Cohort Study Finds Increased Suicide Risk in Survivors of Traumatic Injury
Key Clinical Summary
- Critically injured patients had a markedly higher suicide risk after hospital discharge compared with matched population controls in a Norwegian cohort study.
- Suicide incidence was 9-fold higher at 2 years and nearly 7-fold higher at 5 years after traumatic injury hospitalization.
- Female patients and older age at suicide were notable risk patterns, underscoring the need for targeted post-discharge follow-up.
Patients discharged alive after traumatic injury had a 9-fold higher risk of suicide than the general population 2 years after hospitalization, according to a nationwide cohort study from Norway. Published in JAMA Network Open, the analysis leveraged linked national health registries to assess long-term suicide outcomes while adjusting for comorbidities, psychiatric history, and socioeconomic factors.
Study Design and Findings
The researchers identified 25,536 patients recorded in the Norwegian Trauma Registry who required trauma team activation and were discharged alive between 2015 and 2018. Each patient was matched with 10 general-population controls by sex and birth year, yielding 247,095 controls.
Patients were followed for a minimum of 2 years. Suicide, recorded in the Norwegian Cause of Death Registry, was the primary outcome. Analyses accounted for non-suicidal death as a competing risk and adjusted for Charlson Comorbidity Index scores, prior psychiatric illness, and socioeconomic position using inverse probability of treatment weighting.
The cumulative incidence of suicide among patients with traumatic injuries was 0.18% at 2 years and 0.34% at 5 years. In contrast, controls had incidences of 0.02% and 0.05% at the same time points. This translated to a cumulative incidence ratio (CIR) of 9.3 at 2 years (95% CI, 5.4–13.0) and 6.9 at 5 years (95% CI, 4.4–9.1).
Patients with traumatic injuries were older at the time of suicide than controls, with a mean age of 43 years versus 36 years (P = .03). Female patients with traumatic injury also accounted for a higher proportion of suicides compared with female controls (36% vs 17%; P = .005), highlighting sex-specific differences in risk.
Clinical Implications
For clinicians working with trauma survivors, these findings reinforce that discharge does not mark the end of risk. A substantially elevated suicide risk persisted for years after hospitalization, even after adjustment for psychiatric history and socioeconomic status. This suggests that traumatic injury itself may contribute to long-term psychological vulnerability.
The higher relative burden observed among female patients also suggests that sex-specific approaches to post-trauma mental health support may be beneficial.
Expert Commentary
“Many medical specialties are involved in treatment [of patients with traumatic injuries], which can result in fragmented follow-up with lack of overall responsibility for managing complex problems, such as reduced physical ability, pain, psychiatric, and social problems,” noted Anders Rasmussen, MD, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway, and coauthors.
The researchers concluded that a more comprehensive, targeted approach to evaluating mental health and suicide risk may be warranted in this patient population.
