Screening for atypical suicide risk with person fit statistics among people presenting to alcohol and other drug treatment (original) (raw)
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Suicidal and self-injurious behavior among patients with alcohol and drug abuse
Substance Abuse and Rehabilitation, 2012
Background: Self-injurious behavior, a major public health problem globally, is linked with alcohol and drug abuse. This cross-sectional study aimed to identify the prevalence and correlates of self-harming behavior in patients with alcohol or drug abuse problems. Methods: This was a one-year study that recruited a convenience sample of 736 outpatients and inpatients identified with alcohol or drug abuse, and was conducted at Al-Amal mental health hospitals in three major cities. All consecutively selected patients were interviewed on five working days for data collection on a semistructured sociodemographic form using the Columbia Suicide Severity Rating Scale Risk Assessment version. Results: In addition to the socioclinical profile revealed, 50.7% of respondents reported any suicidal ideation, while 6.9% reported self-injurious behavior without intent to die. Any suicidal and self-injurious behavior was reported by 13.1% of participants. A total of 71.3% of respondents reported any recent negative activating events. In addition to any treatment history, observed correlates were hopelessness (60.7%), perceived burden on family (29.5%), refusing a safety plan (26.1%), and sexual abuse (11%). Conversely, reasons for living (64.9%), fear of death or dying due to pain and suffering (64.3%), and spirituality (92%) were largely endorsed as protective factors. There were multiple significant odds ratios (P # 0.01) revealed when independent socioclinical variables were compared with dependent variables in terms of suspected risk and protective factors. In an adjusted logistic regression model, none of the independent variables contributed significantly to any suicidal and self-injurious behavior, any suicidal ideation, or protection from them (P . 0.05). Conclusion: Our preliminary results suggest that there are some socioclinical correlates of any suicide ideation, suicidal and self-injurious behavior, and protection from risky behavior, but which of them contributes significantly to the risk and protective dimensions is yet to be elucidated in prospective community-based studies with larger and more diverse samples.
Predictors and Correlates of Suicide Attempts Over 5 Years in 1,237 Alcohol-Dependent Men and Women
American Journal of Psychiatry, 2003
Objective: In previous studies, factors related to a history of suicide attempts in persons with alcohol dependence have included sociodemographic variables, a more severe course of alcoholism, additional substance use disorders, and psychiatric comorbidity. This 5-year prospective study evaluated attributes associated with suicide attempts in a group of treatment-seeking persons with alcohol dependence. Psychiatric comorbidity was examined in terms of a distinction between substance-induced and independent psychiatric disorders.
BMC Health Services Research, 2012
Background: Observational research frequently uses administrative codes for mental health or substance use diagnoses and for important behaviours such as suicide attempts. We sought to validate codes (International Classification of Diseases, 9 th edition, clinical modification diagnostic and E-codes) entered in Veterans Health Administration administrative data for patients with depression versus a gold standard of electronic medical record text ("chart notation"). Methods: Three random samples of patients were selected, each stratified by geographic region, gender, and year of cohort entry, from a VHA depression treatment cohort from April 1, 1999 to September 30, 2004. The first sample was selected from patients who died by suicide, the second from patients who remained alive on the date of death of suicide cases, and the third from patients with a new start of a commonly used antidepressant medication. Four variables were assessed using administrative codes in the year prior to the index date: suicide attempt, alcohol abuse/dependence, drug abuse/dependence and tobacco use. Results: Specificity was high (≥ 90%) for all four administrative codes, regardless of the sample. Sensitivity was ≤75% and was particularly low for suicide attempt (≤ 17%). Positive predictive values for alcohol dependence/ abuse and tobacco use were high, but barely better than flipping a coin for illicit drug abuse/dependence. Sensitivity differed across the three samples, but was highest in the suicide death sample. Conclusions: Administrative data-based diagnoses among VHA records have high specificity, but low sensitivity. The accuracy level varies by different diagnosis and by different patient subgroup.
Drug Alcohol Rev, 2009
Introduction and Aims. Alcoholism, depression and suicide attempts (SA) are strongly interrelated.The aims were to determine risk factors and develop a prognostic predictor model for SA in a subgroup of patients with a history of alcohol dependence or abuse and depressive symptoms. Design and Methods. A subgroup analysis from the data of the World Health Organisation (WHO)/the International Society for Biomedical Research on Alcoholism (ISBRA)-collaborative study on biological state and trait marker of alcohol use and dependence, an international multi-centre study with a cross-sectional design, based on a standardised questionnaire. We analysed from 1314 variables 43 factors-including demographic characteristics, dependence variables, comorbid disorders, personality trait markers and family history-that were supposed to be most predictive for SA according to the literature. Correlation analyses by the c 2 -test and Mann-Whitney U-test were performed to obtain statistical meaningful parameters for logistic regression analysis. Results. Of the 1863 persons included in the WHO/ISBRA study, 292 had both a history of depressive symptoms and alcohol dependence or abuse and were included in the subgroup analysis. In the logistic regression analysis, drinking status, depressive symptoms, adverse drinking experiences during alcohol consumption, bad experiences from drug abuse and antidepressant therapy were found to be independent risk factors for SA. Positive family history of alcoholism was a model-improving co-factor. This predictive model explains approximately 60% of the variance (Nagelkerkes' square). Discussion and Conclusions. This prognostic model derived from data of the WHO/ISBRA collaborative study shows important risk factors for SA in patients with history of alcohol abuse or dependence and depressive symptoms. [ Yaldizli Ö, Kuhl HC, Graf M, Wiesbeck GA, Wurst FM. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2010;29:64-74]
Characteristics of depressed suicide attempters with remitted substance use disorders
Journal of Psychiatric Research, 2021
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N=135) were compared to those without lifetime SUD (AT−SUD) (N=219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT−SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT−SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
Drug and Alcohol Review, 2009
Introduction and Aims. Alcoholism, depression and suicide attempts (SA) are strongly interrelated.The aims were to determine risk factors and develop a prognostic predictor model for SA in a subgroup of patients with a history of alcohol dependence or abuse and depressive symptoms. Design and Methods. A subgroup analysis from the data of the World Health Organisation (WHO)/the International Society for Biomedical Research on Alcoholism (ISBRA)-collaborative study on biological state and trait marker of alcohol use and dependence, an international multi-centre study with a cross-sectional design, based on a standardised questionnaire. We analysed from 1314 variables 43 factors-including demographic characteristics, dependence variables, comorbid disorders, personality trait markers and family history-that were supposed to be most predictive for SA according to the literature. Correlation analyses by the c 2 -test and Mann-Whitney U-test were performed to obtain statistical meaningful parameters for logistic regression analysis. Results. Of the 1863 persons included in the WHO/ISBRA study, 292 had both a history of depressive symptoms and alcohol dependence or abuse and were included in the subgroup analysis. In the logistic regression analysis, drinking status, depressive symptoms, adverse drinking experiences during alcohol consumption, bad experiences from drug abuse and antidepressant therapy were found to be independent risk factors for SA. Positive family history of alcoholism was a model-improving co-factor. This predictive model explains approximately 60% of the variance (Nagelkerkes' square). Discussion and Conclusions. This prognostic model derived from data of the WHO/ISBRA collaborative study shows important risk factors for SA in patients with history of alcohol abuse or dependence and depressive symptoms. [ Yaldizli Ö, Kuhl HC, Graf M, Wiesbeck GA, Wurst FM. Risk factors for suicide attempts in patients with alcohol dependence or abuse and a history of depressive symptoms: A subgroup analysis from the WHO/ISBRA study. Drug Alcohol Rev 2010;29:64-74]
Psychiatry Research, 2009
Knowledge of the epidemiology of suicide is a necessary prerequisite for developing prevention programs. The aim of this study was to analyze the risk of completed suicide among individuals with alcohol use disorders (AUD), and to assess the role of other psychiatric disorders in this association. A prospective cohort study was used, containing three updated sets of lifestyle covariates and 26 years follow-up of 18,146 individuals between 20 and 93 years of age from the Copenhagen City Heart Study in Denmark. The study population was linked to four different registers in order to detect: Completed suicide, AUD, Psychotic disorders, Anxiety disorders, Mood disorders, Personality disorders, Drug abuse, and Other psychiatric disorders. Individuals registered with AUD were at significantly increased risk of committing suicide, with a crude hazard ratio (HR) of 7.98 [Confidence interval (CI): 5.27-12.07] compared to individuals without AUD. Adjusting for all psychiatric disorders the risk fell to 3.23 (CI: 1.96-5.33). In the stratified sub-sample of individuals without psychiatric disorders, the risk of completed suicide was 9.69 (CI: 4.88-19.25) among individuals with AUD. The results indicate that individuals registered with AUD are at highly increased risk of completed suicide, and that registered co-morbid psychiatric disorders are neither sufficient nor necessary causes in this association.