Long-term results and quality of life after parasuicidal multiple blunt trauma

Objective: This study evaluates the somatic, Socioeconomic, and psychiatric long-term results, as well as the factors for adverse outcome, in a signif icant subset of patients with severe multiple injuries resulting from attem pted suicide. Design: The follow-up study 6.1 +/- 3 (SD) yrs after trauma was based on pr ospectively documented data of patients with multiple injuries. Setting: Level I university trauma center in a major German city. Measurements and Main Results: Data derived from thorough physical and psyc hiatric evaluations. The Brief Psychiatric Rating Scale and the Global Asse ssment of Functioning Scale served to describe psychiatric outcome. Patients: In a series of 539 severely injured patients (Abbreviated Injury Score in two regions greater than or equal to 3), 65 (12%) attempted suicid es were reported (Injury Severity Score, 40 +/- 15; age, 38 +/- 18 yrs). Tw enty one patients-of the study cohort died during the hospital Stay, and si x subjects died thereafter, none because of suicide. Three patients were lo st to follow-up, resulting in 35 individuals eligible for examination. None of the latter had reattempted suicide. Seventeen (48%) had good or satisfa ctory outcomes reflected by absent or ambulatory psychiatric treatment, emp loyment, normal psychiatric findings (Brief Psychiatric Rating Scale), and good psychosocial ability (Global Assessment of Functioning Scale). For eig ht patients (24%), the result was indeterminate. The adverse outcomes in te n patients (28%) were mainly influenced by the presence of chronic schizoph renia (n = 4), affective disorder (n = 2), or severe traumatic brain injury :(n = 3). Conclusions: Despite the parasuicidal origin, the long term results after s evere trauma were good or satisfactory in approximately half the cases and without further suicide attempts in any of the patients. Good recovery of t he parasuicidal patients in our study is approximately 20% lower than in an unselected group of patients with multiple injuries and may be attributed mainly to the underlying chronic psychiatric disease.