Traumatizing Oneself—Deep Wrist Injuries Self‐Inflicted with Suicidal Intention are Associated with More Severe PTSD Symptomatology than Similar Injuries from Accidents

Abstract

Objective As suicide attempts by definition entail at least some threat to physical integrity and life, they theoretically qualify as an A1 criterion for posttraumatic stress disorder (PTSD). This study uses the unique opportunity of deep wrist injuries to quantify the effect of intentionality on PTSD rates by comparing suicide attempt survivors with patients who sustained accidental injuries similar in mechanism, localization, and extent. Method Patients who had been admitted with an acute deep wrist injury from 2008 to 2016 filled out the revised Impact of Event Scale and reported other known PTSD risk factors. Mental morbidity and intentionality of the injury were determined by psychiatric consultation during the index hospitalization. Results Fifty‐one patients were followed up (72.5% male, 92.2% Caucasian, mean age at injury 42.3 ± 17.5 years, 72.5% accidental injuries), on average 4.2 ± 2.9 years after their injury. The intentionality of the injury alone predicted the severity of intrusions, avoidance, hyperarousal, and probable PTSD (aOR = 14.0). Conclusions Traumatization in the context of a suicide attempt may be a hitherto unknown PTSD risk factor. Patients after suicide attempts, especially medically serious attempts, should be monitored for PTSD symptoms.

Measuring the impact of suicide attempt posttraumatic stress

“…However, the context of when these associations are examined and who is included in the sample makes comparisons difficult. Given the similarity in samples of suicide attempt survivors, our results build most closely on the findings by Westermair et al (2020) by integrating suicide‐specific constructs associated with the IPTS into our design.…”

“…Although understudied in the field of suicide prevention (Stanley et al, 2019), there is reason to believe that medically serious suicide attempts and resulting treatment may be experienced as traumatic by the survivor. A recent study by Westermair et al (2020) found that intentional self‐injury by deep wrist laceration was associated with greater PTSD symptomatology years later in comparison with those treated for similar unintentional injuries. The authors describe the extent to which characteristics of the attempt, such as deciding against dying and needing to treat one's own physical injuries, may be experienced as traumatic.…”

Infusing the trauma-informed approach in youth suicide research: Lessons from the field.

“…Children who have experienced the death by suicide of a parent or a sibling are at elevated risk for psychiatric symptoms, especially depression, posttraumatic stress disorder, and social maladjustment (Pfeffer et al, 1997(Pfeffer et al, , 2000Sethi & Bhargava, 2003). Adult survivors of suicide have been found to be susceptible to developing trauma symptoms, including a preoccupation with and/or avoidance of reminders about suicide, terror-filled recollections, emotional withdrawal, and hyper arousal, among others (Hibberd et al, 2010;Westermair et al, 2020). In a study by Stanley, Hom, et al (2019), over one-quarter of adult suicide attempt survivors (27.5%) reported post-traumatic stress disorder symptoms related to their suicidal behaviors.…”