TBI," said Fazel. "Current guidelines do not recommend assessments of mental health or suicide risk in TBI patients, instead focusing on short-term survival. Looking at these findings, it may make more sense to treat some TBI patients as suffering from a chronic problem requiring longer term management just like epilepsy or diabetes. TBI survivors should be monitored carefully for signs of depression, substance abuse and other psychiatric disorders, which are all treatable conditions."

"This study highlights the important and as-yet unanswered question of why TBI survivors are more likely to die young, but it may be that serious brain trauma has lasting effects on people's judgment," suggests Fazel. "People who have survived the acute effects of TBI should be more informed about these risks and how to reduce their impact."

"When treating traumatic brain injuries focus is placed on immediate treatment and recovery of patients," said Dr John Williams, Head of Neuroscience and Mental Health at the Wellcome Trust. "This new finding offers important insight into the longer-term impact of TBI's on the brain and their effect on survival later in life. We hope that further research into understanding which parts of the brain are responsible will help improve future management program and reduce the potential for premature death."

The findings are published in the journal JAMA Psychiatry.