A systematic review of suicidal ideation and behaviors among adults with spinal cord injury

J Spinal Cord Med. 2023 Jul;46(4):602-613. doi: 10.1080/10790268.2022.2029282. Epub 2022 Feb 22.


Context: Suicide is a public health crisis within the United States. Individuals with spinal cord injury (SCI) are vulnerable to negative outcomes such as suicide.

Objective: This systematic review describes frequency of suicidal ideation (SI) and behaviors (suicide attempt [SA] and deaths) among samples of adults living with SCI. Associated risk and protective factors of SI and suicidal behaviors were also explored.

Methods: On July 7, 2021, OVID Medline, EMBASE, OVID PsycINFO, Web of Science Core Collection, CINAHL, Cochrane Library, and Google Scholar databases were searched for SI, SA, and deaths by suicide among adults with a history of SCI. Risk of bias (RoB) was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool. Results were synthesized descriptively considering the likely impact of RoB. The updated Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 reporting method was used.

Results: Sixty-nine articles were included. Frequency of SI and SAs within study samples ranged from 4% to 67%, and 0% to approximately 66%, respectively. While assessment methods for SI and SA widely varied, suicide deaths data sources were more consistent. Studies assessing SI and SA generally had high RoB and the overall strength of evidence was low. Stronger observational study designs assessing death by suicide had low RoB and the overall strength of evidence was high. Very few studies examined protective factors.

Discussion: Findings support previous work. Quality of evidence, and therefore confidence in the frequency of these outcomes, was impacted by the use of assessment measures without sufficient psychometric properties. The field will benefit from use of psychometrically sound measures to assess for SI, SA and suicide deaths. Furthermore, additional work is needed to elucidate risk and protective factors and to clearly characterize samples to increase generalizability of findings to the larger SCI community, including standardized reporting of SCI characteristics (e.g. use of American Spinal Injury Association classification system). Ultimately, improved suicide assessment and risk management is expected to prevent suicide among those living with SCI.

Registration: CRD42020164686.

Keywords: Adults; Spinal cord injury; Suicidal ideation; Suicide; Systematic review.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Databases, Factual
  • Humans
  • Observational Studies as Topic
  • Risk Factors
  • Spinal Cord Injuries* / epidemiology
  • Suicidal Ideation*
  • Suicide, Attempted / prevention & control

Grants and funding

Support for this effort was provided by the VA Rocky Mountain Mental Illness Research Education and Clinical Center and the Health Sciences Library of the University of Colorado, Anschutz Medical Campus. This manuscript is based on work supported, in part, by the United States Department of Veterans Affairs. The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.