Spinal cord injuries and attempted suicide: a retrospective review

Abstract

Study design: A retrospective review examining the cases of 137 individuals with spinal cord injury (SCI) as a result of a suicide attempt between 1951 ± 1992. Objective: To ascertain demographic details of this participant sample, explore and identify the type of psychiatric condition evident around the time of injury, and to review outcome information of this sample with speci®c focus on mortality, especially further evidence of deliberate self harm. Summary of background data: Research examining suicide rates in SCI populations has found such numbers to be signi®cantly higher than in the general population. However, these studies have typically relied on small samples of individuals and have often failed to distinguish between those individuals who sustained SCI as a result of attempted suicide, and those who ®rst attempted suicide following SCI. Methods: An established database comprising details of 137 people with SCI as a result of attempted suicide was reviewed and updated using patient admission records. The subsequent database comprised: cause, level and completeness of injury; height fallen; psychiatric history; psychiatric diagnosis; date of last contact; further suicide attempts; religious aliation; previous and present employment; date and cause of death; date and place of discharge; and any other relevant details. From this database the three primary objectives of the study were ascertained: demographic detail; psychiatric condition; and outcome information. Results:The ratio of males to females was 1 : 1 with a mean age of 32. Almost half (48.9%) were single, around a third (32.8%) had children and 42.3% were employed. Schizophrenia and depression were evident in 32.8% and 27% of cases respectively. Previous suicide attempts had been made by 23% (n=32). The cause of injury in 85% of cases was`falls'. Thirty-three people are known to have died, of whom eight (24%) committed suicide. During the period between the ®rst and last spinal cord injury examined within this study (1951 ± 1992) 1.6% (n=137) of the total sample of patients treated at the rehabilitation centre (n=8347) sustained a spinal cord injury as a result of a suicide attempt. Conclusion: Signi®cant ®ndings include; a high proportion of patients with schizophrenia; similar ®ndings concerning age pro®le and level of injuries with previous research, but dierent sex ratio; and information on longer-term outcomes. Recommendations for further research include an adaptation of the psychological autopsy approach which would provide information beyond that normally available in actual suicides.Keywords: spinal cord injury; attempted suicide; retrospective review IntroductionIt is estimated that suicide accounts for 2% of all male deaths and 1% of all female deaths within the general population.1 Recent research suggests that the age distribution of suicide has changed, whereby males under the age of 45 years are now at a greater risk than older males.1 In SCI populations, death as a result of suicide is two to six times more prevalent than in t...

Rehabilitation outcomes in people with pre-morbid mental health disorders following spinal cord injury

“…One possible explanation for the higher baseline score may be attributed to the psychological needs of patients with SCI having preexisting MHD being assessed and identified on admission through psychology/psychiatry whereby goals may be set and independence achieved before the first NAC. Early psychological contact is routinely provided for patients with MHD, and the importance of such prompt support has been accentuated in Kennedy et al's study, 4 who highlighted the importance of allocation to psychology and psychiatric liaison on admission. This was further supported in the literature for which all the schizophrenic samples received psychological support on admission and exhibited good rehabilitation outcomes.…”

“…This suggests that an MHD may influence the selected method, which if unsuccessful, may result in physical injury. 4 For suicide attempt within the SCI population, the ratio is higher in women compared with men. 5 Additionally, the complexity of MHD experienced within a suicidal group was observed through the high prevalence of comorbid MHD diagnoses.…”

“…However, there are still a small but significant number of people who have made a further attempt, which underscores cause for concern (7.3%). 4 Second, indirect injury causes have been attributed to concentration loss, higher levels of risk-taking behaviour and substance abuse, which have been found to be associated with an MHD. It is important to recognize this subgroup of patients who have sustained an SCI 4 and to examine their long-term outcomes and rehabilitation performance.…”

“…4 Second, indirect injury causes have been attributed to concentration loss, higher levels of risk-taking behaviour and substance abuse, which have been found to be associated with an MHD. It is important to recognize this subgroup of patients who have sustained an SCI 4 and to examine their long-term outcomes and rehabilitation performance. Positive long-term outcomes were reported with regard to domiciliary arrangements, for which a high percentage (70%) of home arrangements were prepared post-discharge.…”

“…9 It has also been suggested that the further research is needed to assess engagement of people with MHD in the rehabilitation process and possible problems; for example, because of selfneglect (secondary complications) or withdrawal from rehabilitation on account of the experience of symptoms. 4 For example, goals have been reported to be affected because of symptoms. 9 Earlier history of depression was reported to predict depression following SCI, 10,11 which highlights the importance of considering preexisting MHD.…”