Race, Age, and Lack of Insurance Increase Risk of Suicide Attempt in Trauma Patients

Temko, Jamie E.; Grigorian, Areg; Barrios, Cristobal; Lekawa, Michael; Nahmias, Larry; Kuza, Catherine M.; Nahmias, Jeffry

doi:10.1080/13811118.2020.1838370

Cited by 4 publications

(4 citation statements)

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“…However, rates of alcohol and drug testing were low among both groups, particularly the CIV group (n = 135,698, 56% vs. n = 3,266, 59%, p < 0.001; and n = 76,090, 31% vs. n = 2,257, 41%, p < 0.001 respectively). Injury Severity Score was higher after LI (13 [6-25] vs. 9 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17], p < 0.001) (Table 3). Median AIS scores were comparable between groups in the head (p = 0.501), face (p = 0.528), neck (p = 0.144), and spine (p = 0.678) but higher in the LI group for the chest (p < 0.001), abdomen (p < 0.001), upper extremity (p < 0.001), and lower extremity (p = 0.009).…”

Section: Resultsmentioning

confidence: 99%

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Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis

Schellenberg

Liasidis

Inaba

et al. 2021

J Trauma Acute Care Surg

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BACKGROUND:Existing data demonstrate that injuries sustained during legal intervention (LI) differ from those incurred during civilian interpersonal violence (CIV), but gunshot wounds (GSWs) have not yet been specifically examined. This study was undertaken to provide an in-depth analysis of patients shot during LI versus CIV. METHODS:Patients injured by GSW and captured by the National Trauma Data Bank (2007-2017) were included. Exclusions were transfer from outside hospital or self-inflicted, accidental, or undetermined injury intent GSWs. Study groups were defined by injury circumstances: GSWs sustained during LI versus CIV. Univariable analysis compared demographics, clinical/injury data, and outcomes. RESULTS:In total, 248,726 patients met inclusion/exclusion criteria: 98% (n = 243,150) CIV versus 2% (n = 5,576) LI. Race varied significantly between study groups (p < 0.001). White patients were the most commonly injured race after LI (n = 2,176, 39%). Black patients were the most commonly injured race after CIV (n = 139,067, 57%). Psychiatric disease (9% vs. 2%, p < 0.001) was more common among LI GSWs. The LI patients were more frequently tachycardic (18% vs. 13%, p < 0.001), hypotensive (26% vs. 14%, p < 0.001), and comatose (34% vs. 15%, p < 0.001). The LI patients had higher Injury Severity Scores (13 vs. 9, p < 0.001), required emergent surgical intervention (39% vs. 28%, p < 0.001) and intensive care unit admission (47% vs. 32%, p < 0.001) more often, and had longer hospital stay (4 vs. 3 days, p < 0.001). Mortality was higher after LI (27% vs. 14%, p < 0.001). CONCLUSION:Significant racial and injury severity differences exist between patients shot during LI and CIV. White patients were the most commonly injured race after LI, while Black patients were the most commonly injured race during CIV. In addition, Black patients were overrepresented in both groups when compared with their proportion in the US population. LI patients were more significantly injured, as quantified by clinical, injury, and outcomes variables including increased mortality. Further study of patients shot during LI is needed to better understand this increased burden of injury.

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Section: Resultsmentioning

confidence: 99%

“…The intersection of injury and race is complex. Among trauma patients, race has been shown to be associated with risk of injury by specific injury intents, 9 risk of undertriage after injury, 10 and different management strategies after injury 11 . The impact of race on outcomes after trauma is more controversial.…”

Section: Discussionmentioning

confidence: 99%

Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis

Schellenberg

Liasidis

Inaba

et al. 2021

J Trauma Acute Care Surg

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“…As the men got older, their risk of suicide decreased. Trauma patients have shown similar trends, with suicidal behavior decreasing after age 40 [26]. Large demographic studies have found peaks for suicidal behavior in the young and another in the elderly [27] with decreased suicidal behavior in mid-life.…”

Section: Protectors Against Suicidal Behaviormentioning

confidence: 87%

Predictive and protective factors in suicidal behavior among males diagnosed with postural tachycardia syndrome

Pederson¹,

Wagner²

2021

J. Mens. Health

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Background: Postural orthostatic tachycardia syndrome (POTS) is a chronic invisible illness characterized by orthostatic intolerance and increased heart rate upon standing (>30 beats per minute in adults and >40 beats per minute in adolescents). This study seeks to characterize the psychological distress in males who have been diagnosed with POTS. Males are diagnosed at much lower rates than females and are underrepresented in the literature.Methods: Forty-one male POTS patients responded to an online survey including the following instruments: acquired capability for suicide-fearlessness about death, beck depression inventory-II, interpersonal needs questionnaire-15, and the suicide behaviors questionnaire-revised.Results: In this study, 58.5% of men surveyed scored in high-risk group for suicide on the suicide behaviors questionnaire-revised. In a multiple linear regression analysis, perceived burdensomeness (β = 0.72; p = 0.001), age (β = -0.41; p = 0.001), changes in health due to chronic illness (β = -0.39; p = 0.05) and fearlessness about death (β = 0.35; p = 0.01) explained 50.7% of their suicidal behavior. Conclusions:In this small sample of men, perceived burdensomeness was the greatest predictor of suicidal behavior followed by fearlessness about death. Age and changes in health due to chronic illness seem to be protective against suicidal behavior. Therapeutic interventions, both medical and psychological, to decrease perceived burdensomeness could decrease the overall risk of suicide in men with postural orthostatic tachycardia syndrome. Fearlessness about death and increased changes in health due to chronic illness as indicators for suicidal behavior may provide an alternative approach for intervention for some men with postural orthostatic tachycardia syndrome.

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“…In addition, there were no data on mortality rate by location (eg, ER, OR, ICU, etc) or mortality due to suicide, which has been found to be associated with a lack of insurance in the trauma setting. 14 Last, our analysis did not exclude or stratify patients that sustained traumatic brain injury (TBI); however, other studies have shown that a lack of insurance in TBI patients is independently associated with worse outcomes. 15 Despite our limitations, our findings are consistent with previous studies associating a lack of insurance with lower admission and higher mortality rates.…”

Section: Discussionmentioning

confidence: 99%

Increased Mortality in Underinsured Penetrating Trauma Patients

Alaniz

Billimek

Figueroa

et al. 2021

The American Surgeon

Self Cite

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Introduction It remains unclear whether an increased mortality risk in uninsured patients exists across Injury Severity Score (ISS) classifications. We hypothesized that penetrating trauma self-pay patients would have a similarly increased mortality risk across all ISS categories. Methods The National Trauma Data Bank (2013-2015) was queried for patients presenting with penetrating firearm, explosive, or stab wound injuries. 115 651 patients were identified and a stratified multivariable logistic regression model was used. Results In the >15 ISS group, self-pay patients had a lower median total hospital Length of Stay (LOS) (3 vs 8, P < .001), lower median Intensive Care Unit LOS (1 vs 3, P < .001), and lower median ventilator days (0 vs 1, P < .001). Self-pay patients had an increased risk for mortality compared to patients with private insurance in both the ≤15 ISS group (OR 2.68, P < .001) and >15 ISS group (OR 1.56, P < .001). Conclusion Uninsured patients have an increased mortality risk in both low and high ISS groups. A higher mortality risk among uninsured patients in the high ISS group can be explained by decreased resource availability and lower ICU days and ventilator time. However, more studies are needed to determine why there is an even greater mortality risk among uninsured patients with mild ISS.

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Race, Age, and Lack of Insurance Increase Risk of Suicide Attempt in Trauma Patients

Cited by 4 publications

References 45 publications

Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis

Gunshot wounds sustained during legal intervention versus those inflicted by civilians: A comparative analysis

Predictive and protective factors in suicidal behavior among males diagnosed with postural tachycardia syndrome

Increased Mortality in Underinsured Penetrating Trauma Patients

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