Treatment of severe injuries caused by attempted suicide: Pattern of injury and influence of the psychiatric disorder on the postoperative course

Abstract

Objective: To assess the influence of psychiatric disorders on the treatment and postoperative course of patients severely injured as a result of attempted suicide. Design: Retrospective case study. Setting: University hospital, Germany. Subjects: 36 patients who had multiple injuries after attempting suicide during the five year period 1991-95. Interventions: Operative and psychiatric treatment. Main outcome measure: Functional results assessed with the Trauma Outcome Profile (TOP) score, psychiatric state, and risk of further suicide attempts. Results: 30 of the 36 patients attempted suicide by jumping from a height, and the most common injuries were fractures of the spine (n = 33) and lower limbs (n = 43). All patients had a psychiatric disorder, and 18 had previously attempted suicide at least once though had inflicted only minor injuries. 29 of the 36 were receiving psychiatric care at the time of the suicide attempt. Five patients died. 27 of the 31 survivors were available for follow up and 26 of them had good or excellent functional results. 30 of the 31 underwent psychiatric assessment (one refused) and none was judged to be at risk of a further attempt. Conclusions: The functional results were better than we expected. The psychological effect of severe injuries and a long hospital stay seems to reduce the risk of a further attempt, so all treatment (both surgical and psychiatric) is worthwhile.