title: Novel risk factors associated with current suicidal ideation and lifetime suicide attempts in individuals with spinal cord injury.
abstract: OBJECTIVE
  To determine unique associations of suicidal ideation (SI) and lifetime suicide attempts (SAs) in individuals with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional analysis.
  
  
  METHODS
  Outpatient.
  
  
  METHODS
  Individuals with SCI (N=2533) who were 18 years or older with a history of traumatic SCI.
  
  
  METHODS
  None.
  
  
  METHODS
  Any SI in the past 2 weeks (9-item Patient Health Questionnaire) and any lifetime SA.
  
  
  RESULTS
  Three hundred twenty-three individuals (13.3%) reported SI in the past 2 weeks and 179 (7.4%) reported lifetime SA. After controlling for other factors, both lifetime SA and current SI were associated with study site and current level of depression. In addition, SA was associated with less education, younger age at injury, having current or past treatment of depression, and having bipolar disorder or schizophrenia. SI was associated with more years since injury and lifetime SA. Several psychological factors were associated with current SI and lifetime SAs, including lower environmental reward and less positive affect. In addition, control of one's community activities and spiritual well-being were associated with current SI. In bivariate comparisons, severity of SCI was also associated with the 47% of the SAs that occurred after injury.
  
  
  CONCLUSIONS
  Several unique associations of SI and lifetime SA in individuals with SCI were identified, including level of environmental reward and control, spiritual well-being, and severity of SCI. These factors bear further investigation as prospective risk factors for suicidal behavior after SCI.
authors.affiliation: Department of Psychiatry and Behavioral Neurobiology, University of Cincinnati, Cincinnati, OH; Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL. Electronic address: cheryl.mccullumsmith@uc.edu.
authors.forename: Cheryl B
authors.initials: CB
authors.lastname: McCullumsmith
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Claire Z
authors.initials: CZ
authors.lastname: Kalpakjian
authors.affiliation: Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: J Scott
authors.initials: JS
authors.lastname: Richards
authors.affiliation: Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
authors.forename: Martin
authors.initials: M
authors.lastname: Forchheimer
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL.
authors.forename: Allen W
authors.initials: AW
authors.lastname: Heinemann
authors.affiliation: Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Richardson
authors.affiliation: Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Physical Medicine and Rehabilitation, James A. Haley Veterans' Hospital, Tampa, FL.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wilson
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Jason
authors.initials: J
authors.lastname: Barber
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Temkin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Charles H
authors.initials: CH
authors.lastname: Bombardier
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA.
authors.forename: Jesse R
authors.initials: JR
authors.lastname: Fann
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D004777:Environment; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D058992:Social Participation; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000523:psychology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices
keywords: Depression; Rehabilitation; Spinal cord injuries; Suicidal ideation; Suicide; Suicide, attempted