Do Surgical Treatments for Spinal Fractures Affect Outcomes in Suicidal Jumpers?

The study aimed to investigate the influence of trauma etiology on the management, functional outcomes, and psychiatric characteristics of individuals who either attempted suicide by jumping or experienced accidental falls from height. The research included 89 patients, comprised of 48 individuals who fell accidentally and 41 who jumped with suicidal intent, all of whom underwent spinal surgery. Clinical and radiological assessments were conducted, including the Visual Analog Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), and McGill Pain Questionnaire (MPQ) for functional evaluation, along with the BECK Hopelessness Scale (BHS), BECK Depression Inventory (BDI), and SF-36 instruments for psychiatric evaluation. Results from these assessments were compared across the two groups.

The RMDQ and Oswestry Disability Index (ODI) revealed a greater disability in the suicidal jump group, indicating statistically significant differences (p = 0.001 and p = 0.029 respectively). However, the VAS and MPQ scores showed no significant differences between the groups (p = 0.182 and p = 0.306 respectively). The SF-36 scale revealed poorer outcomes related to physical function, emotional roles, vitality, and mental health in the suicide jumpers, with statistical significance reported (p = 0.001, p = 0.029, p = 0.014, and p = 0.030 respectively). The BDI scores were significantly elevated in the suicidal jump group, highlighting a discrepancy in mental health outcomes compared to the accidental fall group (p = 0.017), while no significant difference was identified in terms of hopelessness (p = 0.940).

Patients with suicidal intentions tend to exhibit higher rates of psychiatric disorders, significantly impacting functional recovery after surgical treatment for spinal fractures. The findings emphasize the necessity for a multidisciplinary approach in addressing the clinical outcomes of patients, especially those with substantial physical disabilities.

Falls from a height can result from various factors, including suicide, accidents, or crime. Traumatic spinal injuries are often associated with high-energy impacts, commonly resulting from such falls. Depression and other psychiatric disorders frequently accompany individuals with spinal injuries following suicide attempts, necessitating focused attention from mental health professionals during the rehabilitation phase. Individuals struggling with mental health issues reportedly face a 1.5 times higher risk of complications post-fall compared to their mentally stable counterparts, indicating the significant role of psychiatric conditions in prognostic evaluations.

Numerous previous studies have highlighted demographic differences, injury patterns, and severe trauma presentations between accidental falls and suicide jumps. These studies show that individuals who jump tend to be younger and often possess pre-existing psychiatric histories. In contrast, those who fall accidentally typically sustain compression fractures, whereas burst and chance fractures are more prevalent in patients who jumped. This distinction leads to a heightened need for blood transfusions during surgical procedures involving suicidal jumpers.

The retrospective analysis examined patients admitted for fall-related injuries from January 2015 to December 2020, adhering to local ethical standards. Exclusion criteria comprised individuals under 18, those with cognitive impairments or previous spinal surgery unrelated to fracture, as well as patients lacking adequate follow-up. Evaluation encompassed both clinical and radiological examinations, employing imaging techniques to assess spinal conditions post-injury.

High falls, defined by established clinical standards as falls exceeding 3 meters, were scrutinized, with trauma causation corroborated through interviews and investigations of accident scenes. Psychiatric assessments were conducted by experienced psychiatrists who classified patients based on their psychiatric history, focusing on newly diagnosed conditions upon admission. Functional assessments utilized standardized measures, enabling comprehensive analyses of disability and pain evaluation.

Statistical analysis involved descriptive methods and various comparative tests to assess data between the two patient groups. Notably, descriptive characteristics indicated that the suicide jump group had a significantly lower mean age and higher representation of females in comparison to those who fell accidentally. A greater frequency of accompanying injuries and psychiatric disorders was also noted in the suicidal group.

Outcomes suggested that although pain scores did not differ significantly, overall disability was notably higher among suicide jumpers, highlighting their greater challenges in functional recovery post-injury. Preoperative measures of spinal alignment did not differ significantly; however, postoperative evaluations showed improvements in both groups, albeit the suicide jumpers experienced worse overall disability metrics and depression scores.

The study’s findings signify the importance of recognizing the multifaceted nature of trauma resulting from height-related falls, especially among individuals exhibiting suicidal behaviors. The implications necessitate that orthopedic surgeons conduct thorough psychological evaluations in patients presenting with spinal fractures due to falls, considering potential underlying psychiatric conditions that could hinder recovery. In conclusion, the investigation underscores the need for integrated care methodologies to enhance clinical results for patients recovering from spinal injuries, regardless of the nature of their fall.