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Snyder SM, Scott L. Do Peers, Neighborhood Disorder, Religiosity, Spirituality, and Family Support Influence Polysubstance Use Among Older Youth Transitioning from Foster Care? JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2024; 21:18-31. [PMID: 37640297 DOI: 10.1080/26408066.2023.2252417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE Few studies have explored polysubstance use among youths aging out of foster care, despite higher rates of substance misuse for youths exiting foster care than those in the general population. Polysubstance use has been linked to substance use disorders, health problems, cognitive impairment, suicide, and overdose. METHOD This study investigates understudied risk and protective factors associated with polysubstance use with data from 384 youth who turned 17 years old between December 1, 2001, and June 30, 2003, and were transitioning out of foster care from the Missouri Children's Division. We conducted bivariate analyses with chi-square tests for categorical variables and Analysis of Variance with continuous independent variables. Then we conducted a multinomial logistic regression to explore differences between individuals who used 1 or no substances, individuals who used only alcohol and marijuana, and individuals who used 2 or more substances. RESULTS Bivariate analyses found that being white, having deviant peers, and living in a more disordered neighborhood were risk factors for polysubstance use. Multinomial logistic regression results found that being white (RR = 6.89, p < .001), having deviant peers (RR = 1.15, p < .001), and living in a more disordered neighborhood (RR = 1.13, p < .05), increased the risk engaging in polysubstance use. DISCUSSION Similar to findings in other studies, we found that deviant peers and neighborhood disorder increase the risk of polysubstance use, but family support, church attendance, and spirituality were not protective against polysubstance use. CONCLUSION Interventions should work to reduce deviant peer relationships among foster youth.
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Affiliation(s)
- Susan M Snyder
- School of Social Work, Georgia State University, Atlanta, GA, USA
| | - Lionel Scott
- School of Social Work, Georgia State University, Atlanta, GA, USA
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2
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Ataiants J, Mazzella S, Roth AM, Robinson LF, Sell RL, Lankenau SE. Multiple Victimizations and Overdose Among Women With a History of Illicit Drug Use. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP1588-NP1613. [PMID: 32536256 PMCID: PMC7808297 DOI: 10.1177/0886260520927501] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
The experiences of violence and overdose are highly prevalent among women who use illicit drugs. This study sought to ascertain whether multiple victimizations during adulthood increase the frequency of women's overdose. The sample comprised 218 women recruited at Philadelphia harm reduction sites during 2016-2017. Victimization was assessed as exposure to 16 types of adulthood violence. Three measures were constructed for multiple victimizations: continuous and categorical polyvictimization, and predominant violence domain. Negative binomial regression estimated the incidence rate ratio (IRR) of lifetime overdoses from multiple victimizations. Lifetime history of opioid use (88.6%) and drug injection (79.5%) were common. Among overdose survivors (68.5%), the median of lifetime overdoses was 3. The majority of participants (58.7%) were victims of predominantly sexual violence, 26.1% experienced predominantly physical abuse/assault, and 3.7% were victims of predominantly verbal aggression/coercive control. Participants reported a mean of seven violence types; the higher-score category of polyvictimization (9-16 violence types) comprised 41.7% of the total sample. In multivariable models, one-unit increase in continuous polyvictimization was associated with 4% higher overdose rates (IRR: 1.04, 95% confidence interval [CI]: [1.00, 1.08]). Compared to women who were not victimized (11.5%), those in the higher-score category of polyvictimization (IRR: 2.01; 95% CI: [1.06, 3.80]) and exposed to predominantly sexual violence (IRR: 2.10, 95% CI: [1.13, 3.91]) were expected to have higher overdose rates. Polyvictimization and sexual violence amplified the risk of repeated overdose among drug-involved women. Female overdose survivors need to be screened for exposure to multiple forms of violence, especially sexual violence. Findings underscore the need to scale-up victimization support and overdose prevention services for disenfranchised women.
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3
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Barnes DM, Xu S, Cleland CM, McKnight C, Des Jarlais D. Recurrent Injecting Drug Use as a Mediator between Psychiatric Disorder and Non-Fatal Overdose. Subst Use Misuse 2022; 57:1248-1256. [PMID: 35611936 DOI: 10.1080/10826084.2022.2076877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Unintentional drug overdose has increased markedly in the United States. Studies document an association between psychiatric disorder and unintentional overdose; we extend this research through a preliminary test of a causal model of recurrent injection drug use mediating this relationship. METHODS In a cross-sectional study of 241 adults in New York City with a possible current substance use disorder, we conducted conventional and Imai's mediation analyses to examine if psychiatric disorder is associated with increased prevalence of ever overdosing and if recurrent injection drug use mediates this association. Our cross-sectional data permit the first step of assessing causal models: testing if statistical associations are consistent with the model. RESULTS Fifty-eight percent of the sample endorsed previous psychiatric disorder diagnosis and 35.7% reported ever overdosing. Imai's mediation analysis showed that, adjusting for covariates, the total association between psychiatric diagnosis and ever overdosing (adjusted prevalence difference [aPD] = 0.16, 95% CI 0.04-0.28) was composed of a direct effect (aPD = 0.09, 95% CI -0.03 - 0.21, p = 0.136) and an indirect effect (aPD = 0.07, 95% CI 0.02-0.13). Recurrent injecting drug use contributed to 42% (ratio of indirect effect to total effect; 95% CI 12 - 100%, p = 0.02) of the association between psychiatric diagnosis and ever overdosing. Conventional mediation analysis produced similar results. CONCLUSIONS Our results provide a warrant for taking the necessary next step for assessing a causal model using longitudinal data, potentially providing a strong rationale for intervening on psychiatric disorders to stem overdose.
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Affiliation(s)
- David M Barnes
- School of Global Public Health, New York University, New York, NY, USA
| | - Shu Xu
- School of Global Public Health, New York University, New York, NY, USA
| | - Charles M Cleland
- Department of Population Health, Grossman School of Medicine, New York University, New York, NY, USA
| | - Courtney McKnight
- School of Global Public Health, New York University, New York, NY, USA
| | - Don Des Jarlais
- School of Global Public Health, New York University, New York, NY, USA
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4
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Sakai-Bizmark R, Kumamaru H, Estevez D, Marr EH, Haghnazarian E, Bedel LEM, Mena LA, Kaplan MS. Health-Care Utilization Due to Suicide Attempts Among Homeless Youth in New York State. Am J Epidemiol 2021; 190:1582-1591. [PMID: 33576370 PMCID: PMC8484771 DOI: 10.1093/aje/kwab037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022] Open
Abstract
Suicide remains the leading cause of death among homeless youth. We assessed differences in health-care utilization between homeless and nonhomeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009-2014) were used to identify homeless and nonhomeless youth aged 10-17 who utilized health-care services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models adjusted for individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with health-care utilization rates of 347.2 (95% confidence interval (CI): 317.5, 377.0) and 67.3 (95% CI: 66.3, 68.3) per 100,000 person-years for homeless and nonhomeless youth, respectively. Length of stay for homeless youth was statistically longer than that for nonhomeless youth (incidence rate ratio = 1.53, 95% CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with nonhomeless youth. Interventions tailored to homeless youth should be developed.
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Affiliation(s)
- Rie Sakai-Bizmark
- Correspondence to Dr. Rie Sakai-Bizmark, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, 1124 W. Torrance Street, Torrance, CA 90502 (e-mail: )
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Armoon B, SoleimanvandiAzar N, Fleury MJ, Noroozi A, Bayat AH, Mohammadi R, Ahounbar E, Fattah Moghaddam L. Prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among people with substance use disorders: a systematic review and meta-analysis. J Addict Dis 2021; 39:550-569. [PMID: 33896407 DOI: 10.1080/10550887.2021.1912572] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case-control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Santo T, Campbell G, Gisev N, Tran LT, Colledge S, Di Tanna GL, Degenhardt L. Prevalence of childhood maltreatment among people with opioid use disorder: A systematic review and meta-analysis. Drug Alcohol Depend 2021; 219:108459. [PMID: 33401031 PMCID: PMC7855829 DOI: 10.1016/j.drugalcdep.2020.108459] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Experience of childhood maltreatment (CM) is a risk factor for opioid use disorder (OUD). CM is also associated with comorbid mental disorders and poor treatment outcomes among people with OUD. To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of CM among people with OUD. METHODS We searched MEDLINE, EMBASE, and PsycINFO to identify observational studies that evaluated CM among people with OUD from January 1990 to June 2020. Prevalence of each CM type, sample characteristics, and methodological factors were extracted from each eligible study. Random-effects meta-analyses were used to pool prevalence estimates. Stratified meta-analyses were used to assess heterogeneity. RESULTS Of the 6,438 publications identified, 113 studies reported quantitative CM data among people with OUD and 62 studies (k = 62; N = 21,871) were included in primary analyses. Among people with OUD, the estimated prevalence of sexual abuse was 41% (95% CI 36-47%; k = 38) among women and 16% (95% CI 12-20%; k = 25) among men. Among all people with OUD, prevalence estimates were 38% (95% CI 33-44%; k = 48) for physical abuse, 43% (95% CI 38-49%; k = 31) for emotional abuse, 38% (95% CI 30-46%; k = 17) for physical neglect, and 42% (95% CI 32-51%; k = 17) for emotional neglect. Sex, history of injecting drug use, recruitment methods, and method of assessing CM were associated with substantial heterogeneity. CONCLUSIONS People with OUD frequently report the experience of CM, supporting the need for trauma-informed interventions among this population. Future research should consider the impact of CM on OUD presentations and when assessment is appropriate, use of validated instruments.
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Affiliation(s)
- Thomas Santo
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia.
| | - Gabrielle Campbell
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia; School of Health and Sports Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, 4556, Australia
| | - Natasa Gisev
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Lucy Thi Tran
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Samantha Colledge
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
| | - Gian Luca Di Tanna
- The George Institute for Global Health, UNSW Sydney, 1 King Street, Newtown, NSW, 2042, Australia; Faculty of Medicine, UNSW Sydney, Wallace Wurth Building, 18 High Street, Kensington, NSW, 2052, Australia
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, 22-32 King Street, Randwick, NSW, 2031, Australia
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Keen C, Young JT, Borschmann R, Kinner SA. Non-fatal drug overdose after release from prison: A prospective data linkage study. Drug Alcohol Depend 2020; 206:107707. [PMID: 31757517 DOI: 10.1016/j.drugalcdep.2019.107707] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/10/2019] [Accepted: 10/21/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Adults released from prison are at increased risk of poor health outcomes and preventable mortality, including from overdose. Non-fatal overdose (NFOD) is a strong predictor of future overdose and associated with considerable morbidity. This study aims to the determine the incidence, predictors and clinical characteristics of NFOD following release from prison. METHODS We used pre-release interview data collected for a randomised controlled trial in 2008-2010, and linked person-level, state-wide ambulance, emergency department, and hospital records, from a representative sample of 1307 adults incarcerated in Queensland, Australia. The incidence of NFOD following release from prison was calculated. A multivariate Andersen-Gill model was used to identify demographic, health, social, and criminal justice predictors of NFOD. RESULTS The crude incidence rate (IR) of NFOD was 47.6 (95%CI 41.1-55.0) per 1000 person-years and was highest in the first 14 days after release from prison (IR = 296 per 1000 person-years, 95%CI 206-426). In multivariate analyses, NFOD after release from prison was positively associated with a recent history of substance use disorder (SUD), dual diagnosis of mental illness and SUD, lifetime history of injecting drug use, lifetime history of NFOD, being dispensed benzodiazepines after release, a shorter index incarceration, and low perceived social support. The risk of NFOD was lower for people with high-risk alcohol use and while incarcerated. CONCLUSIONS Adults released from prison are at high risk of non-fatal overdose, particularly in the first 14 days after release. Providing coordinated transitional care between prison and the community is likely critical to reduce the risk of overdose.
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Affiliation(s)
- Claire Keen
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia.
| | - Jesse T Young
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; School of Population and Global Health, The University of Western Australia, Perth, Western Australia, Australia; National Drug Research Institute, Curtin University, Perth, Western Australia, Australia
| | - Rohan Borschmann
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stuart A Kinner
- Justice Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, Australia; Mater Research Institute-UQ, University of Queensland, Brisbane, Queensland, Australia; Griffith Criminology Institute, Griffith University, Brisbane, Queensland, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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8
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Connery HS, Taghian N, Kim J, Griffin M, Rockett IR, Weiss RD, McHugh RK. Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder. Drug Alcohol Depend 2019; 205:107612. [PMID: 31627077 PMCID: PMC6929689 DOI: 10.1016/j.drugalcdep.2019.107612] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/24/2019] [Accepted: 08/27/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Prior studies in heroin use disorder reported low rates (10%) of suicidal intention with non-fatal opioid overdose but did not assess dimensional ratings of suicidal ideation. This study aims to quantify the frequency and intensity of ratings of desire to die and perceived overdose risk proximal to the most recent opioid overdose event among individuals admitted for opioid use disorder detoxification/stabilization. METHODS Cross-sectional study (June 2017-July 2018) assessing patterns of opioid use and variables related to overdose history was conducted in a not-for-profit psychiatric hospital. Adults (>18 years) with opioid use disorder were eligible and 120 of 122 participants completed all measures. Forty-one percent were women and 85% self-identified as white. Participants' perceptions of the likelihood of overdose and their suicidal motivations (defined as desire to die) prior to most recent opioid overdose was self-rated on a scale of 0 (no desire to die/no risk of death) to 10 (I definitely wanted to die/I definitely thought I would die). RESULTS Most (92%) surviving opioid overdose used heroin/fentanyl; over half reported some desire to die prior to their most recent overdose, with 36% reporting strong (>7/10) desire to die and 21% reporting 10/10 "I definitely wanted to die." Perceptions of overdose risk were also variable, with 30% reporting no (0/10) likelihood of overdose and 13% reporting a high (10/10) likelihood. CONCLUSIONS Suicidal motivation prior to opioid overdose is common and falls along a continuum of severity. Longitudinal studies are needed to determine if suicide prevention interventions may reduce opioid overdose in those at risk.
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Affiliation(s)
- Hilary S. Connery
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
| | - Nadine Taghian
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA.
| | - Jungjin Kim
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Partners Health Care Addiction Psychiatry Fellowship Training Program, 115 Mill Street, Belmont, MA 02478, USA.
| | - Margaret Griffin
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA; Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Ian R.H. Rockett
- West Virginia University, Department of Epidemiology, One Waterfront Place, Morgantown, WV 26506-6009, USA,University of Rochester Medical Center, Department of Psychiatry, 601 Elmwood Avenue, Rochester, NY 14642, USA
| | - Roger D. Weiss
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
| | - R. Kathryn McHugh
- McLean Hospital, 115 Mill Street, Belmont, MA 02478, USA,Harvard Medical School, Departments of Psychiatry/Psychology, 25 Shattuck Street, Boston, MA 02115, USA
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Fruhbauerova M, Comtois KA. Addiction counselors and suicide: Education and experience do not improve suicide knowledge, beliefs, or confidence in treating suicidal clients. J Subst Abuse Treat 2019; 106:29-34. [PMID: 31540608 DOI: 10.1016/j.jsat.2019.08.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 08/15/2019] [Accepted: 08/16/2019] [Indexed: 01/28/2023]
Abstract
Substance use disorders (SUDs) are strongly associated with suicide deaths. However, SUD treatment is associated with lower suicide risk. To this date, we know little about whether SUD counselors are sufficiently knowledgeable about suicide and feel prepared and comfortable with treating and assessing their suicidal clients. This study was designed to characterize SUD counselors' general knowledge and confidence in treating suicidal clients, which was measured by their self-report of general knowledge of suicide prevention and belief in common myths about suicide as well as their self-reported confidence in treating suicidal clients. We hypothesized that confidence would be greater for counselors with more years of education and experience, that degree of education would predict greater knowledge and fewer beliefs in suicide myths, and finally that those counselors with greater knowledge and fewer beliefs in myths would have more confidence when treating suicidal clients. A total of 118 SUD counselors from 15 sites in Western Washington State agreed to participate in the study and completed baseline assessments. They were consented in group setting, usually during a staff meeting, and they were administered surveys on tablet computers. On average, the SUD counselors answered more than half the knowledge questions correctly and disagreed or strongly disagreed with common suicide myths. Their confidence in treating suicidal clients scored across the entire range. Our hypotheses were not supported: Confidence was not greater for those with more education or with more years of experience; degree of education and experience did not predict fewer beliefs in suicide myths; degree of education and experience did not predict greater knowledge; and greater knowledge and fewer beliefs in myths did not predict more confidence. The surprising finding that neither general suicide knowledge nor confidence were associated with the years of their work experience as a SUD counselor nor the level of their education and neither was associated with the other suggests that SUD treatment leadership should not depend on experience, education, general suicide knowledge to assure counselors are confidently able to treat suicidal clients. New or more precise training methods should be considered and evaluated.
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Affiliation(s)
- Martina Fruhbauerova
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington.
| | - Katherine Anne Comtois
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington
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Espinet S, Corrin T, Baliunas D, Quilty L, Zawertailo L, Rizvi SJ, deRuiter W, Bonato S, De Luca V, Kennedy S, Selby P. Predisposing and protective factors influencing suicide ideation, attempt, and death in patients accessing substance use treatment: a systematic review and meta-analysis protocol. Syst Rev 2019; 8:115. [PMID: 31092292 PMCID: PMC6518617 DOI: 10.1186/s13643-019-1028-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 04/15/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The lifetime risk of suicide in patients with substance use disorder is five to ten times the risk in the general population. Critically, up to 19% of patients continue to think about and attempt suicide even after accessing treatment. Therefore, suicidality represents a significant clinical concern in patients struggling with substance use that warrants careful investigation of the factors involved. While most previous research has relied on limited cross-sectional designs, a growing number of prospective studies are improving our understanding of the factors involved. However, a systematic study of these factors has not yet been conducted. METHODS The primary objective of this review and possible meta-analysis will be to identify key risk and protective factors for suicide ideation, attempt, and death in patients accessing substance use treatment, guided by current models of suicide. Secondary and tertiary objectives will be to obtain pooled effect sizes for the factors identified and to disaggregate factors for suicidality before and after treatment, and for suicidal thought versus action. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we will conduct an electronic search of the literature using the databases Embase, Medline, PsycINFO, and Web of Science. Two authors will independently screen studies based on pre-specified inclusion and exclusion criteria, extract relevant data, and assess study quality. Observational and randomized-controlled studies will be included, whereas case-studies and reviews will be excluded. We will extract data on risk and protective factors associated with suicide ideation, attempt (odds or risk ratios), and death (hazard ratio). Given sufficient data (> 5 studies), we will calculate pooled effects using comprehensive meta-analysis. DISCUSSION This systematic review will contribute to our knowledge of risk and protective factors for suicidality in patients before and after treatment. Understanding these factors will help define areas of research for further investigation to ultimately inform risk assessment and prevention strategies. SYSTEMATIC REVIEW REGISTRATION PROSPERO (reference number: CRD42018076260).
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Affiliation(s)
- S Espinet
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada.
| | - T Corrin
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada
| | - D Baliunas
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada
| | - L Quilty
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Canada
| | - L Zawertailo
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada
| | - S J Rizvi
- Department of Psychiatry, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, Toronto, Canada
| | - W deRuiter
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada
| | - S Bonato
- Department of Library Services, CAMH, Toronto, Canada
| | - V De Luca
- Department of Psychiatry, Campbell Family Mental Health Research Institute, CAMH, University of Toronto, Toronto, Canada
| | - S Kennedy
- Department of Psychiatry, Arthur Sommer Rotenberg Suicide and Depression Studies Unit, St. Michael's Hospital, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute and the Toronto Western Research Institute, University of Toronto, Toronto, Canada
| | - P Selby
- Addiction Program, Centre for Addiction and Mental Health, Nicotine Dependence Clinic, (CAMH), 175 College street, Toronto, ON, M5T 1P7, Canada
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Walsh RFL, Sheehan AE, Liu RT. Prospective prediction of first lifetime onset of suicidal ideation in a national study of substance users. J Psychiatr Res 2018; 107:28-33. [PMID: 30312914 PMCID: PMC6287622 DOI: 10.1016/j.jpsychires.2018.09.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 10/28/2022]
Abstract
Suicide rates have increased over the past several decades. Prior research has evaluated risk factors for suicidal behavior, but much of this work does not adequately differentiate between risk factors for suicidal ideation (SI) and suicide attempts, nor does it differentiate between first-onset SI and recurrent ideation. This study seeks to identify risk factors for first-onset SI among a high-risk group: individuals receiving treatment for substance use disorders. Data were drawn from the National Treatment Improvement Evaluation Study, a prospective study examining the impact of addiction treatment programs. Patients with no lifetime history of suicide attempts or ideation (n = 2560) were assessed at baseline and one year later for prospectively-occurring SI. Sociodemographic variables, mental health indices, interpersonal factors, and substance use severity indicators were evaluated as prospective predictors of first-onset SI in linear regression models. Current mental health problems (OR = 1.54, 95% CI = 1.19-2.01), current substance use problems (OR = 1.33, 95% CI = 1.04-1.70), and difficulty accessing treatment for substance use problems (OR = 1.90, 95% CI = 1.16-3.11) emerged as significant predictors of first-onset SI in a multivariate analysis, suggesting that individuals with current mental health or substance use related symptoms are among the most at risk for developing SI. Difficulty obtaining treatment remained significant, highlighting the importance of treatment accessibility. Future clinical work and research would benefit by addressing these issues, potentially by focusing on mental health treatment in substance abuse programs and evaluating barriers to treatment.
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Affiliation(s)
- Rachel F. L. Walsh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States
| | - Ana E. Sheehan
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States
| | - Richard T. Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States
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12
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Systematic Review of Suicidal Behaviour in Individuals Who Have Attended Substance Abuse Treatment. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-9994-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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13
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Bugaev N, McKay K, Breeze JL, Arabian SS, Rabinovici R. Self-Inflicted Abdominal Stab Wounds Have a Higher Rate of Non-therapeutic Laparotomy/Laparoscopy and a Lower Risk of Injury. World J Surg 2018. [PMID: 28634840 DOI: 10.1007/s00268-017-4083-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND The profile and management of self-inflicted abdominal stab wounds (SI-ASW) patients is still obscure. METHODS The National Trauma Data Bank (2012) was queried for adults with abdominal stab wounds (n = 9544). Patients with SI-ASW (n = 1724) and non-SI-ASW (n = 7820) were compared. Predictors for non-therapeutic laparotomy/laparoscopy (non-TL) in SI-ASW patients were identified. RESULTS SI-ASW patients were older, had more females and behavioral disorders, similar physiology, but a lower Injury Severity Score. They had more laparotomies overall (54 versus 48%, p < 0.0001) and more non-TL (42 versus 32%, p < 0.0001), but less injuries (43 versus 53%, p < 0.0001), although peritoneal violation rate was similar. Complications and mortality were similar. In the SI-ASW cohort, non-TL patients were more likely to be female and younger, and to have Glasgow Coma Scale (GCS) ≥13 and a higher systolic blood pressure. History of psychiatric, drug and alcohol disorders was associated with SI-ASW, but did not independently predict the need for treatment in adjusted models. CONCLUSION Patients with SI-ASW underwent more non-TL than patients with non-SI-ASW. Female gender, younger age, and a higher GCS and systolic blood pressure predicted non-TL in this group.
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Affiliation(s)
- Nikolay Bugaev
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111, USA.
| | - Kevin McKay
- Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111, USA
| | - Janis L Breeze
- Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington st, #63, Boston, MA, 02111, USA.,Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington st, #63, Boston, MA, 02111, USA
| | - Sandra S Arabian
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111, USA
| | - Reuven Rabinovici
- Division of Trauma and Acute Care Surgery, Tufts Medical Center, Tufts University School of Medicine, 800 Washington st, #4488, Boston, MA, 02111, USA
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14
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O'Keefe D, Bowring A, Aitken C, Dietze P. The Association between Intentional Overdose and Same-Sex Sexual Intercourse in a Cohort of People who Inject Drugs in Melbourne, Australia. Subst Use Misuse 2018; 53:755-762. [PMID: 28960149 DOI: 10.1080/10826084.2017.1363240] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND People who inject drugs (PWID) are at disproportionately high risk of suicidal behaviors, as are individuals who report same-sex attraction or experience. However, there is little evidence of compounded risk of suicide for individuals who report same-sex sexual intercourse (SSI) and are PWID. OBJECTIVES To explore the associations of lifetime intentional overdose amongst a cohort of PWID, with particular attention to those reporting SSI. METHODS The sample included 529 participants, from an ongoing cohort of 757 PWID. An "ever" SSI variable was created for participants who reported sexual intercourse with a same-sex partner at any longitudinal interview. We explored the adjusted associations between SSI and lifetime intentional overdose using logistic regression. RESULTS Ninety-one (17%) participants reported ever experiencing an intentional overdose. Forty-one (8%) participants reported SSI at any interview. Three hundred and sixty (68%) participants reported diagnosis of a mental health condition. Diagnosis of a mental health condition (AOR = 2.02, 95% CIs: 1.14, 3.59) and SSI (AOR = 2.58, 95% CIs: 1.22, 5.48) significantly increased the odds of lifetime intentional overdose. Conclusions/Importance: We found a heightened risk of intentional overdose amongst PWID reporting SSI, after controlling for diagnosis of a mental health condition. Services need to be aware of this heightened risk and target interventions appropriately.
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Affiliation(s)
- Daniel O'Keefe
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Anna Bowring
- a Burnet Institute , Melbourne , Victoria , Australia.,c Bloomberg School of Public Health , Johns Hopkins University , Baltimore , Maryland , USA
| | - Campbell Aitken
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
| | - Paul Dietze
- a Burnet Institute , Melbourne , Victoria , Australia.,b School of Public Health and Preventive Medicine , Monash University , Melbourne , Victoria , Australia
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15
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Yule AM, Carrellas NW, Fitzgerald M, McKowen JW, Nargiso JE, Bergman BG, Kelly JF, Wilens TE. Risk Factors for Overdose in Treatment-Seeking Youth With Substance Use Disorders. J Clin Psychiatry 2018; 79:17m11678. [PMID: 29701935 PMCID: PMC6043357 DOI: 10.4088/jcp.17m11678] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 10/09/2017] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Overdoses (ODs) are among the leading causes of death in youth with substance use disorders (SUDs). Our aim was to identify the prevalence of OD and characteristics associated with a history of OD in youth presenting for SUD outpatient care. METHODS A systematic retrospective medical record review was conducted of consecutive psychiatric and SUD evaluations for patients aged 16 to 26 years with DSM-IV-TR criteria SUD at entry into an outpatient SUD treatment program for youth between January 2012 and June 2013. Unintentional OD was defined as substance use without intention of self-harm that was associated with a significant impairment in level of consciousness. Intentional OD was defined as ingestion of a substance that was reported as a suicide attempt. T tests, Pearson χ² tests, and Fisher exact tests were performed to evaluate characteristics associated with a history of OD. RESULTS We examined the medical records of 200 patients (157 males and 43 females) with a mean ± SD age of 20.2 ± 2.8 years. At intake, 58 patients (29%) had a history of OD, and 62% of those patients had a history of unintentional OD only (n = 36). Youth with ≥ 2 SUDs were 3 times more likely to have a history of OD compared to youth with 1 SUD (all P < .05). Compared to those without a history of OD, those with an OD were more likely to be female and have lifetime histories of alcohol, cocaine, amphetamine, anxiety, depressive, and/or eating disorders (all P < .05). CONCLUSIONS High rates of OD exist in treatment-seeking youth with SUD. OD was associated with more SUDs and psychiatric comorbidity.
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Affiliation(s)
- Amy M. Yule
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114,Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Nicholas W. Carrellas
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - Maura Fitzgerald
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114
| | - James W. McKowen
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Jessica E. Nargiso
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Brandon G. Bergman
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - John F. Kelly
- Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
| | - Timothy E. Wilens
- Pediatric Psychopharmacology Program, Division of Child Psychiatry, Massachusetts General Hospital, Boston, MA 02114,Addiction Recovery Management Service, Center for Addiction Medicine, Massachusetts General Hospital, Boston, MA 02114,Department of Psychiatry, Massachusetts General Hospital, and Harvard Medical School, Boston, MA 02114
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16
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Icick R, Karsinti E, Lépine JP, Bloch V, Brousse G, Bellivier F, Vorspan F. Serious suicide attempts in outpatients with multiple substance use disorders. Drug Alcohol Depend 2017; 181:63-70. [PMID: 29035706 DOI: 10.1016/j.drugalcdep.2017.08.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 08/29/2017] [Accepted: 08/30/2017] [Indexed: 12/17/2022]
Abstract
BACKGROUND Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs. MATERIAL AND METHODS 433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately. RESULTS 32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues. CONCLUSIONS Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence.
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Affiliation(s)
- R Icick
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; FondaMental Foundation, Créteil, F-94000, France.
| | - E Karsinti
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
| | - J-P Lépine
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
| | - V Bloch
- INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; Hospital Pharmacy, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France
| | - G Brousse
- Psychiatry B-Department of Addiction Psychiatry, Université Clermont 1, UFR Médecine, EA7280, Clermont-Ferrand, France; CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
| | - F Bellivier
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; FondaMental Foundation, Créteil, F-94000, France
| | - F Vorspan
- Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
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17
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Trout ZM, Hernandez EM, Kleiman EM, Liu RT. Prospective prediction of first lifetime suicide attempts in a multi-site study of substance users. J Psychiatr Res 2017; 84:35-40. [PMID: 27693980 PMCID: PMC5293731 DOI: 10.1016/j.jpsychires.2016.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 09/12/2016] [Accepted: 09/20/2016] [Indexed: 11/23/2022]
Abstract
Although considerable empirical work has been devoted to identifying risk factors for suicide attempts, most longitudinal research has studied recurrent attempts rather than first lifetime attempts. The present study sought to examine prospective predictors of first lifetime suicide attempts among adults receiving treatment for substance use. Data were drawn from the National Treatment Improvement Evaluation Study, a study of addiction treatment programs. Data were collected at treatment intake, treatment exit, and one year post-treatment. Patients (n = 3518) with no lifetime history of suicide attempts at treatment intake were followed at treatment exit and one year post-treatment, when they reported on the occurrence of suicide attempts since the prior assessment. Prospective suicidal behavior was assessed using logistic regression in relation to sociodemographic variables, health-related work impairment, history of psychiatric treatment utilization, history of suicidal ideation, history of depressive symptoms, substance use, and childhood abuse, assessed at intake. Health-related work impairment, history of suicidal ideation, and childhood physical abuse significantly predicted first lifetime attempts in a multivariate analysis. Suicidal ideation, health-related functional impairments, and childhood physical abuse may be particularly important in assessing risk for first lifetime suicide attempts. Findings suggest that future clinical work and research would benefit from considering these factors when identifying individuals at heightened risk of making a first suicide attempt.
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Affiliation(s)
- Zoë M Trout
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States.
| | - Evelyn M Hernandez
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States.
| | - Evan M Kleiman
- Department of Psychology, Harvard University, 33 Kirkland St, Cambridge, MA 02138, United States.
| | - Richard T Liu
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Bradley Hospital, 1011 Veterans Memorial Parkway, East Providence, RI 02915, United States.
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18
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Gjersing L, Jonassen K, Skurtveit S, Bramness J, Clausen T. Emergency service use is common in the year before death among drug users who die from an overdose. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1208778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Lee D, Delcher C, Maldonado-Molina MM, Thogmartin JR, Goldberger BA. Manners of Death in Drug-Related Fatalities in Florida. J Forensic Sci 2016; 61:735-42. [DOI: 10.1111/1556-4029.12999] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 01/18/2023]
Affiliation(s)
- Dayong Lee
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
| | - Chris Delcher
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | - Mildred M. Maldonado-Molina
- Department of Health Outcomes and Policy; Institute for Child Health Policy; University of Florida College of Medicine; Gainesville FL
| | | | - Bruce A. Goldberger
- UF Health Pathology Laboratories; Department of Pathology, Immunology and Laboratory Medicine; University of Florida College of Medicine; Gainesville FL
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20
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Improvements in health-related quality of life among methadone maintenance clients in Dar es Salaam, Tanzania. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 30:74-81. [PMID: 27017376 DOI: 10.1016/j.drugpo.2016.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 03/04/2016] [Accepted: 03/06/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Injection of heroin has become widespread in Dar es Salaam, Tanzania and is spreading throughout the country. To prevent potential bridging of HIV epidemics, the Tanzanian government established a methadone maintenance treatment (MMT) clinic in February 2011. We assess the effect of MMT on health-related quality of life (HRQOL) and examine factors, particularly HIV infection and methadone dose, associated with changes in HRQOL. METHODS This study utilized routine data on clients enrolling in methadone from February 2011 to April 2012 at Muhimbili National Hospital. Change in physical (PCS) and mental health (MCS) composite scores, as measured by the SF-12 tool, were the primary outcomes. Backward stepwise linear regression, with a criterion of p<0.2 was used to identify baseline exposure variables for inclusion in multivariable models, while adjusting for baseline scores. RESULTS A total of 288 MMT clients received baseline and follow-up assessments. Mean methadone dose administered was 45mg (SD±25) and 76 (27%) were confirmed HIV-positive. Significant improvements were observed in PCS and MCS, with mean increases of 15.7 and 3.3, respectively. In multivariable models, clients who had previous poly-substance use with cocaine [p=0.040] had a significantly higher mean change in PCS. Clients who were living with HIV [p=0.002]; satisfied with current marital situation [p=0.045]; had a history of suicidal thoughts [p=0.021]; and previously experienced cognitive difficulties [p=0.012] had significantly lower mean change in PCS. Clients with shorter history of heroin use [p=0.012] and who received higher methadone doses [p=0.028] had significantly higher mean change in MCS, compared to their counterparts. CONCLUSION Aspects of mental and physical health, risk behaviors and quality of life among drug users are intertwined and complex. Our research revealed positive short-term effects of MMT on HRQOL and highlights the importance of sustained retention for optimal benefits. Comprehensive supportive services in addition to provision of methadone are needed to address the complex health needs of people who inject drugs.
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Carmel A, Ries R, West II, Bumgardner K, Roy-Byrne P. Suicide risk and associated demographic and clinical correlates among primary care patients with recent drug use. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:351-7. [PMID: 26910262 DOI: 10.3109/00952990.2015.1133634] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is an increased need to prepare primary care clinicians to effectively gauge the risk of suicidal behavior occurring within primary care patients who may abuse drugs, especially those served in safety-net settings. OBJECTIVES The objectives of this paper were to explore suicide risk in a population of individuals endorsing recent drug use, and to describe patient demographic, medical, psychiatric, social, and substance use characteristics across different levels of suicide risk. METHODS A total of 867 primary care patients with reported drug use in the previous 90 days were studied. Based upon their responses to two Addiction Severity Index questions, four suicide risk categories were constructed: (1) low risk; (2) moderate-low (suicidal ideation in the past 30 days); (3) moderate-high (history of a lifetime suicide attempt); and (4) high risk (history of a lifetime suicide attempt and suicidal ideation in the past 30 days). The association between suicide risk groups and demographic and clinical variables were assessed. RESULTS A total of 40% of primary care patients endorsing recent drug use reported a lifetime suicide attempt. Compared to individuals in other suicide risk groups, individuals at high suicide risk had higher rates of substance use severity, recently used two or more substances, and were more likely to have a comorbid psychiatric condition. CONCLUSION These findings indicate that the percentage of patients with suicide risk may be higher among patients with recent drug use. Primary care clinicians should be aware that they may be encountering patients with suicide risk among those with recent drug use.
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Affiliation(s)
- Adam Carmel
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA.,b Massachusetts Mental Health Center, Division of Public Psychiatry, Beth Israel Deaconess Medical Center , Harvard Medical School , Boston , MA , USA
| | - Richard Ries
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Imara I West
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Kristin Bumgardner
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
| | - Peter Roy-Byrne
- a Department of Psychiatry & Behavioral Sciences , University of Washington at Harborview Medical Center , Seattle , WA , USA
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22
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Chen VCH, Wu MH, Lin TY, Ho YF, Wang HY, Gossop M. Comparison of socio-demographic characteristics, substance, and depression among male heroin users attending therapeutic community and methadone maintenance treatment program in Nantou, Taiwan. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2015; 10:41. [PMID: 26507876 PMCID: PMC4624703 DOI: 10.1186/s13011-015-0037-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 10/19/2015] [Indexed: 11/18/2022]
Abstract
Background Little is known about differences between the characteristics and psychopathological symptoms of heroin users attending TC or MMT in Asia. This study aimed to compare characteristics and prevalence of depressive disorders among male heroin users in TC and MMT program in Nantou, Taiwan. Methods The study sample (n = 705) comprised male heroin users with heroin dependence recruited from the MMT program and TC program at a psychiatric center in Nantou, Taiwan between 2006 and 2014. Socio-demographic and heroin-related characteristics were obtained from self-report questionnaires. DSM-IV diagnoses of heroin dependence, major depressive disorder, and dysthymic disorder were evaluated by trained interviewers. T-test and chi-square test and multivariate logistic regression were performed to measure the differences on variables between samples of TC and MMT. Results Compared to MMT, TC participants had poorer family support, higher rate of unmarried, higher rate of unemployment, earlier onset of heroin use, longer length of heroin use, and lower daily dosage of heron. MMT heroin users had higher 1-month prevalence of major depressive disorder than TC participants. We found the distribution of current major depression disorder differed between heroin users choosing different treatment models even controlling for other demographic factors, substance related factors and psychosocial factors. The underlying explanations require further investigation. Conclusions This study found differences in the characteristics and prevalence of psychopathology. Further study to explore the effect of these differences on the outcome between MMT and TC is warranted.
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Affiliation(s)
- Vincent Chin-Hung Chen
- Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, 613, Chiayi County, Taiwan. .,Chang Gung University, 333, Tao-Yuan, Taiwan.
| | - Meng-Huan Wu
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Tsang-Yaw Lin
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Yi-Feng Ho
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Hsin-Yi Wang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nan-Tou County 542, No.161, Yu-Pin Rd, Caotun Township, Nan-Tou, Taiwan, R.O.C (542).
| | - Michael Gossop
- King's College London, Institute of Psychiatry, London, SE5 8AF, UK.
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Tripp JC, McDevitt-Murphy ME, Henschel AV. Firing a weapon and killing in combat are associated with suicidal ideation in OEF/OIF veterans. PSYCHOLOGICAL TRAUMA-THEORY RESEARCH PRACTICE AND POLICY 2015; 8:626-633. [PMID: 26460495 DOI: 10.1037/tra0000085] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Combat veterans are at risk for several adverse outcomes such as posttraumatic stress disorder (PTSD), depression, hazardous alcohol use, and most critically, suicidal behaviors. The high rate of suicide in veterans has been understood as a correlate of PTSD and depression, but it is possible that certain specific types of combat experiences may lead to suicidal behaviors. Acts committed by veterans in the context of war such as killing may evoke a "moral injury," which leads to thoughts of ending one's life. METHOD The present exploratory research examined relationships between combat experiences and suicidal ideation (SI) and PTSD in a sample of 68 Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans (91% male, mean age = 32.31 years) who had screened positive for alcohol misuse. We examined firing a weapon/killing in combat (Firing/Killing) and killing in combat (Killing) alone as predictors of SI and PTSD severity in both the full sample and men only. RESULTS Firing/Killing were associated with SI for the full sample and men only, and Killing showed a trend toward significance in predicting SI. Hierarchical regression analyses suggested that Firing/Killing did not predict PTSD for the full sample or men only, but Killing was predictive of PTSD for both samples. CONCLUSIONS These results indicate that there may be differences in Firing/Killing and Killing alone in OEF/OIF veterans who screened positive for alcohol misuse. Thorough screening of combat experiences and addressing moral injury in returning combat veterans may help reduce high rates of suicide and PTSD. (PsycINFO Database Record
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Hadland SE, Wood E, Dong H, Marshall BD, Kerr T, Montaner JS, DeBeck K. Suicide Attempts and Childhood Maltreatment Among Street Youth: A Prospective Cohort Study. Pediatrics 2015; 136:440-9. [PMID: 26240210 PMCID: PMC4552091 DOI: 10.1542/peds.2015-1108] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Although suicide is a known leading cause of death among street youth, few prospective studies have explored childhood experiences as risk factors for future suicide attempt in this population. We examined the risk of attempted suicide in relation to childhood maltreatment among street youth. METHODS From September 2005 to November 2013, data were collected from the At Risk Youth Study (ARYS), a prospective cohort of street youth in Vancouver, Canada. Inclusion criteria were age 14 to 26 years, past-month illicit drug use, and street involvement. Participants completed the Childhood Trauma Questionnaire, an instrument measuring self-reported sexual, physical, and emotional abuse and physical and emotional neglect. Suicide attempts were assessed semiannually. Using Cox regression, we examined the association between the 5 types of maltreatment and suicide attempts. RESULTS Of 660 participants, 68.2% were male and 24.6% were Aboriginal. Median age was 21.5 years. The prevalence of moderate to extreme childhood maltreatment ranged from 16.8% (sexual abuse) to 45.2% (emotional abuse). Participants contributed 1841 person-years, with suicide attempts reported by 35 (5.3%) individuals (crude incidence density: 1.9 per 100 person-years; 95% confidence interval [CI]: 1.4-2.6 per 100 person-years). In adjusted analyses, types of maltreatment associated with suicide attempts included physical abuse (adjusted hazard ratio [HR]: 4.47; 95% CI: 2.12-9.42), emotional abuse (adjusted HR: 4.92; 95% CI: 2.11-11.5), and emotional neglect (adjusted HR: 3.08; 95% CI: 1.05-9.03). CONCLUSIONS Childhood maltreatment is associated with subsequent risk of suicidal behavior among street youth. Suicide prevention efforts should be targeted toward this marginalized population and delivered from a trauma-informed perspective.
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Affiliation(s)
- Scott E. Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Huiru Dong
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island; and
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julio S. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada;,Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, St Paul's Hospital, Vancouver, British Columbia, Canada; School of Public Policy, Simon Fraser University, Vancouver, British Columbia, Canada
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Associations between childhood trauma and non-fatal overdose among people who inject drugs. Addict Behav 2015; 43:83-8. [PMID: 25588793 DOI: 10.1016/j.addbeh.2014.12.014] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 12/22/2014] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Although people who inject drugs (IDU) remain at a high risk of accidental overdose, interventions that address overdose remain limited. Accordingly there is a continuing need to identify psychological and social factors that shape overdose risk. Despite being reported frequently among IDU, childhood trauma has received little attention as a potential risk factor for overdose. This study aims to evaluate relationships between non-fatal overdose and five forms of childhood maltreatment among a cohort of IDU in Vancouver, Canada. METHODS Data was obtained from two prospective cohorts of IDU between December 2005 and May 2013. Multivariate generalized estimating equations (GEEs) were used to explore relationships between five forms of childhood trauma and non-fatal overdose, adjusting for potential confounders. RESULTS During the study period, 1697 IDU, including 552 (32.5%) women, were followed up. At baseline, 1136 (67.0%) participants reported at least one form of childhood trauma, while 4-9% reported a non-fatal overdose at each semi-annual follow-up. In multivariate analyses, physical [adjusted odds ratio (AOR): 1.36, 95% confidence interval (CI): 1.08-1.71], sexual (AOR: 1.48, CI: 1.17-1.87), and emotional abuse (AOR: 1.54, CI: 1.22-1.93) and physical neglect (AOR: 1.28, CI: 1.01-1.62) were independently associated with non-fatal overdose (all p<0.05). CONCLUSIONS Childhood trauma was common among participants, and reporting an experience of trauma was positively associated with non-fatal overdose. These findings highlight the need to provide intensive overdose prevention to trauma survivors and to incorporate screening for childhood trauma into health and social programs tailored to IDU.
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Jakubczyk A, Klimkiewicz A, Krasowska A, Kopera M, Sławińska-Ceran A, Brower KJ, Wojnar M. History of sexual abuse and suicide attempts in alcohol-dependent patients. CHILD ABUSE & NEGLECT 2014; 38:1560-8. [PMID: 24997776 PMCID: PMC4601637 DOI: 10.1016/j.chiabu.2014.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 06/10/2014] [Accepted: 06/12/2014] [Indexed: 05/25/2023]
Abstract
History of child abuse is considered one of the important risk factors of suicide attempt in general population. At the same time it has been shown that suicide attempts appear significantly more frequently in alcoholics than in healthy individuals. The objective of this study was to investigate associations between history of childhood sexual abuse and suicide attempts in a sample of Polish alcohol dependent patients. A sample of 364 alcohol-dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, family history of psychiatric problems, history of suicide attempts, sexual and physical abuse during childhood and adulthood and severity of alcohol problems. When analyzed by gender, 7.4% of male and 39.2% of female patients had a lifetime history of sexual abuse; 31.9% of the study group reported at least one suicide attempt during their lifetime. Patients who reported suicide attempts were significantly younger (p=0.0008), had greater severity of alcohol dependence (p=0.0002), lower social support (p=0.003), and worse economic status (p=0.002). Moreover, there was a significant association between history of suicide attempts and family history of psychiatric problems (p=0.00025), suicide attempts in the family (p=0.0073), childhood history of sexual abuse (p=0.009) as well as childhood history of physical abuse (p=0.002). When entered into linear regression analysis with other dependent variables history of childhood sexual abuse remained a significant predictor of suicide attempt (OR=2.52; p=0.035). Lifetime experience of sexual abuse is a significant and independent risk factor of suicide attempts in alcohol-dependent individuals.
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Affiliation(s)
- A Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - A Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - A Krasowska
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - M Kopera
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - A Sławińska-Ceran
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - K J Brower
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - M Wojnar
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Relationship between Personality Profiles and Suicide Attempt via Medicine Poisoning among Hospitalized Patients: A Case-Control Study. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:675480. [PMID: 27433491 PMCID: PMC4897309 DOI: 10.1155/2014/675480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/30/2014] [Revised: 10/30/2014] [Accepted: 10/31/2014] [Indexed: 11/17/2022]
Abstract
Objectives. Inflexible personality traits play an important role in the development of maladaptive behaviors among patients who attempt suicide. This study was conducted to investigate the relationship between personality profiles and suicide attempt via medicine poisoning among the patients hospitalized in a public hospital. Materials and Methods. Fifty-nine patients who attempted suicide for the first time and hospitalized in the poisoning ward were selected as the experimental group. Sixty-three patients hospitalized in the other wards for a variety of reasons were selected as the adjusted control group. Millon Clinical Multiaxial Personality Inventory, 3rd version (MCMI-III) was used to assess the personality profiles. Results. The majority of the suicide attempters were low-level graduates (67.8% versus 47.1%, OR = 2.36). 79.7% of the suicide attempters were suffering from at least one maladaptive personality profile. The most common maladaptive personality profiles among the suicide attempters were depressive personality disorder (40.7%) and histrionic personality disorder (32.2%). Among the syndromes the most common ones were anxiety clinical syndrome (23.7%) and major depression (23.7%). Conclusion. Major depression clinical syndrome, histrionic personality disorder, anxiety clinical syndrome, and depressive personality disorder are among the predicators of first suicide attempts for the patients hospitalized in the public hospital due to the medicine poisoning.
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Bartoli F, Carrà G, Brambilla G, Carretta D, Crocamo C, Neufeind J, Baldacchino A, Humphris G, Clerici M. Association between depression and non-fatal overdoses among drug users: a systematic review and meta-analysis. Drug Alcohol Depend 2014; 134:12-21. [PMID: 24210424 DOI: 10.1016/j.drugalcdep.2013.10.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/23/2013] [Accepted: 10/13/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Assessing factors associated with non-fatal overdose is important as these could be useful to identify individuals with substance use disorders at high risk of adverse outcomes and consequences. Depression may play an important role in terms of overdose risk. We aimed to test if drug users suffering from a depressive disorder might have significantly higher risk of non-fatal overdose as compared with drug users without depression. METHODS We conducted a systematic review and meta-analysis. PubMed, Embase and Web of Knowledge were searched. The pooled analyses were based on prevalence rates, risk difference (RD) and odds ratio (OR), reporting 95% confidence intervals (CIs). The combined estimates were obtained weighting each study according to random effects model for meta-analysis. RESULTS Seven articles, involving 12,019 individuals, and run in the US, Canada, Sweden, Norway, and Australia, were included. Pooled analyses comparing depressed with not depressed individuals highlighted a RD (95% CIs) for non-fatal overdose of 7.3% (4.8-9.7%) and an OR (95% CIs) of 1.45 (1.17-1.79). The subgroups analyses based on specific characteristics of included studies confirmed the association between depression and overdose. CONCLUSIONS Depressive disorders seem to be important factors associated to the risk of non-fatal overdose. Longitudinal studies might appropriately clarify causal inference issues. Future research should address the role of depressive disorders as predictors of subsequent non-fatal overdoses.
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Affiliation(s)
- Francesco Bartoli
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milano 20126, Italy
| | - Giuseppe Carrà
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, W1W 7EJ, UK.
| | - Giulia Brambilla
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milano 20126, Italy
| | - Daniele Carretta
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milano 20126, Italy
| | - Cristina Crocamo
- Department of Mental Health, San Gerardo Hospital, Monza 20900, MB, Italy
| | - Julia Neufeind
- Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Alex Baldacchino
- Division of Neuroscience, Medical Research Institute, University of Dundee, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - Gerry Humphris
- Medical and Biological Sciences Building, University of St Andrews, North Haugh, St Andrews KY16 9TF, UK
| | - Massimo Clerici
- Department of Surgery and Interdisciplinary Medicine, University of Milano Bicocca, Milano 20126, Italy
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Marshall BDL, Galea S, Wood E, Kerr T. Longitudinal associations between types of childhood trauma and suicidal behavior among substance users: a cohort study. Am J Public Health 2013; 103:e69-75. [PMID: 23865651 PMCID: PMC3966683 DOI: 10.2105/ajph.2013.301257] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVES We examined the longitudinal associations between different types and severities of childhood trauma and suicide attempts among illicit drug users. METHODS Data came from 2 prospective cohort studies of illicit drug users in Vancouver, Canada, in 2005 to 2010. We used recurrent event proportional means models to estimate adjusted and weighted associations between types and severities of childhood maltreatment and suicide attempts. RESULTS Of 1634 participants, 411 (25.2%) reported a history of suicidal behavior at baseline. Over 5 years, 80 (4.9%) participants reported 97 suicide attempts, a rate of 2.6 per 100 person-years. Severe to extreme levels of sexual abuse (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI] = 1.4, 4.4), physical abuse (AHR = 2.0; 95% CI = 1.1, 3.8), and emotional abuse (AHR = 3.5; 95% CI = 1.4, 8.7) predicted suicide attempts. Severe forms of physical and emotional neglect were not significantly associated with an increased risk of suicidal behavior. CONCLUSIONS Severe sexual, physical, and emotional childhood abuse confer substantial risk of repeated suicidal behavior in adulthood. Illicit drug users require intensive secondary suicide prevention efforts, particularly among those with a history of childhood trauma.
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Affiliation(s)
- Brandon D L Marshall
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Silva K, Schrager SM, Kecojevic A, Lankenau SE. Factors associated with history of non-fatal overdose among young nonmedical users of prescription drugs. Drug Alcohol Depend 2013; 128:104-10. [PMID: 22974490 PMCID: PMC4184803 DOI: 10.1016/j.drugalcdep.2012.08.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 08/09/2012] [Accepted: 08/14/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The current study examines the prevalence and correlates of lifetime non-fatal overdose (OD) involving the nonmedical use of prescription opioids and tranquilizers among a sample of high-risk young adults in New York, NY and Los Angeles, CA. METHODS Data were derived from a cross-sectional study of 16-25 year old nonmedical users of prescription drugs (n=596). Unadjusted associations between OD history and socio-demographic and drug use variables were investigated in bivariate logistic regression models. Multivariate logistic regression models identified correlates of non-fatal OD. RESULTS Lifetime prevalence of non-fatal overdose involving prescription opioids and/or tranquilizers was 23.6%. Factors associated with increased risk of non-fatal overdose included lower social class while growing up (OR: 1.81, 95% CI: [1.15, 2.83], p<0.01), having ever received care at a psychiatric hospital (OR: 1.79, 95% CI: [1.12, 2.85], p<0.05), ever witnessing a family member OD on drugs (OR: 1.59, 95% CI: [1.02, 2.50], p<0.05), being prescribed tranquilizers (OR: 2.07, 95% CI: [1.29, 4.27], p<0.01), ever snorting or sniffing opioids (OR: 2.51, 95% CI: [1.48, 4.27], p<0.001), injecting tranquilizers (OR: 3.09, 95% CI: [1.61, 5.93], p<0.001), and past 90-day injection drug use (OR: 1.68, 95% CI: [1.03, 2.74], p<0.05). Participants who reported past 90-day stimulant misuse had lower odds of reporting OD compared to those who were not recent stimulant users (OR: 0.60, 95% CI: [0.38-0.96], p<0.05). CONCLUSIONS This study documents the high prevalence of experiencing non-fatal overdose among young nonmedical users of prescription drugs. Results could inform overdose prevention efforts throughout the U.S.
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Affiliation(s)
- Karol Silva
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA.
| | - Sheree M. Schrager
- Children’s Hospital Los Angeles, Division of Adolescent Medicine, 5000 Sunset Boulevard, 7th Floor, Los Angeles, CA 90027, USA
| | - Aleksandar Kecojevic
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA
| | - Stephen E. Lankenau
- Drexel University, School of Public Health, Department of Community Health and Prevention, 1505 Race Street, 11th Floor, Philadelphia, PA 19102, USA
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Webster L, Eisenberg A, Bohnert ASB, Kleinberg F, Ilgen MA. Qualitative evaluation of suicide and overdose risk assessment procedures among veterans in substance use disorder treatment clinics. Arch Suicide Res 2012; 16:250-62. [PMID: 22852786 DOI: 10.1080/13811118.2012.695273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The objective of this study was to examine risk assessment practices for suicide and unintentional overdose to inform ongoing care in substance use disorder clinics. Focus groups were conducted via telephone among a random sample of treatment providers (N = 19) from Veterans Health Administration substance use disorder clinics across the nation. Themes were coded by research staff. Treatment providers reported consistent and clear guidelines for risk assessment of suicide among patients. Unintentional overdose questions elicited dissimilar responses which indicated a lack of cohesion and uniformity in risk assessment practices across clinics. Suicide risk assessment protocols are cohesively implemented by treatment providers. Unintentional overdose risk, however, may be less consistently assessed in clinics.
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Affiliation(s)
- Linda Webster
- VA Serious Mental Illness Treatment Resource and Evaluation Center, VA Center for Clinical Management Research; and Department of Psychiatry, University of Michigan, Ann Arbor, MI 48109, USA
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