How does active substance use at psychiatric admission impact suicide risk and hospital length-of-stay?

Abstract

Background/Objective Despite their high prevalence, little is known about the effects of substance use disorders (SUD) and active substance use on the suicide risk or length of stay (LOS) of psychiatric inpatients. This study examines the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and LOS. Methods Admission and discharge ratings on the Suicide Status Form-II-R, diagnoses, and toxicology data from 2333 unique psychiatric inpatients were examined. Data for patients using alcohol, THC, methamphetamines, cocaine, benzodiazepines, opiates, barbiturates, PCP and multiple substances on admission were compared with data from 1426 admissions without substance use. Results Patients with substance use by toxicology on admission had a 0.9 day shorter LOS compared to toxicology-negative patients. During initial nurse evaluation on the inpatient unit, these patients reported lower suicide measures (i.e. suicidal ideation frequency, overall suicide risk, and wish-to-die). No significant between-group differences were seen at discharge. Patients admitted with a SUD diagnosis had a 1.0 day shorter LOS than those without, while those with a SUD diagnosis and positive toxicology reported the lowest measures of suicidality on admission. These results remained independent of psychiatric diagnosis. Discussion For acute psychiatric inpatients, suicide risk is higher and LOS is longer in patients with SUDs who are NOT acutely intoxicated compared with patients without a SUD. Toxicology-positive patients are less suicidal on admission and improve faster than their toxicology-negative counterparts. This study gives support to the clinical observation that acutely intoxicated patients may stabilize quickly with regard to suicidal urges and need for inpatient care.

Adult psychiatric inpatient admissions and length of stay before and during the COVID-19 pandemic in a large urban hospital setting in Vancouver, British Columbia

“…Despite reductions in acute care capacity, outpatient mental health services rapidly adapted to support patients using virtual health solutions and were associated with improved visit adherence over time and have emerged as a promising model for improving the efficiency of mental health care delivery ( 66 , 67 ). Moreover, substance use disorders were significantly associated with a shorter LOS which is consistent with findings from prior research examining psychiatric hospitalizations ( 58 , 68 , 69 ). Specifically, hospital LOS in the pre-COVID and during-COVID periods was 69% and 55% shorter, respectively, for patients with substance-related disorders compared to those without substance-related disorders.…”

Study of Factors Influencing the Length of Hospital Stay of Patients with Anxiety Disorders

“…In the current study, we found no significant relation between substance dependence and the length of hospitalization, However, Rise, in a study on schizophrenia patients who had simultaneously substance dependence disorder, concluded these patients compared to schizophrenic patients who had no substance dependence, had less hospitalization time, and suggest this hypothesis that the substance temporarily strengthen patients' symptoms and may also be effective on the prognosis of patients (21). In another study by Miller (2016), the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay was examined. The results showed patients with a substance use disorder had a 1.0 day shorter length-of stay and the lowest measures of suicide on admission (22).…”

“…In another study by Miller (2016), the relationship between active substance use at the time of psychiatric hospitalization and changes in suicide risk measures and length-of-stay was examined. The results showed patients with a substance use disorder had a 1.0 day shorter length-of stay and the lowest measures of suicide on admission (22).…”

Mortality in people with schizophrenia: a systematic review and meta‐analysis of relative risk and aggravating or attenuating factors

“…Comorbid substance use disorders were found in our meta‐analysis to be a significant risk factor for increased mortality in people with schizophrenia. This finding is likely due to the multiple adverse physical as well as intentional or accidental suicide‐related effects of these disorders 177‐181 . Additionally, comorbid substance use, and cannabis use in particular, can worsen adherence to antipsychotics 182‐184 .…”