New research outlines how spinal injuries in suicidal jumpers differ from those in non-suicidal patients with regard to patient demographics, mental health condition, injury location, neurological damage and associated injuries. The study was carried out by Hiroki Kano and colleagues from Osaka General Medical Center (Osaka, Japan), and has been recently published in Spine.
According to the authors, previous research indicates that spinal injuries are seen in half of survivors of suicide jumping; of which are known to display common characteristics. Alongside a large proportion of suicide jumpers having a psychiatric diagnosis, they are predominantly male, middle-aged, unemployed and single. Yet, irrespective of these demographics, the authors note that the aetiology of spinal injuries in suicide jumpers is not well understood.
Furthermore, Kano et al emphasise the importance of clinicians being well-versed in the characteristics of spinal injuries in suicide jumpers; they write: “Traumatic suicidal jumping is no longer rare because the number of patients with mental health problems is increasing.”
The retrospective case series, carried out at a single institution, was performed to investigate the characteristics of spinal injuries in survivors of suicide jumping.
Kano et al identified 87 survivors of suicidal jumping who sustained spinal injuries from 2007 to 2016. The demographic data, mental health condition, neurological status, injury location, associated injuries and treatments were compiled and compared between the survivors and non-suicidal patients with spinal injuries (n=204).
Patients’ mental health condition was evaluated by interviewing patients, checking their use of tranquilisers or antidepressants, and assessing their history of mental illness, while neurological status was evaluated using the American Spinal Injury Association Impairment Scale (AIS) at the time of admission. The spinal injuries themselves were evaluated by whole-body helical computed tomography.
Of the total number of patients with spinal injuries, 196 were male and 95 were female (with a mean age of 47.5 years). However, suicide jumpers were predominantly female (67%) and 10 years younger than non-suicidal patients (mean age of 40.3 and 50.5, respectively).
Mental health problems were diagnosed in 66 (77%) of 87 suicidal jumpers, with a large proportion of patients found to have schizophrenia (29%) and depression (29%). Comparisons of neurological deficits found that spinal trauma was generally less severe in suicidal jumpers than in non-suicidal patients.
The majority of spinal injuries in suicidal jumpers were located in the thoracic or lumbar spine region, where as cervical spine injury was observed in 49% of patients who had accidentally fallen compared with 15% of suicidal patients. Neurological deficits in suicidal jumpers were rare compared with those in non-suicidal patients regardless of injury location. Among comorbid injuries, extremity injuries were highly associated with spine injury in contrast to 33% of non-suicidal patients.
Furthermore, approximately 25% of suicidal jumpers underwent surgical treatment. Interestingly, surgical treatment was similarly performed on suicidal jumpers and non-suicidal patients regardless of the discrepancy in neurological damage between the two groups.
In conclusion, the authors write: “Spinal injuries differ in many aspects between suicidal jumpers and non-suicidal patients.” Kano et al’s study investigates survivors of suicidal jumping that were young, predominantly female with mental health problems—the majority of which tended to have thoracic and lumbar spine trauma compared with cervical trauma with less severe neurological deficits and a higher incidence of accompanying limb injury.
As recent research outlines that suicide is the eighth most frequent cause of death in Japan—with more than 23,000 fatalities a year—the authors reiterate the importance of well-advised clinicians, as spinal injuries in suicidal survivors are only expected to increase.