Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up

Abstract

BackgroundThis is a six-year prospective follow-up of a former cross sectional study of suicide attempters in a sample of treatment-seeking substance-dependent patients. The aims were to explore the frequency of patients with new suicide attempts (SA) during the six-year observation period, and to explore the predictive value of lifetime Axis I and II disorders, measured at index admission, on SA in the observation period, when age, gender and substance-use variables, measured both at admission and at follow-up, were controlled for.MethodsA consecutive sample of 156 alcohol-dependent and 131 poly-substance-dependent inpatients and outpatients in two Norwegian counties were assessed at index admission (T1) with the Composite International Diagnostic Interview (Axis I disorders), Mon's Clinical Multiaxial Inventory (Axis II disorders) and Hopkins Symptom Checklist-25 (mental distress). At follow-up six years later (T2), 56% (160/287 subjects, 29% women) were assessed using the HSCL-25 and measures of harmful substance use (Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test).ResultsThe prevalence of patients with SA between T1 and T2 was 19% (30/160), with no difference between sexes or between patient type (alcohol-dependent versus poly-substance-dependent). Sober patients also attempted suicide. At the index admission, lifetime eating disorders, agoraphobia with and without panic disorder, and major depression were significantly and independently associated with SA. Prospectively, only lifetime dysthymia increased the risk of SA during the following six years, whereas lifetime generalized anxiety disorder reduced the risk of SA. Individually, neither the numbers of Axis I and Axis II disorders nor the sum of these disorders were independently related to SA in the observation period. Substance use measured at T1 did not predict SA in the follow-up period, nor did harmful use of substances at follow-up or in the preceding year.ConclusionA high prevalence of SA was found six years later, both in patients still abusing substances and in sober patients. To prevent SA, treatment of both affective disorders and substance abuse is important.

A Brief Report on Predicting Self-Harm: Is It Gender or Abuse that Matters?

“…For a variety of reasons, however, empirical studies examining predictors of nonsuicidal self-injury and/or attempted suicide often have not included abuse history. More commonly, other relevant predictors, such as lifetime psychiatric disorders and self-harm, depression, anxiety, impulsivity, borderline personality disorder, nonsuicidal self-injury, other personality disorders, and substance dependence have been examined (K. Bakken & Vaglum, 2007;Chartrand, Sareen, Toews, & Bolton, 2012;Klonsky, May, & Glenn, 2013). At the same time, many of these predictors have also been associated with abuse history.…”

“…Future studies should address these and any other limitations by using diverse samples with even distributions of men and women, and a larger number of items to capture the complexity of self-harm and abuse history, including elements of abuse, such as severity and betrayal, and modes of self-harm. Additionally, future studies should measure abuse history alongside other known predictors of self-harm, such as previous self-harm (Chartrand et al, 2012) and substance dependence (K. Bakken & Vaglum, 2007), to better understand the associations among contributing mechanisms of self-harm.…”

Suicidio y Trastorno Mental

“…Los trastornos mentales más frecuentes en adultos que han realizado intentos de suicidio son depresión, distimia, bipolaridad, trastorno de personalidad, ansiedad, agorafobia, abuso de sustancias (drogas psicoactivas, alcohol y tabaco), esquizofrenia, somatización y trastornos alimentarios como la anorexia nerviosa (Balhara & Verma, 2012;Chesney, Goodwin, & Fazel, 2014;Rodríguez & Guerrero, 2005;Silva, Vicente, Saldivia, & Kohn, 2013;Soloff, Fabio, Kelly, Malone, & Mann, 2005). En adolescentes se encuentran trastornos de conducta, depresión, fobias simples y ansiedad generalizada (Pelkonen & Marttunen, 2003).…”

Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT) in Heroin Dependent Adults and Adolescents with Drug Use Disorder

“…Psychometric evaluations of the DUDIT have been mostly studied in Europe (three in Sweden, one in Norway, one in England) with severely dependent drug abusers in highly constrained settings (e.g., detoxification and inpatient units, prisons) 2,[5][6][7][8][9][10][11][12] . The measure was also evaluated with less severe substance abusing clinical populations in the United States of America (USA) 13 .…”