Intentional Injury and the Risk of Subsequent Hospitalization for Attempted Suicide

Abstract

Trauma patients are at increased risk of suicidal behavior. The association between assault injury and subsequent suicidal behavior relative to unintentional injury remains under-studied. This study hypothesized that trauma patients with assault injuries would demonstrate greater risk of subsequent suicide attempt hospitalization compared to patients with unintentional injury. Trauma patients hospitalized in Washington State were identified via administrative records. Proportional hazard analysis was conducted to test differences in risk of suicide attempt hospitalization up to 5years after the initial trauma hospitalization, and time to onset of first suicide attempt hospitalization by subgroup. Approximately 2% (n=1264) of trauma inpatients were subsequently hospitalized for attempted suicide, and 0.3% died by suicide (n=177) during the follow-up period. Relative to patients with unintentional injuries, those with assault-related injuries (aHR=1.38, 95% CI: 1.02 to 1.86), and self-inflicted injuries (aHR=8.22, 95% CI: 7.24 to 9.33) demonstrated greater risk of suicide attempt hospitalization after discharge. These findings demonstrate a greater risk of suicidal behavior among trauma patients with assault injuries relative to patients with unintentional injuries. This suggests the importance of intentional cause of injury as a risk factor for suicidal behavior to be considered in assessment of suicidality and discharge planning for trauma patients.