Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

Robins, Julian; Morley, Katherine I.; Hayes, Richard D.; Ross, Kezia R.; Pritchard, Megan; Curtis, Vivienne; Kalk, Nicola J.

doi:10.1016/j.drugalcdep.2021.108725

Cited by 4 publications

(5 citation statements)

References 38 publications

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“…Current suicidal ideation in the absence of an historic attempt was also associated with a significant increase in hazard of later crisis care contact or death by suicide, supporting results from crisis assessment settings that found that whilst acute alcohol use and binge drinking are associated with transient suicidal intent, alcohol dependence is not, and is the form of alcohol use most associated with later suicidal behaviour (43,44).…”

Section: Discussionsupporting

confidence: 60%

Risk factors for suicide attempts in community alcohol treatment

Robins,

Morley,

Hayes

et al. 2024

Preprint

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Background Alcohol Use Disorder is associated with suicide and suicide attempts, and addiction treatment services have a role in suicide prevention. We aimed to identify risk factors for suicide attempt among a cohort of community-based alcohol treatment service users. Methods Linked data from 4415 adults accessing secondary addiction services for alcohol treatment between 2006 and 2019 in London, UK, were used to identify risk factors for suicide attempt. Cox proportional hazards regression estimated the relative increase or decrease in hazard associated with each risk factor on a composite outcome event; death by suicide or contact with emergency psychiatric care within one year of starting treatment. Findings There were 468 (10.5%) crisis care contact events, and <10 suicide deaths. After adjustment, factors associated with increased hazard of crisis care contact or death by suicide were history of suicide attempt (HR 1.83[1.43-2.33]), poor mental health (HR 1.81[1.41-2.32]), current suicidal ideation (HR 1.65[1.18-2.31]), use of drugs other than cocaine, cannabis and opiates (HR 1.41[1.02-1.95]), female sex (HR 1.34[1.10-1.65]) and social isolation (HR 1.24[1.02 - 1.51]). Factors associated with reduced hazard of crisis care contact or death by suicide were alcohol abstinence (HR 0.51[0.31-0.83], ref>30 units), drinking 1-15 units (HR 0.64[0.49-0.85], ref>30 units), Black ethnicity (HR 0.61[0.45-0.83]) and living with children (HR 0.74[0.56-0.99]). Interpretation The identified risk factors for suicide attempt can help risk formulation and safety planning among patients accessing alcohol treatment services. Funding National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London.

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Section: Discussionsupporting

confidence: 60%

Risk factors for suicide attempts in community alcohol treatment

Robins,

Morley,

Hayes

et al. 2024

Preprint

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“…This is perhaps unsurprising given that medically assisted withdrawal is likely necessary in this group and national guidance recommends that for patients with significant psychiatric comorbidity, consideration should be given to in-patient medically assisted withdrawal (National Institute for Health and Care Excellence (NICE) 2011) although suicidality is not explicitly referred to. Our results do point to a potential treatment gap when considered in the light of research showing that patients who are intoxicated in association with a suicidal act are less likely to be admitted to a psychiatric in-patient unit following crisis assessment (Robins et al 2021b). This is especially concerning given that alcohol dependence is associated with a two-fold increase in the odds of death or representation to crisis care following a suicidal act (Robins et al 2021b).…”

Section: Discussionmentioning

confidence: 71%

“…Our results do point to a potential treatment gap when considered in the light of research showing that patients who are intoxicated in association with a suicidal act are less likely to be admitted to a psychiatric in‐patient unit following crisis assessment (Robins et al . 2021b). This is especially concerning given that alcohol dependence is associated with a two‐fold increase in the odds of death or representation to crisis care following a suicidal act (Robins et al .…”

Section: Discussionmentioning

confidence: 99%

Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team

Robins

Morley

Hayes

et al. 2023

Int J Mental Health Nurs

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Despite associations between alcohol use and suicidal acts, little research measures prognoses of alcohol‐using patients treated by Crisis Resolution Teams (CRTs), an intensive community‐based intervention. We estimated the association of alcohol use amongst patients accepted following suicidal acts or ideation in four London‐based Crisis Resolution Teams, with death‐by‐any‐cause or recontact with crisis care. We analysed the electronic health records of 1615 CRT patients accepted following suicidal acts or ideation over 38 months, following STROBE guidelines. Using logistic regression we estimated the association of alcohol use (indicated by risk‐assessment, AUDIT, or ICD‐10 diagnosis) with death‐or‐recontact at (i) 30‐days and (ii) 1‐year after treatment start, adjusted for age, sex, ethnicity, psychiatric diagnosis, and severity of need. Hazardous, harmful, or dependent drinking was identified in 270 cases at baseline (16.7%); 73 (4.5%) were alcohol dependent. By 1‐year, 622 patients (38.5%) had recontacted crisis care or died. After adjustment, alcohol use at a hazardous, harmful, or dependent level was not associated with increased odds of death‐or‐recontact at 30‐days (AOR 1.17, 95%CI 0.73, 1.88) or 1‐year (AOR 1.17, 95%CI 0.85, 1.60). Patients with hazardous, harmful, and dependent alcohol use are a small proportion of CRT patients, despite being more commonly encountered in emergency settings from which patients may be referred to CRTs, indicating a potential gap in provision. Those who are included in CRTs are not at increased risk of death‐or‐recontact within 1 year of treatment, suggesting that their inclusion can work, at least in a sample with predominantly hazardous or harmful alcohol use.

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“…To identify risk profiles, we employed latent class analysis (LCA), a data-driven method that can identify subgroups of people based on frequently co-occurring patterns in the data. For example, LCA has been applied to characterizing subgroups of people based on patterns of alcohol use (Robins et al, 2021), other behavioral factors such as physical inactivity and poor diet (Cook et al, 2020), and multimorbidity (Smith et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

“…To identify risk profiles, we employed latent class analysis (LCA), a data‐driven method that can identify subgroups of people based on frequently co‐occurring patterns in the data. For example, LCA has been applied to characterizing subgroups of people based on patterns of alcohol use (Robins et al., 2021), other behavioral factors such as physical inactivity and poor diet (Cook et al., 2020), and multimorbidity (Smith et al., 2021). This study aimed to: (1) identify and describe risk profiles of adults with heavy alcohol use by heavy drinking patterns, other behavioral and metabolic factors, and morbidity, using LCA; and (2) examine whether there were racial and ethnic disparities in the risk profiles identified.…”

Section: Introductionmentioning

confidence: 99%

Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities

Palzes,

Chi,

Weisner

et al. 2023

Alcohol: Clinical and Experimental Research

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BackgroundHeavy alcohol use is a growing risk factor for chronic disease, yet little is known about its co‐occurrence with other risk factors and health problems. This study aimed to identify risk profiles of adults with heavy alcohol use and examine potential disparities by race and ethnicity.MethodsThis cross‐sectional study included 211,333 adults with heavy alcohol use (exceeded daily or weekly limits recommended by National Institute on Alcohol Abuse and Alcoholism) between June 1, 2013 and December 31, 2014 in Kaiser Permanente Northern California. Latent class analysis was used to examine how heavy drinking patterns clustered with other behavioral and metabolic risk factors and health problems to form risk profiles. Multinomial logistic regression models were fit to examine associations between race, ethnicity, and risk profiles.ResultsA 5‐class model was selected as best fitting the data and representing clinically meaningful risk profiles: 1) “heavy daily drinking and lower health risks” (DAILY, 44.3%); 2) “substance use disorder and mental health disorder” (SUD/MH, 2.3%); 3) “heavy weekly drinking and lower health risks” (WEEKLY, 19.6%); 4) “heavy daily drinking and more health risks” (DAILY‐R, 18.5%); 5) “heavy weekly drinking and more health risks” (WEEKLY‐R, 15.3%). American Indian or Alaska Native (AIAN) and Black patients had higher odds than White patients of being in the SUD/MH, DAILY‐R, and WEEKLY‐R profiles rather than the DAILY profile. AIAN, Black, and Latino/Hispanic patients had higher odds than White patients of being in the SUD/MH, DAILY‐R, and WEEKLY‐R profiles rather than the WEEKLY profile.ConclusionsAIAN, Black, and Latino/Hispanic patients with self‐reported heavy drinking were more likely to be in risk profiles with greater alcohol consumption, more health risks, and higher morbidity. Targeted, culturally appropriate interventions for heavy alcohol use that may address other modifiable risk factors are needed to work towards health equity.

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Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

Cited by 4 publications

References 38 publications

Risk factors for suicide attempts in community alcohol treatment

Risk factors for suicide attempts in community alcohol treatment

Outcomes following suicidal crisis among hazardous and harmful alcohol users in the Crisis Resolution Team

Risk profiles of adults with heavy alcohol use: Drinking patterns, behavioral and metabolic factors, health problems, and racial and ethnic disparities

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