Spinal cord injuries and attempted suicide: a retrospective review

Study design: A retrospective review examining the cases of 137 individuals with spinal cord injury (SCI) as a result of a suicide attempt between 195 1-1992. Objective: To ascertain demographic details of this participant sample, exp lore and identify the type of psychiatric condition evident around the time of injury, and to review outcome information of this sample with specific focus on mortality, especially further evidence of deliberate self harm. Summary of background data: Research examining suicide rates in SCI populat ions has found such numbers to be significantly higher than in the general population. However, these studies have typically relied on small samples o f individuals and have often failed to distinguish between those individual s who sustained SCI as a result of attempted suicide, and those who first a ttempted 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 adm ission records. The subsequent database comprised: cause, level and complet eness of injury; height fallen; psychiatric history, psychiatric diagnosis; date of last contact; further suicide attempts; religious affiliation; pre vious and present employment; date and cause of death; date and place of di scharge; and any other relevant details. From this database the three prima ry objectives of the study were ascertained: demographic detail; psychiatri c condition; and outcome information. Results: The ratio of males to females was 1.1 with a mean age of 32. Almos t half (48.9%) were single, around a third (32.8%) had children and 42.3% w ere 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 peri od between the first 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: Significant findings include; a high proportion of patients wit h schizophrenia; similar findings concerning age profile and level of injur ies with previous research, but different sex ratio; and information on lon ger-term outcomes. Recommendations for further research include an adaptati on of the psychological autopsy approach which would provide information be yond that normally available in actual suicides.