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European Journal of Physical and Rehabilitation Medicine 2022 Sep 01

DOI: 10.23736/S1973-9087.22.07341-5

Copyright © 2022 THE AUTHOR(s)

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language: English

Factors influencing the length of stay in a unit with mixed rehabilitation and psychiatric care after a suicide attempt by jumping: a cohort observational retrospective study

France HIROT 1, 2, 3 , Aminata ALI 1, 2, Philippe AZOUVI 1, 3, 4, Caroline HUAS 1, 2, Raphaël EZRATTY 1, 2, 3, Philippe LEMARCHAND 5, Françoise PETAT 5, Sophie BALOGH 5, Philippe LESIEUR 5, Nathalie GODART 1, 2, 3

1 INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Hôpital Paul Brousse, Université Paris-Saclay, Villejuif Cedex, France; 2 Fondation Santé des Etudiants de France (FSEF), Service hospitalo-universitaire de Santé Mentale de l’Adolescent et du Jeune Adulte (SAMAJA), Paris, France; 3 Université Versailles Saint-Quentin-en-Yvelines, UFR Simone Veil-Santé, Montigny-le-Bretonneux, France; 4 APHP - Hôpital Raymond Poincaré. Service de Médecine Physique et de Réadaptation, Garches, France; 5 Clinique FSEF Bouffémont - Service Transdisciplinaire, Bouffémont, France


BACKGROUND: Persons who have attempt suicide by jumping often require intensive treatment for their somatic injuries and the high risk of future completed suicide. The FSEF (French student health foundation) developed a Transdisciplinary unit specifically designed for these people.
AIM: investigate psychiatric and somatic factors associated with Length Of Stay (LOS) in this unit.
DESIGN: cohort observational retrospective study.
SETTING: the Transdisciplinary unit provide a dual approach, combining rehabilitation (physiotherapy, balneotherapy, occupational therapy, speech therapy, cognitive rehabilitation, social and family support) and psychiatric care.
POPULATION: men and women admitted into the Transdisciplinary unit, after a suicide attempt by jumping from a height with severe somatic injuries.
METHODS: we examined the associations between potential predictors and LOS with Stepwise regressions: - Model 1 included all variables assessed at admission (age, sex, occupational status, psychiatric disorder history, height of the fall, type of injury, LOS in acute care units and dependences at admission). - Model 2: all variables at discharge (main psychiatric diagnosis, orientation at discharge, psychotropic
treatments, pain treatments, arms mobility limitation, legs mobility limitation, sphincter disorders and dependences at discharge). - Final model: all significant variables in models 1 and 2.
RESULTS: 197 subjects were included (49.7% of men; mean age: 25.6 years, ± 6.21). Most factors associated with LOS were related to injuries due to the suicide attempt. LOS in the Transdisciplinary unit increased with longer LOS in acute care (β=0.589; p=0.003), higher dependence for continence at admission (β=44.640; p<0.001) and sphincters disorders at discharge (β=78.034; p<0.001). LOS was also
longer with higher dependence for behaviour at discharge (β=30.182; p=0.042) and unemployed status (β=59.496; p=0.008), which could reflect psychiatric disorders severity. LOS was shorter when subjects had arms mobility limitation at discharge (β=-42.591; p=0.018).
CONCLUSIONS: The persons admitted into this unit have serious physical injuries due to their fall. These injuries require intensive rehabilitation and their severity is the largest contributing factor to the LOS. Some findings also advocate for influence of psychiatric factors on LOS, underlying the need for both concomitant psychiatric and somatic care for these people.
CLINICAL REHABILITATION IMPACT: People should ideally receive both psychiatric and rehabilitation care after a suicide attempt by jumping.

KEY WORDS: Suicide attempt; Transdisciplinary; Jump from a height; Mixed somatic and psychiatric unit; Length of stay

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