Vertebral fracture secondary to suicide attempt: demographics and patient outcome in a Scottish spinal rehabilitation unit

Abstract

Objective

To establish occurrence, method of injury, length of stay (LOS), psychiatric diagnosis, rehabilitation outcome, and demographic data for those admitted to a Scottish Spinal Injuries Rehabilitation Unit as a consequence of deliberate self-harm (DSH).

Design

A retrospective audit of case-notes and electronic databases of admissions and rehabilitation outcome in a spinal cord injury (SCI) unit where the mechanism of injury was (DSH).

Results

Forty-six (44 having detailed data available) patients were identified with 95% of injuries resulting from falls. Thirty-six people had pre-existing mental health problems (82%) with 15 (34%) having this diagnosis established shortly after admission. Seventy-five per cent received follow-up from mental health services. Ninety-five per cent returned to their pre-injury (or similar) residence. LOS and functional independence measure (FIM) for the DSH group were compared with a non-DSH group. No differences were found in those with SCI. LOS was significantly longer in the patients with vertebral fracture and no neurological impairment (32 versus 22 days). Sixty-four per cent of those who had self-harmed had substance dependence problems. The predominance of falls (63%) occurred in a residential setting. Annual admissions due to individuals self-harming were stable across the studied period.

Conclusions

Spinal column fracture in the DSH group is predominantly caused by falls. High levels of mental health and substance abuse problems are noted necessitating formal mental health assessment and follow-up. DSH as a mechanism for injury appears to have a significant impact on LOS only if the patient has fracture without SCI. Immediate rehabilitation outcomes are similar to that of non-DSH group.

Keywords:

• Spinal cord injuries
• Rehabilitation
• Self-injurious behaviour
• Suicide