Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care

Abstract

Background Suicide is a major public health concern, particularly among people who use illicit substances and/or non-prescribed medications. Objective The present study prospectively assessed the incidence and predictors of suicidal ideation (SI) and suicide attempt (SA) among such substance-using patients over 12 months after receiving primary care. Design Secondary analysis of data from a randomized clinical trial of screening, brief intervention, and referral to treatment for substance use within seven public, safety-net, primary care clinics. Participants Adults (N=868) who used illicit drugs or non-prescribed medications at least once in the past 90 days prior to the baseline primary care visit and consented to participate. Main Measures At baseline, interviewers assessed demographics, psychiatric symptoms, substance use, psychosocial stressors, treatment service utilization, quality of life, past-month SI, and lifetime SA. Follow-up interviews three, six, nine, and twelve months later assessed past-month SI and any SA since the previous assessment. Key Results Participants reported a high incidence of SI (25.9%) and SA (7.1%) over the year following the baseline primary care visit. In univariate analyses, odds of SI or SA during the one-year follow-up were significantly elevated in patients who were female; lacked a high school diploma; were unemployed; reported depression, anxiety, hallucinations, concentration difficulty, or violent behavior in the past 30 days; used nicotine or stimulants on a daily basis; used the emergency department or mental health services in the past 90 days; reported current quality-of-life impairment in mobility or usual activities; or reported past 30-day SI or any lifetime SA at baseline. In multiple regression analyses, only past 30-day SI, any lifetime SA, past 90-day violent behavior, and current impairment due to anxiety or depression at baseline uniquely predicted SI or SA beyond other variables over the one-year follow-up. Conclusions Results support the need for screening for suicidality among primary care patients who use illicit substances and identify key subgroups of these patients who are at particularly elevated risk for suicidality.

Determinants of suicidal ideation among patients with mental disorders visiting psychiatry outpatient unit in Mekelle town, psychiatric clinics, Tigray, Northern Ethiopia: a case–control study

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Alcohol use and its correlates in suicide attempters in a rural tertiary care teaching hospital in south India

“…These findings are similar to those found in another study which predicted that risk for subsequent attempts is higher among those with recent suicidal ideation and previous suicide attempts. 35 History of smoking was positive in greater number of participants in the group, which used alcohol to facilitate the suicidal attempt. This finding concurs to previous study showing cigarette smoking is associated with higher rates of suicide.…”

Increased relapse to cocaine‐seeking in a genetic model for depression

“…In the general population, major depression increases the risk of patients to suffer from comorbid cocaine dependence by more than twice . In turn, this comorbidity reduces the chances of abstinence, and perhaps increase the risk of relapse to drug use .…”

“…Epidemiological studies have indicated a strong association between cocaine dependence and depression, yielding higher risk of suicide and greater social and personal impairment, with each disorder being complicated by the other . One of the leading hypotheses regarding this comorbidity postulates that depressed patients tend to consume drugs in an attempt to “self‐medicate”; however, the experimentally controlled evidence for this hypothesis is limited and animal models that can validate and evaluate the relation between depression and addiction or contribute to the understanding of the neurobiological mechanism, are lacking.…”