Suicide in a spinal cord injured population: its relation to functional status.

OBJECTIVE: To determine the relation between functional status and risk of suicide among individuals with spinal cord injury (SCI).

DESIGN: A follow-up study of all individuals who survived a traumatic SCI during the period from 1953 through 1990.

SETTING: An SCI center in eastern Denmark.

SUBJECTS: A total of 888 individuals with SCI, including 236 who died, 23 of whom committed suicide.

MAIN OUTCOME MEASURES: Standardized Mortality Ratios (SMRs) of suicides among individuals with SCI.

RESULTS: A 100% follow-up was established January 1, 1993. The total suicide rate among individuals with SCI was nearly five times higher than expected in the general population and lower for men than for women. The suicide rate doubled from an early inclusion period (1953-1971) to a later period (1972-1990). An unexpected finding was that the suicide rate in the group of marginally disabled persons was nearly twice as high as the group of functionally complete tetraplegic individuals.

CONCLUSION: Given the high frequency of suicide, there is a need for increased awareness by rehabilitation staff and general practitioners regarding depression and psychological adjustment difficulties. Such conditions should be given special attention during rehabilitation and follow-up, especially among women with SCI and the marginally disabled.