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.
Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than normal, even with optimal medical management. But improvement has been achieved, as shown by this study of an unselected population of survivors of traumatic SCI, dead or still living. There has been complete follow-up over four decades. The survey included a total of 888 individuals who had survived the injury and were rehabilitated at the Centre for the Spinal Cord Injured, East-Denmark between 1.1.1953-31.12.1990. At the end of the follow-up, 31st of December 1992, 236 had died. The most common causes of death were lung diseases, ischaemic heart diseases and suicide. The Standardised Mortality Ratios (SMRs) were highest for septicaemia, uraemia and pneumonia. Likewise, except for pneumonia, suicide and ischaemic heart disease, a decrease over time in SMRs was seen for all causes of death. The patterns of causes of death in the study group begin to approximate those of the general population.
Life expectancy among individuals with spinal cord injuries (SCI) has remained lower than in the normal population, even with optimal medical management. But significant improvement has been achieved, as will be illustrated in this retrospective study of an unselected group of traumatic survivors of SCI, dead or still living. There has been a complete follow-up over 4 decades, information being obtained from available medical records, death certificates, and post mortem records. The survey included a total of 888 individuals (713 men and 175 women) who had survived the injury and primary treatment and were rehabilitated at the centre for Spinal Cord Injured in Hornbaek, Denmark. At the end of the follow-up, 31st December 1992, 236 (197 men and 39 women) had died. The commonest causes of death were lung diseases, particularly pneumonia; suicide; and ischaemic heart disease. Among functionally complete tetraplegic individuals there was a recognizably high percentage of deaths from pneumonia, and among the least disabled individuals (Frankel class E) we found a high frequency of suicides. The Standardised Mortality Ratios (SMRs) were highest for septicaemia, followed by uraemia and pneumonia. A significant decrease in the overall mortality was observed from the first (1953-1973) to the second half of the observation period (1972-1992). Similarly the survival curves for both men and women demonstrate that the gap in survival probability between the normal population and the SCI has diminished considerably from the early to the later period. Likewise, except for suicide and ischaemic heart disease, a decrease in SMRs was seen for all causes of death. In particular there were large decreases related to lung embolus, septicaemia, pneumonia, and uraemia. The patterns of causes of death in the study group begin to approximate those of the general population, though many cause-specific deaths for SCI remain substantially above the normal population. Continuous improvement in preventive measures as well as treatment procedures is still necessary.