Research Program Coordinator II Medical College of Wisconsin Milwaukee, Wisconsin, United States
Body of Abstract: IRB Approval: This project was approved by the Medical College of Wisconsin/Froedtert Hospital Institutional Review Board #5. Research
Aims: The aim of this study was to determine whether mental health outcomes following a medically serious injury (e.g., motor-vehicle collision) were poorer among those who had experienced a suicide loss in the year prior to injury compared to those with no recent suicide loss. We hypothesized that the context of a suicide loss surrounding a traumatic injury would contribute to higher risk for injury-related posttraumatic stress disorder and depression.
Methods: We analyzed cross-sectional data with a sample of traumatic injury patients who were recently discharged from a Level I Trauma Center in Milwaukee County, Wisconsin. Chi-square analyses and independent samples T-tests were used to test between-group differences in mental health outcomes. Participants were grouped as those who had lost an individual to suicide in the year prior to their traumatic injury versus those who had no suicide loss during that time. Between two- and four-weeks post-injury, participants completed self-report questionnaires, and study analyses focused on the Injured Trauma Survivor Screen (ITSS), PTSD Checklist for DSM-5 (PCL-5), and Exposure to Violence (ETV) scale. The ITSS is a 9-item clinical screening tool used to identify risk for PTSD and depression in patients being treated for a traumatic injury, the PSCL-5 is a 30-item self-report measure of PTSD symptoms, and the ETV measures participants’ exposure to violent events and includes 25 items.
Results: The sample was comprised of 143 participants, 28.9% of which (n = 27) reported on the ETV that within the preceding year they had “found out someone [they] knew killed themselves”. On the ITSS, those who reported a suicide loss in the preceding year displayed significantly higher risk for injury-related PTSD (M = 2.67, SD = 1.49; t(141) = -2.89, p = .005) than those who had not experienced a loss by suicide within the last year (M = 1.72, SD = 1.53). They also exhibited higher risk for depression (M = 2.37, SD = 1.67) than those who did not endorse a suicide loss (M = 1.80, SD = 1.50), although group differences in depression risk did not reach statistical significance (t(141) = -1.73, p = .085). Participants with a recent suicide loss were also significantly more likely to reach the threshold for a provisional diagnosis of PTSD (total score of 30 or greater; χ2(1) = 5.85, p = .016) than those without a recent suicide loss.
Conclusions: Our results suggest that the negative psychological effects of an acute stressor (a traumatic injury) are magnified when it takes place in the context of a recent suicide loss. These results are relevant to both suicide postvention initiatives and to trauma centers. To our knowledge, programs supporting individuals following a suicide loss uniformly consider the mental health effects of that loss. However, assessment of and provision of resources to address traumatic stressors outside of the suicide loss may increase their overall effectiveness. Clinicians providing suicide bereavement counseling should assess for the presence of traumatic stressors unrelated to the suicide loss that may influence the individual's wellbeing. Finally, although the American College of Surgeons, which authors the standards for trauma center accreditation, calls for mental health screening of all trauma survivors, our results highlight the importance of considering patients’ psychosocial contexts in formulating plans to prevent PTSD and depression following injury. While these findings need to be replicated in order to inform specific intervention development, they are an important reminder that coping with a suicide loss does not take place in a vacuum, and effective responses are likely to be multi-faceted.
Learning Objectives:
Articulate the mental health outcomes of traumatic injury patients who are recent suicide loss survivors.
Identify potential interventions for recent suicide loss survivors who have sustained a traumatic injury.
Describe where gaps in research exist in relation to suicide loss survivors in trauma centers and postvention efforts involving traumatic injury survivors.
