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Long-term follow-up after severe suicide attempt by multiple blunt trauma

Published online by Cambridge University Press:  16 April 2020

Frank-Gerald Pajonk ,
Steffen Ruchholtz ,
Christian Waydhas  and
Thomas Schneider-Axmann
Frank-Gerald Pajonk*
Affiliation:
Department of Psychiatry and Psychotherapy, The Saarland University Hospitals, Homburg66421, Germany
Steffen Ruchholtz
Affiliation:
Department of Trauma Surgery, University of Essen, Essen, Germany
Christian Waydhas
Affiliation:
Department of Trauma Surgery, University of Essen, Essen, Germany
Thomas Schneider-Axmann
Affiliation:
Department of Psychiatry and Psychotherapy, The Saarland University Hospitals, Homburg66421, Germany
*
*Corresponding author. Tel.: +49 6841 162 4204; fax: +49 6841 162 4270. E-mail address: frank.pajonk@uniklinik-saarland.de (F.-G. Pajonk).
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Abstract

Background

After parasuicide there is a high risk of reattempts. However, it seems that patients who survived severe suicidal trauma recover well. Therefore, the outcome of patients with severe multiple blunt trauma as a result of a suicide attempt was investigated with respect to psychiatric and somatic health, quality of life (QOL) and suicide reattempt rates.

Methods

Patients who underwent a suicide attempt were isolated from a prospectively collected sample of trauma patients from a level I University Trauma Centre. Follow-up examination was performed 6.1 ± 3 years after the trauma. A physical and psychiatric examination was performed, using established psychiatric scales.

Results

Twelve percent of severely injured patients were identified as suicide attempters (male/female: 37/28, mean age 38 ± 18 years, mean Injury Severity Score (ISS) 40 ± 15 points). A psychiatric diagnosis was present in 90% at the time of the suicide attempt. Twenty-one patients died during the hospital stay (32%) and six subjects died thereafter, none due to suicide. Thirty-five individuals were eligible for examination. None of them had reattempted suicide. Seventeen (48%) had good outcomes reflected by absent or ambulatory psychiatric treatment, employment, normal psychiatric findings and good psychosocial ability. An indeterminate outcome was determined in 24%. Predictive variables for an adverse outcome (10 patients, 28%) were found to be a diagnosis of schizophrenia, continued psychiatric treatment and being without employment.

Conclusions

Despite the seriousness of the suicide attempt, survivors recovered well in about half the cases with no further suicide attempt in any patient. An early psychiatric consultation already on the Intensive Care Unit (ICU) is recommended.

Keywords

Suicide attemptMultiple injuryTraumaTreatment outcomeQuality of life
Type
Original article
Information
European Psychiatry , Volume 20 , Issue 2 , March 2005 , pp. 115 - 120
Copyright
Copyright © Elsevier SAS 2005

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References

American Psychiatric Association The Global Assessment of Functioning Scale. Diagnostic and statistical manual of mental disorders. 3rd ed., revised. Washington DC: American Psychiatric Association; 1987.Google Scholar
Anke, AGW, Stanghelle, JK, Finset, A, Roaldsen, KS, Pillgram-Larsen, J, Fugl-Meyer, ARLong-term prevalence of impairments and disabilities after multiple trauma. J. Trauma 1997;42:54–61.CrossRefGoogle ScholarPubMed
Association for Methodology and Documentation in Psychiatry (Arbeitsgemeinschaft für Methodik und Dokumentation in der Psychiatrie AMDP). Das AMDP-System: Manual zur Dokumentation psychiatrischer Befunde. 5th ed. Göttingen: Hogrefe-Verlag; 1995.Google Scholar
Baker, SP, O’Neill, B, Haddon, W, Long, WThe Injury Severity Score. J. Trauma 1974;14:187–196.CrossRefGoogle ScholarPubMed
Chesnut, RM, Marshall, LF, Klauber, MR, Blunt, AB, Baldwin, N, Eisenberg, HMet al.The role of secondary brain injury in determining outcome from severe head injury. J. Trauma 1993;30:480–483.Google Scholar
Committee on Injury Scaling Abbreviated Injury Scale 1990 Revision. Des Plaines, IL: Associationforthe Advancement of Automovement Medicine; 1990.Google Scholar
Curran, S, Fitzgerald, M, Greene, VTPsychopathology 8 1/2 years post parasuicide. Crisis 1999;20:115–120.CrossRefGoogle ScholarPubMed
Federal Statistical Office Gesundheitsbericht für Deutschland. Stuttgart: Metzler-Poeschel Verlag; 2001.Google Scholar
Heimann, H, Schmocker, AMZur Problematik der Beurteilung des Schweregrades psychiatrischer Zustandsbilder. Arzneim Forsch 1974;24:1004–1006.Google Scholar
Holbrook, TL, Anderson, JP, Sieber, WJ, Browner, D, Hoyt, DBOutcome after major trauma: 12- and 18-month follow-up results from the Trauma Recovery Project. J. Trauma 1999;46:765–773.CrossRefGoogle ScholarPubMed
Katz, K, Gonen, N, Goldberg, I, Mizrahi, J, Radwan, M, Yosipovitch, ZInjuries in attempted suicide by jumping from a height. Injury 1988;19:371–374.CrossRefGoogle ScholarPubMed
Kivioja, AH, Myllynen, PJ, Rokkanen, PUIs the treatment of the most severe multiple injured patients worth the effort? A follow-up examination 5–20 years after severe multiple injury. J. Trauma 1990;30:480–483.CrossRefGoogle Scholar
Kurz, A, Möller, HJAttempted suicide: efficacy of treatment programs. Psychiatr. Clin. Neurosci.. 49Suppl 11995 99–103.CrossRefGoogle ScholarPubMed
Miller, RS, Patton, M, Graham, RM, Hollins, DOutcomes of trauma patients who survive prolonged lengths of stay in the Intensive Care Unit. J. Trauma 2000;48:229–234.CrossRefGoogle Scholar
Motto, JA, Heilbron, DC, Juster, RPDevelopment of a clinical instrument to estimate suicide risk. Am. J. Psychiatry 1985;142:680–686.Google ScholarPubMed
Nordentoft, M, Breum, L, Munck, LK, Nordestgaard, AG, Hunding, A, Laursen Bjaeldager, PAHigh mortality by natural and unnatural causes: a 10 year follow-up study of patients admitted to a poisoning treatment center after suicide attempts. BMJ 1993;306:1637–1641.CrossRefGoogle Scholar
Overall, JE, Gorham, DRThe Brief Psychiatric Rating Scale. Psychol. Rep. 1962;10:799–812.CrossRefGoogle Scholar
Owens, D, Dennis, M, Jones, S, Dove, A, Dave, SSelf-poisoning patients discharged from accident and emergency: risk factors and outcome. J. R. Coll. Phys. London 1991;25:218–222.Google ScholarPubMed
Pajonk, FG, Fischer, A, Waydhas, C, Bregenzer, T, Schweiberer, LResults after prolonged surgical Intensive Care Unit treatment. Unfallchirurg 2002;105:423–430.CrossRefGoogle Scholar
Ruchholtz, S, Pajonk, FG, Waydhas, C, Lewan, U, Nast-Kolb, D, Schweiberer, LLong-term results and quality of life after parasuicidal multiple blunt trauma. Crit. Care Med. 1999;27:522–530.CrossRefGoogle ScholarPubMed
Schmidtke, ASuicide: individual, cultural and international perspectives: Germany/Europe. Suicide Life Threat. Behav. 1997;27:127–136.Google Scholar
Schmidtke, A, Weinacker, B, Fricke, SSuicides and suicide attempts in Germany. Suizidprophylaxe 1998; 25(Suppl): 37–49.Google Scholar
Schweiberer, L, Ruchholtz, S, Pajonk, FG, Waydhas, C, Gürtner, I, Schneider, Iet al.Chances and limitations of intensive care medicine in severely injured patients. Intensivmedizin. 33Suppl 11996 51–59.Google Scholar
Seekamp, A, Regel, G, Tscherne, HRehabilitation and reintegration of multiple injured patients: an outcome study with special reference to multiple lower limb fractures. Injury 1996;27:133–138.CrossRefGoogle ScholarPubMed
Suokas, J, Lonnquist, JOutcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a 5 year follow-up. Acta Psychiatr. Scand. 1991;84:545–549.CrossRefGoogle Scholar
Suokas, J, Suominen, K, Isometsa, E, Ostamo, A, Lonnqvist, JLong-term risk factors for suicide mortality after attempted suicide—findings of a 14-year follow-up study. Acta Psychiatr. Scand. 2001;104:117–121.CrossRefGoogle ScholarPubMed
Van Aalst, JA, Shotts, SD, Vitsky, JL, Bass, SM, Miller, RS, Meador, KGet al.Long-term follow-up of unsuccessful violent suicide attempts: risk factors for subsequent attempt. J. Trauma 1992;33:457–464.CrossRefGoogle Scholar
Von Zerssen, DKlinische Selbstbeurteilungsskalen aus dem Münchener Psychiatrischen Informationssystem: Die Befindlichkeitsskala. Arzneim Forsch 1970;20:915–918.Google Scholar
Wirbel, R, Olinger, A, Karst, M, Mutschler, WETreatment of severe injuries caused by attempted suicide: pattern of injury and influence of the psychiatric disorder on the postoperative course. Eur. J. Surg. 1998;164:109–113.CrossRefGoogle ScholarPubMed
World Health Organisation International classification of psychic disorders: ICD-10 Chapter V (F). 3rd ed Bern: Verlag Hans Huber; 1999.Google Scholar
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