title: Increased suicidal activity following major trauma: a population-based study.
abstract: BACKGROUND
  Nonfatal injuries are a leading cause of morbidity and mortality. In 2008, 14,065 patients with major trauma were hospitalized across Canada. With individuals surviving trauma, the psychosocial sequelae of severe physical injury have become an important area of research. No previous studies have used a population-based sample to estimate the incidence of suicidality (suicide or suicide attempt) following physical injury. This study aimed to assess the odds ratio (OR) of suicidality among adults with major trauma compared with a matched cohort.
  
  
  METHODS
  This retrospective study included persons older than 18 years who experienced an unintentional major traumatic injury (Injury Severity Score [ISS] > 12) at a regional academic trauma center between April 1, 2001, and March 31, 2011. Individuals who had no suicide attempts in the previous 5 years were identified from the trauma registry. These individuals were matched with data from provincial administrative databases. A cohort matched in terms of age, sex, and date of indexed injury was created from the general population with five controls for each trauma case, and the rate of suicidality was compared between groups.
  
  
  RESULTS
  A total of 2,198 adults with major were matched to 10,990 individuals. Suicidality was increased in the trauma cohort (OR, 4.31). This increase persisted even if adjusted for anxiety/mood disorders and substance abuse (adjusted OR1, 3.65) as well as residence, physical comorbidities, income quintile and those factors in adjusted OR1 (adjusted OR2, 3.30). All ORs were significant with p < 0.05 CONCLUSION: Individuals who experience major traumatic injuries are at a greater risk for postinjury suicidality compared with those in a matched cohort.
  
  
  METHODS
  Epidemiologic study, level IV.
authors.affiliation: Department of Psychiatry (J.M., J.S., S.N., W.H., D.P., M.W.E.), University of Manitoba, Manitoba, Canada; Department of Surgery (J.P.G., S.L.), Section of Plastic Surgery, University of Manitoba, Winnipeg, Manitoba, Canada; Manitoba Centre for Health Policy (M.D., D.C., S.K.), University of Manitoba, Manitoba, Canada; Department of Surgery (M.H.), University of Manitoba, Winnipeg, Manitoba, Canada; Department of Internal Medicine (W.D.L.), University of Manitoba, Winnipeg, Manitoba, Canada 6: Department of Family and Preventive Medicine (M.B.S.), University of California San Diego, San Diego, California; Anxiety and Illness Behaviours Laboratory (G.J.G.A.), University of Regina, Regina, Saskatchewan, Canada; Department of Psychology (M.M.), University of Manitoba, Manitoba, Canada.
authors.forename: Justin
authors.initials: J
authors.lastname: March
authors.forename: Jitender
authors.initials: J
authors.lastname: Sareen
authors.forename: Justin Peter
authors.initials: JP
authors.lastname: Gawaziuk
authors.forename: Malcolm
authors.initials: M
authors.lastname: Doupe
authors.forename: Dan
authors.initials: D
authors.lastname: Chateau
authors.forename: Mike
authors.initials: M
authors.lastname: Hoppensack
authors.forename: Saman
authors.initials: S
authors.lastname: Nour
authors.forename: Will
authors.initials: W
authors.lastname: Husarewycz
authors.forename: Dan
authors.initials: D
authors.lastname: Palitsky
authors.forename: Sazzadul
authors.initials: S
authors.lastname: Khan
authors.forename: William D
authors.initials: WD
authors.lastname: Leslie
authors.forename: Murray W
authors.initials: MW
authors.lastname: Enns
authors.forename: Murray B
authors.initials: MB
authors.lastname: Stein
authors.forename: Gordon J G
authors.initials: GJ
authors.lastname: Asmundson
authors.forename: Maria
authors.initials: M
authors.lastname: Medved
authors.forename: Sarvesh
authors.initials: S
authors.lastname: Logsetty
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008350:Manitoba / Q000453:epidemiology; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data; D014947:Wounds and Injuries / Q000523:psychology*