33-002 · EVIDENCE A · SOURCE-SENSITIVE
The first decade after becoming disabled is a high-risk period for suicide; this shouldn’t be dismissed as “just a matter of staying positive.”
致残之后的头十年是自杀的高风险期，别当成「想开点」就行的事
No cost at all. It only requires a phone call or a single appointment booking.
In the first few years after becoming disabled, it’s very common for both the disabled individual and their family members to experience severe emotional distress — this is not a sign of weak willpower at all. Long-term follow-up studies conducted at two spinal cord injury centers in the UK found that the suicide rate among this group is five times higher than that of the general population. Over 90% of all suicides among these individuals occur within the first decade after their injury. For people whose injury was directly caused by a prior suicide attempt, this risk is even higher.
A
Move “The first decade after becoming disabled is a high-risk period for suicide; this shouldn’t be dismissed as “just a matter of staying positive.”” to Future Me's calendar
The excuse
If I do not open the notes, no new task has technically appeared.
What feels good now
Today I keep a few minutes, a bit of persistence and avoid interrupting my default routine.
What the source says
The source summarizes the return this way: “In the first few years after becoming disabled, it’s very common for both the disabled individual and their family members to experience severe emotional distress — this is not a sign of weak willpower at all. Long-term follow-up studies conducted at two spinal cord injury centers in the UK found that the suicide rate among this group is five times higher than that of the general population. Over 90% of all suicides among these individuals occur within the first decade after their injury. For people whose injury was directly caused by a prior suicide attempt, this risk is even higher.” Evidence grade A. The original states the population, caveats, and sources; this is not a personal forecast.
Use the original facts and limits. For an urgent medical, safety, financial, or legal issue, contact a qualified local professional or service.
THE ENGLISH EDITION
Original recommendation and evidence
2. The first decade after becoming disabled is a high-risk period for suicide; this shouldn’t be dismissed as “just a matter of staying positive.”
Cost: No cost at all. It only requires a phone call or a single appointment booking.
In plain terms: In the first few years after becoming disabled, it’s very common for both the disabled individual and their family members to experience severe emotional distress — this is not a sign of weak willpower at all. Long-term follow-up studies conducted at two spinal cord injury centers in the UK found that the suicide rate among this group is five times higher than that of the general population. Over 90% of all suicides among these individuals occur within the first decade after their injury. For people whose injury was directly caused by a prior suicide attempt, this risk is even higher.
Benefit: This study tracked 2,304 patients with traumatic spinal cord injuries who were newly admitted between 1991 and 2010, survived the first year after injury, and had residual neurological impairments at discharge, with follow-up lasting until the end of 2014. Among them, 63 patients (2.7%) had suffered their injury as a direct result of a prior suicide attempt. By the end of the follow-up period, 533 patients had died, of which 4.2% died by suicide; 91% of all suicides occurred within the first ten years after injury. The age-standardized suicide mortality rate was 62.5 cases per 100,000 people per year (95% CI 36.4–88.6), which is five times the average suicide rate of 12.2 cases per 100,000 people in England and Wales in 2014. Compared to patients with other causes of injury, those whose injury was triggered by a prior suicide attempt had a 4.32-fold higher risk of death overall (P<0.001), and a 9.46-fold higher risk of suicide specifically (P<0.001).
Evidence grade: A
Sources: Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S (2018). Suicide and traumatic spinal cord injury - a cohort study. Spinal Cord, 56(1):2-6. <https://doi.org/10.1038/sc.2017.98>
Notes: This research was limited to spinal cord injury patients only, so the findings should be extrapolated with caution to other causes of disability such as blindness, amputation, or burns. Its main takeaway is the time window of heightened risk: this elevated risk does not fade away immediately after discharge, and requires close monitoring for a full decade. For support services, please refer to Section 29, Item 11 (12356). To prevent accidental harm, avoid storing sleeping pills or pesticides at home; see Section 1, Item 25 (thoughts of suicide). If feelings of grief and emotional distress persist for more than six months, seek help from a psychiatrist or clinical psychologist; see Section 29, Item 8 (grief lasting over half a year).
Read the complete Chinese source and notes
2. 致残之后的头十年是自杀的高风险期，别当成「想开点」就行的事
成本: 不花钱。打一个电话，或者挂一次号。
说人话: 刚残疾那几年，自己或者家人情绪垮掉，是常见的，不是意志力的问题。英国两家脊髓损伤中心的长期随访发现，这群人的自杀率是普通人的五倍。九成以上的自杀发生在受伤后的头十年。受伤原因本身就是自杀的人，风险还要高出一截。
收益: 研究跟踪了 1991 到 2010 年新入院、熬过伤后第一年、出院时有神经功能缺损的 2304 例外伤性脊髓损伤患者，随访到 2014 年底。其中 63 例（2.7%）的受伤原因本身就是自杀未遂。到随访结束共 533 人死亡，其中 4.2% 死于自杀，91% 的自杀发生在受伤后的头十年。按年龄标化的自杀死亡率是每年每 10 万人 62.5 例（95% CI 36.4–88.6，可信范围），是 2014 年英格兰和威尔士普通人群自杀率（每 10 万人 12.2 例）的五倍。因自杀未遂致伤的那部分人，和其他致伤原因相比，死亡的比值比是 4.32（P<0.001），自杀的比值比是 9.46（P<0.001）
证据等级: A
来源: Savic G, DeVivo MJ, Frankel HL, Jamous MA, Soni BM, Charlifue S (2018). Suicide and traumatic spinal cord injury - a cohort study. Spinal Cord, 56(1):2-6. <https://doi.org/10.1038/sc.2017.98>
备注: 这项研究只看了脊髓损伤，套到失明、截肢、烧伤这些别的致残原因上属于往外推。它能说明的是时间窗：风险不是出院就过去了，要盯十年。要人陪着说话打 12356，见第 29 节第 11 条（12356）。家里别囤安眠药和农药，见第 1 节第 25 条（自杀念头）。哀伤和情绪卡住半年还在原地，去精神科或临床心理科挂号，见第 29 节第 8 条（哀伤过了半年）。
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