Intentional injury and the risk of subsequent hospitalization for attempted suicide

OBJECTIVE:
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.

METHOD:
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 5 years after the initial trauma hospitalization, and time to onset of first suicide attempt hospitalization by subgroup.

RESULTS:
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.

CONCLUSION:
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.