A study funded by the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR).
According to the National Spinal Cord Injury Statistical Center, nearly 18,000 people in the US experience a traumatic spinal cord injury (SCI) each year, and about 294,000 people are currently living with SCI. SCI results in damage to the nerves along the spinal cord and may cause a change or loss of function in the arms, legs, and other body parts. People with SCI are more likely to experience psychological distress, depression, anxiety, and post-traumatic stress disorder than people without SCI. These psychological symptoms are associated with a higher likelihood of considering suicide, also known as suicidal ideation. Studies have found that people with SCI have higher rates of suicidal ideation, suicide attempts, and death by suicide than the general population. However, there is limited research on the potential risk factors for suicidal ideation among people with SCI.
In a recent NIDILRR-funded study, researchers wanted to examine the frequency of suicidal ideation and associated risk factors among people with SCI. Researchers also wanted to identify any medical, demographic, and psychosocial factors that were associated with suicidal ideation.
Researchers at the Northern California Spinal Cord Injury Model System of Care gathered data from 246 people with SCI enrolled in Spinal Cord Injury Model Systems (SCIMS). All participants had temporary or permanent loss of sensory and motor functions and received care at a SCIMS hospital within a year after injury. Participants answered questions about their demographics, level of injury, and whether they had been rehospitalized within the past year. They also reported how often they had thoughts about suicide or harming themselves in the previous two weeks. Participants also answered questions about their mental and physical health, such as their experiences with pain and mobility, satisfaction with life, resilience, and independence at home and in the community.
The majority of participants were White male, had a college degree, and used Medicaid/Medicare as their primary insurance. Most participants had tetraplegia (paralysis of upper and lower body). Eleven percent of participants experienced suicidal ideation. Among these participants, 22% had a plan to harm themselves. Among those who reported suicidal ideation, the researchers found that:
- There was no association between suicide ideation and demographic characteristics of age, sex, race, marital status, and education.
- Participants who reported suicidal ideation had lower levels of physical independence, lower mobility function, lower ability to perform daily self-care activities, lower fine motor ability, and higher perceived pain.
- Participants who reported suicidal ideation had more depressive symptoms, lower satisfaction with life, less resilience, and lower perceived health.
- Depressive symptoms were the strongest predictor of experiencing suicidal ideation while resilience and physical independence were protective against experiencing suicidal ideation.
According to the authors, the findings of this study are consistent with previous studies: suicidal ideation among people with SCI is significantly higher than that of the general population and poorer physical and mental health are risk factors. Contrary to other studies showing women being more likely to report suicidal ideation, the authors noted that the lack of association between sex and suicidal ideation in this study could be due to a small sample size and the participants being predominantly male. Future studies may want to look at larger, more diverse groups of people with SCI or study people with SCI over time to gain a fuller understanding of the risks of suicidal ideation.
The authors noted that improving physical health, stronger social connections, and reducing psychological distress among people with SCI may help reduce their risk for suicide. Practitioners and caregivers may want to identify possible risk factors and offer supports to increase access to healthcare, mental health programs, and community resources, such as peer support for those who are at the highest risk. Interventions delivered by SCI specialists via apps and telehealth have been shown to improve life satisfaction and mental health of people with SCI. Providers may want to explore accessible interventions, such as online exercise classes or nutrition and mental health coaching sessions conducted via mobile phones.
To learn more:
The Model Systems Knowledge Translation Center offers a large collection of evidence-based information resources for people with spinal cord injury, their families and caregivers, and the practitioners who support their physical and mental health and independence. Resources are available in English and Spanish.
The National Paralysis Resource Center fosters involvement in the community and promotes health and improved quality of life for those living with or impacted by paralysis. The center offers information resources, peer support programs, and events for the community.
To learn more about this study:
Khong, CM., Chan, J., Pasipanodya, E., Dirlikov, B., Shem, K. (2023). Risk factors associated with suicidal ideation in individuals with spinal cord injury. Archives of Rehabilitation Research and Clinical Translation. 5:100284. This article is available from the NARIC collection under Accession Number J92939.