Spinal cord and related injuries after attempted suicide: psychiatric diagnosis and long-term follow-up

Abstract

Study Design: Retrospective analysis of acute spinal cord injuries (ASCI). Objectives: Determine incidence of ASCI due to suicide attempt from 1970 to 2000. Describe demographics, injuries, mental illness, functional outcomes and nature of subsequent deaths. Setting: State spinal cord injury services, New South Wales, Australia. Methods: Retrospective record review and follow-up interview. Results: Of 2752 ASCI admissions, 56 were because of attempted suicide (55 falls, one gunshot wound). Thirty-six males and 20 females. Median age 30 years (15-74). Most common levels of vertebral injury were C5 and L1. Twenty-three had complete spinal cord injury. Thirtytwo had an Injury Severity Score of 415. Forty had more than one major injury. There was a significant rise in the incidence of ASCI following self-harm over time (Poisson regression, P ¼ 0.004). There was a significant change in scene of injury away from hospitals over time (w 2 test, df ¼ 1, P ¼ 0.0001). Psychiatric diagnoses were personality disorder 27; schizophrenia 16; depression 14; chronic alcohol abuse 10; mood disorder 10; chronic substance abuse 10; other four. Follow-up was available in 47 cases (84%) at an average of 8 years. Four subsequent deaths were by suicide. Domiciliary arrangements were: home 28; hospital five; nursing home three; group home/hostel four. Conclusions: Community placement outcomes for survivors were good. Subsequent death by suicide was high. There was a significant rise in cases and a change in injury scene away from hospitals over time.

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

“…5 Additionally, the complexity of MHD experienced within a suicidal group was observed through the high prevalence of comorbid MHD diagnoses. 1 This is also significant because of the observed elevated incidence of SCI owing to suicide attempt, which has been observed across time. 3 Long-term follow-ups have revealed a high percentage of deaths because of suicide: 2%.…”

“…The MHD reported in the literature are schizophrenia, depression, personality disorder, alcohol and substance abuse and mood disorder. 1 There are two possible explanations for people with preexisting MHD being at increased risk of sustaining an SCI. First, a high percentage of people with SCI have sustained their injury through attempted suicide, for which the majority of the sample has been reported to have MHD.…”

“…3 In Stanford et al's study, 48% of the cases in a sample who have attempted suicide had an MHD; 29% were schizophrenic and 25% had depression. 1 Interestingly, the method chosen for attempted suicide was 'jumping', which may account for the higher percentage of those with schizophrenia who attempt suicide than in the general population. This suggests that an MHD may influence the selected method, which if unsuccessful, may result in physical injury.…”

“…3 Long-term follow-ups have revealed a high percentage of deaths because of suicide: 2%. 1 This may assist to explain the leading cause of death as suicide in the SCI population 3 and the higher incidence of suicide in the SCI population compared with the general population. 6 Overall, studies have shown that the majority of those who have sustained their injury through a suicide attempt have not made a further suicide attempt, which suggests that the problems may have been overcome.…”

“…Positive long-term outcomes were reported with regard to domiciliary arrangements, for which a high percentage (70%) of home arrangements were prepared post-discharge. 1 The majority of research has focused on the long-term outcomes for people who have sustained their injury through suicide attempt, which may indicate an underlying cause of MHD. However, little research has included people with preexisting MHD, who sustain an injury through nonsuicidal causes.…”