Statement of Purpose The causes of suicide attempts or ideation are complex and multifaceted. This study analyzes physical traumatic injury as a risk factor for suicide ideation and intentional self-harm.

Methods/Approach A retrospective analysis of an all-inclusive inpatient dataset, comparing the one-year hospital readmission rate, involving intentional self-harm or suicide ideation, of two groups of injured patients: (a) those classified as trauma alerts (TAs) at a Level I or II trauma center or (b) individuals who were treated as emergencies without activation (EMWA) of trauma services. We compared readmission rates (per 1000) of TAs and EMWAs using t-tests. Logistic regression further examined the probability of readmission with suicide ideation or intentional self-harm, controlling for patient demographics, pre-existing mental health conditions, injury type, and socioeconomic status.

Results Rates of readmission with intentional self-harm and suicide ideation were, on average, 60 and 45 percent higher for the TA compared to the EMWA patient group (P < 0.001). Compared to the population at large, the post-trauma hospitalization rate for self-harm and suicide ideation was, respectively, 8.7 and 7.6 times greater (P < 0.001). Over 80% of patients readmitted with intentional self-harm or suicide ideation had a pre-existing mental health condition. Logistic regression results indicate these patients had an odds-ratio of near six, predicting the readmission. Examining the subset of patients without a documented history of a mental health condition, trauma alert patients were significantly more likely to commit initial and intentional self-harm (OR=1.26, 95% CI 1.03–1.53) or develop suicide ideation (OR=1.28, 95% CI 1.08–1.42), diagnosed during an inpatient readmission within one year of the signature event. Gender, race, insurance status, socioeconomic status, and injury type were also significant.

Conclusions There is a significant difference between trauma alerts versus emergencies without trauma services as it pertains to the post-hospitalization development of suicide ideation or engagement in intentional self-harm.

Significance Mental health support must be made available to survivors of major trauma, particularly those with a preexisting mental health condition and traumatic brain injury.