Self-directed violence and unclear intent presentation within a major trauma system. A multisite analysis.

Area of Science:

• Trauma care
• Public health
• Clinical psychology

Background:

• Differentiating trauma from self-directed violence (SDV) or unclear intent (UI) is challenging for clinicians.
• Patient sex and injury mechanism can influence trauma classification.
• This study examined differences in characteristics and outcomes between SDV and UI groups within a regional trauma system.

Purpose of the Study:

• To investigate the characteristics and outcomes of patients with self-directed violence (SDV) versus those with unclear intent (UI).
• To explore sex-based differences in presentation and outcomes within SDV and UI trauma cohorts.
• To identify factors associated with unclear intent in trauma patients.

Main Methods:

• Retrospective data collection from January 2018 to December 2021.
• Inclusion of patients identified with self-directed violence (SDV) or unclear intent (UI) behaviors.
• Analysis of demographic, clinical, and injury data, including sex-based comparisons.

Main Results:

• 2760 patients were analyzed; 45% had SDV, while 55% had UI.
• Previous mental health diagnoses were significantly higher in the SDV group (42%) compared to UI (13%).
• Older females (≥65) with UI were more likely to have sustained high-level falls.

Conclusions:

• Mental health comorbidity is associated with SDV, but intent remains unclear for over half of patients.
• Trauma clinicians should assess injury intent and involve mental health specialists.
• Older females and those with prior depression presenting with unclear intent require further investigation for suicide prevention strategies.