Self-harm and suicide before and after spinal cord injury: a systematic review

Study design: This is a systematic literature review. Objectives: The objectives of this study were to investigate, first, the proportion of spinal cord injury (SCI) caused by suicidal behaviour; second, the proportion of deaths in the SCI population caused by suicide; and third, the risk factors associated with suicidal behaviour. Setting: This study was conducted in the UK. Methods: AMED, EMBASE, HMIC, BNI, Medline, PsycInfo, CINAHL and HEALTH BUSINESS ELITE were searched between January and February 2016, identifying a total of 404 articles published between 1990 and 2016. Full articles, written in English, looking at suicide before and after SCI were selected. On the basis of the inclusion criteria, 22 relevant articles were included in this literature review. Results: Studies reported that between 0 and 6.8% of individuals with SCI had acquired their injury as a result of attempted suicide. The predominant method used in these attempts was deliberate falling/jumping from buildings and bridges. Suicidal behaviour post SCI was frequently reported as a cause of death; studies reported that between 5.8 and 11% of deaths were a result of suicide. The predominant methods used were gunshot and overdose. Psychiatric diagnoses were identified to be a major risk factor for suicidal behaviour. Conclusion: Individuals with SCI are at risk of attempting suicide; this risk is increased by the presence of a psychiatric diagnosis. There is a crucial need for risk assessment and psychological intervention for individuals with mental health issues following SCI.