Addressing Suicidality and Non-Suicidal Self-Injury after Acquired Brain Injury

Acquired brain injury (ABI) is a prevalent physical health condition associated with a 2–4 times higher risk of suicide. Non-suicidal self-injury, such as cutting, remains unexplored in the ABI context, despite its connection to suicidality. People with ABI face unique challenges, including changes to self-identity, reduced coping abilities, and diverse cognitive and communication skills. This population therefore requires tailored resources for addressing suicidality and self-injury. Unfortunately, individuals with ABI are often overlooked in suicide prevention research, resulting in limited practical guidance to assess and respond to these issues. Additionally, there is no research on the experiences of clinicians and researchers in navigating suicidality and self-injury after ABI.

The proposed research has three aims. First, it seeks to gather insights into the experiences, needs, and preferences of individuals with ABI, clinicians, and researchers in addressing suicidality and non-suicidal self-injury. Second, it will investigate novel associations of suicidality and NSSI after ABI with ABI-related stigma, use of unhealthy coping strategies, and positive psychological constructs. Third, guided by the insights gathered, the research aims to develop practical, ABI-tailored training, assessment, and support resources for addressing suicidality and non-suicidal self-injury. We hypothesize that ABI-related stigma and the use of unhealthy coping strategies will positively correlate with suicidality and non-suicidal self-injury. In contrast, healthy coping strategies, self-efficacy, self-esteem, and spirituality will be negatively associated with these issues, beyond the level of emotional distress.

This mixed-methods research will span two years, aiming to survey 320 individuals with ABI in Australia and 500 ABI clinicians and researchers worldwide, followed by 30 qualitative interviews with each group. The research will be guided by conceptual frameworks to ensure the usefulness of the developed resources and emphasize an evidence-based needs- and strengths-focused approach to suicide prevention. Living Experts with firsthand experience of ABI and post-injury suicidality and self-injury will collaborate as equal partners, producing co-designed research materials and practical resources.

Although some structured questionnaires will be included, survey and interview questions will be largely purpose-designed to provide Living Experts with greater opportunity to shape the study and allow the research team to adapt questions to the ABI context. In addition to the aforementioned variables, questions will ask about factors contributing to suicidality and non-suicidal self-injury after ABI, barriers to receiving help, clinicians’ current practices, knowledge, and confidence, training experiences and needs, and suggestions for resources. Inspiration will be drawn from existing measures, including the Columbia Suicide Severity Rating Scale, Non-Suicidal Self-Injury Assessment Tool, and Zero Suicide Workforce Survey.

The proposed research will result in practical resources for addressing suicidality and non-suicidal self-injury after ABI, a vulnerable yet overlooked group. By gaining a comprehensive understanding of stakeholders’ real-world experiences and collaborating with Living Experts, the resources will be tailored to the needs of those who will use them. Our mixed-methods approach will ensure a thorough investigation of the complex nature of ABI, suicidality, and non-suicidal self-injury from multiple perspectives. Moving forward, the next steps in this research will involve disseminating the developed resources, monitoring their use, and evaluating their impact.