Epidemiology of Traumatic SCI

Self-Harm

There were 21 papers reporting on SCI as a result of self-harm (Table 11). The majority of the studies used admission data (N=13 studies) from one or multiple hospitals; one study used an SCI-specific registry, and another used a national health database (Wu et al. 2011). Eight studies were conducted in Europe; five studies were from each of North America and Asia, and one from Oceania.

Proportions of SCI caused by self-harm ranged from a low of 0.4% in Manitoba, Canada (McCammon and Ethans 2011) to a high of 25.9% in Greenland (Pedersen et al. 1989). Thirteen studies reported SCI due to self-harm in the range of 0.4% to 4.5%. In addition to Greenland, two other countries reported relatively higher proportions of self-harm as SCI cause: Finland with 10% (Dahlberg et al. 2005) and Israel with 13.6% (Catz et al. 2002). All three countries with high proportions of SCI due to self-harm also reported high frequencies of suicide

Table 11. Self-Harm

Author Year N of study population	Geographic region	Inclusion/ exclusion criteria	Study population	Injury features	Cause: %(n of cases)
McCammon and Ethans 2011 N=553	Manitoba, Canada	1981-1985, 1998- 2002, 2003-2007 Inclusion criteria: survival to hospital admission with TSCI, or outpatient referral to an SCI rehabilitation specialist. Exclusion criteria: congenital causes of paralysis such as spina bifida or cerebral palsy as well as acquired paralysis from multiple sclerosis or Guillan-Barre syndrome	75.8% male Mean Age: 1981-1985: 29.0 years 1998-2002: 35.3 years 2003-2007: 39.8 years	1981-1985: Cervical: 46.2% Thoracic:33.0% Lumbar: 20.9% Sacral:0.0% 1998-2002: Cervical:45.0% Thoracic:33.3% Lumbar: 21.6% Sacral:0.0% 2003-2007: Cervical:51.3% Thoracic:34.9% Lumbar:12.5% Sacral:1.3%	Self Harm: 81-85: 0.0% 98-02: 1.0% 03-07: 0.4%
Wu et al. 2011 N=41,586	Taiwan	All SCI patients older than 20 years of age and admitted to medical services from 1998-2008 that were identified using the National Health Insurance Research Database of Taiwan.	62% male (n=25857) 61.2% had traumatic SCI (n=25,439)	Cervical: 51.8% N=21,557 Thoracic: 12.3% N=5,098 Lumbar: 22.9% N=9,533 Other SCI: 13.0% N=5,398	Attempted suicide: (2.3%) n=574 calculated using N traumatic SCI= 25,439)
Stanford et al. 2007 N=2,752	Sydney, Australia	1970-2000 All SCI injuries with neurological deficits and documented evidence of self-harm in New South Wales, Australia	36 males; Median age =30 (range 15-74) years	ASIA A n=23 ASIA B n=7 ASIA C n=4 ASIA D n=22	Self-Harm: 2.6% (n=72)
Pickett et al 2006 N=151	London, Ontario, Canada	1997-2006 Admissions to hospital in London, Ontario with SCI	Men=74.2% Mean age = 42.2 ± 20.9 (9-96) years Mortality=12 (8%)	Cervical=75% Thoracic= 10% Lumbar=9% Junctional=6% Complete=35% Incomplete=65%	Self-Harm: 1.3% (n=2)
Dahlberg et al. 2005 N=152	Helsinki, Finland	January 1, 1999 cross-section date Adult citizens (18 years or more) of Helsinki who had permanent sensory or motor deficits because of traumatic SCI (ASIA A–D). ASIA-E cases were excluded.	Males = 76% Average age of injury=47.9 years	Data only for 121 subjects: 46% (n=56) tetraplegia 54% (n=65) paraplegia 57% (n=69) incomplete 43% (n=52) complete	Self-Harm: 10% (n=15)
Gur et al. 2005 N=539	Southeastern Anatolia, Turkey	1990-1999 4 hospitals that were major referral centers for trauma	Males = 77% Average age of injury=30.62 (1-70) years Civil servants: 22.6% (n=120) Housewives: 20.2% (n=109) Soldiers: 15.0% (n=79)	Incomplete paraplegia 29.3% (n=158) Complete paraplegia 45.1% (n=243) Incomplete tetraplegia 13.7% (n=74) Complete tetraplegia 13.9% (n=75) Cervical: 25.4% (n=137) Thoracic: 36.7% (n=198) Lumbar: 34.0% (n=183)	Self-Harm: 2.8% (n=15)
Martin et al. 2005 N=563 (SCI=13)	USA	All patients from the National Trauma Data Bank (2002) with a diagnosis of hanging injury, and survival to admission.	Males=65% Mean age =30.4±13.1 years.	13 patients had SCI: 12 cervical 1 thoracic	Self-Harm: 3% (n=13)
Dryden et al. 2003 N=450	Alberta, Canada	1997-2000 Data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner	Males= 71.6% Median age of injury=35.0 years	61.5% (n=277) cervical 17.3% (n=78) thoracic 17.1% (n=77) lumbar/sacral/cauda equina 4.0% (n=18) unspecified	Self-Harm: 2.0% (n=9)
Pagliacci et al. 2003 N=684	Italy	1997-1999 Rehabilitation admissions to 32 institutions in Italy with traumatic SCI.	Males=80% Mean age=38.5 (11-94) years.	ASIA Scores: A=346 (50%) B=72 (10%) C=149 (22%) D=94 (14%) E=12 (2%)	Self-Harm: 4.4% (n=30)
Pickett et al. 2003 N=2385	Ontario, Canada	1994-1999 SCI in Ontario Trauma Registry	Males= 59% <20 years =2 (11%) 20-39 years= 19 (56%) 40-59 years=13 (25%) ≥60 years=4 (8%)	No details	Self-Harm: 1.4% (n=33)
Catz et al. 2002 N=250	Israel	1959-1992 Traumatic SCI, admitted to the Loewenstein Rehabilitation Center, the major referral center for rehabilitation medicine in Israel.	Males= 75.6% Mean age = 34.5 years (range 6-83 years).	High cervical 7.6% low cervical 28.8% thoracic 32.4% lumbar 31.2%	Self-Harm: 13.6% (n=34)
Exner & Meinecke 1997 N= 22,212	Germany	1976-1996 All traumatic and nontraumatic SCI	72% male.	62% paraplegic 38% tetraplegic	Self-Harm: 5% (n=1080
Otom et al. 1997 N=151	Jordan	1988-1993 Royal Jordanian Rehabilitation Centre (RJRC) King Hussein Medical Centre (KHMC)	Males= 85.4% Average age of injury=33 years	Cervical=31.8% (n=48) Thoraco-lumbar= 68.2% (n=103) Frankel A= 53.6% (n=81) Frankel B = 10% (n=15) Frankel C =22.5% (n=34) Frankel D= 13.9% (n=21)	Self-Harm: 0.7% (n=1)
Levi et al. 1995 N=353	Stockholm, Sweden	1991-1994 Survey of the regional Stockholm SCI population	Males=81% Average age of injury=31 (3-77) years	Cervical 41.6% (n=147) Thoracic 36.0% (n=127) Lumbar 14.7% (n=52) Sacral 1.4% (n=5) Complete 39.4% (n=139) Incomplete 59.5% (n=210)	Self-Harm: 4.0% (n=14)
Shingu et al. 1995 N=9752	Japan	1990-1992 Survey of nationwide institutions assumed to accept SCI patients. Exclusion criteria: Patients only receiving outpatient services in this period	Males= 80.4% Mean age=48.6±19.1 (0.92-96) years.	Frankel levels: A=2518 (25.8%) B=1208 (12.4%) C=1984 (20.3%) D=1761 (18.1%) E=2242 (23.0%) Unknown=39 (0.4%) Cervical=7317 (75.0%) Below cervical=2408 (24.7%) Unknown=27 (0.3%) Complete=61.1%	Self-Harm: 1.7% (n=166)
Silberstein & Rabinovich 1995 N=196	Novosibirsk, Russia	1989-1993 All in patients with SCI admitted to the Department of SCI. Nerve root or plexus injury was excluded.	183 males. Mean age =34.7 years.	Cervical spine C1-2 n=15 C3-7 n=81 Thoracic T1-12 n=54 Lumbar L1-5 n=46	Self-Harm: 3.1% (n=6)
Shingu et al. 1994 N=3465	Japan	1990 Survey of nationwide institutions assumed to accept SCI patients; Exclusion criteria: Traumatic cervical syndrome cases and extradural nerve root; Patients only receiving outpatient services in this year or who obtained injury abroad	Males (overall) = 81.2% Mean age (selfharm) =31.3 years	Cervical=14 (23%) Below cervical=46 (77%)	Self-Harm: 1.7% (n=59)
Lan et al. 1993 N=99	Hualien, Taiwan	1986-1990 Treatment of traumatic SCI in 4 hospitals in Hualien county. Exclusion Criteria: People who died before hospitalization; nontraumatic SCI; patients with transient paralysis; non residents of Hualien.	Males=80%) Mean age (males)=44 years Mean age (females)=46 years Mortality=10 (10%)	Complete paraplegia=1 Incomplete paraplegia=1	Self-Harm: 2.0% (n=2)
BieringSorensen et al. 1990 N=268	Kingdom of Denmark (Denmark, Greenland, Faroe Islands)	January 1975- December 1984 Admission to national specialized rehabilitation hospitals	Male=76.9% 40% within 15-24 years old	268 traumatic lesions Cervical = 136 Thoracic = 76 Lumbar = 56 Complete tetraplegia = 22% Incomplete tetraplegia = 29% Complete paraplegia = 26% Incomplete paraplegia = 23%	Self-Harm: 8% (n=21)
Pedersen et al. 1989 N=27	Greenland	1965-1986 Admissions to rehabilitation hospital in Hornback with traumatic SCI; Patients injured in Greenland.	Males=74% Mean age=33.5 (14-50) years.	Complete paraplegia=5 Incomplete paraplegia=2	Self-Harm: 25.9% (n=7)
Chen et al. 1985 N=560	Taipei, Taiwan	1978-1981 All record from general hospitals in Taipei. Included all spinal cord lesion with or without vertebral injury.	Males= 86% Mean age = 35.9 (range 20-49) years	Incomplete Paraplegia n=118 Complete paraplegia n=180 Incomplete Tetraplegia n=117 Complete Tetraplegia n=145 Death n=31	Self-Harm: 1.4% (n=8)