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Attempted Suicide, Self-Harm, and Violent Victimization among Regular Illicit Drug Users
Abstract
Relationships among attempted suicide, nonsuicidal self-harm, and physical assault were examined in 400 regular users of heroin and/or psychostimulants. Twenty-eight percent had episodes of nonsuicidal self-harm, 32% had attempted suicide, and 95% had been violently assaulted. The number of suicide attempts and nonsuicidal self-harm incidents were correlated (ρ = 0.44). There were also significant correlations between the number of assaults and nonsuicidal self-harm incidents (ρ = 0.17), and suicide attempts (ρ = 0.27). The mean age onset for non-suicidal self-harm (18.9 yrs) was significantly younger than that of initial suicide (22.3 yrs). The age at initial physical assault (16.0yrs) was significantly younger than that of nonsuicidal self-harm and initial suicide attempt. Screening for all forms of violence appears warranted when determining suicide risk for this population.
... William & Adamson [18] found such factors to include imprisonment status (being convicted or not convicted) among other criminological factors. It has been reported that non-convicted (awaiting trial) inmates were more likely to selfharm than the convicted ones and that sometimes such self-injury may be an attempt to seek attention or to manipulate others to attain some goals [19][20][21]. ...
... with a Cronbach's co-efficient of 0.67. Scores on this scale range from 0-21 with scores categorized as follows: normal (0-7), mild (8-10), moderate (11)(12)(13)(14), severe (15)(16)(17)(18)(19)(20)(21). As used in this study, inmates who scored from 1-10 (normal to mild) did not participate while those who scored from 11-21 (moderate to severe) participated in the study. ...
... Firstly, the result of this study indicated that the non-convicted prison inmates experienced higher self-harm urges than their convicted counterparts. This result supported earlier findings such as those of [19,20] implicated imprisonment status, among other factors in self-harm urges. It further confirmed the findings that non-convicted inmates involved more in self-harm and reported higher self-harm urges than the convicted ones [53]. ...
... A possible explanation for the link between DSH and SA can be that only those people who acquired ability, through habituation, to physically painful and fear-inducing experiences, are capable to enact suicide (Darke et al., 2010;Joiner, 2005;Joiner et al., 2007). Regular illicit drug users present a significant correlation between the number of suicide attempts and selfharm incidents (Darke et al., 2010), whilst, in a sample of adolescent psychiatric inpatients, DSH with subsequent SA was related with a bigger number of different methods of self-harming used (Nock et al., 2006). ...
... A possible explanation for the link between DSH and SA can be that only those people who acquired ability, through habituation, to physically painful and fear-inducing experiences, are capable to enact suicide (Darke et al., 2010;Joiner, 2005;Joiner et al., 2007). Regular illicit drug users present a significant correlation between the number of suicide attempts and selfharm incidents (Darke et al., 2010), whilst, in a sample of adolescent psychiatric inpatients, DSH with subsequent SA was related with a bigger number of different methods of self-harming used (Nock et al., 2006). As in the present study the same correlations were found, we hypotesize a common underlying etiology to be present in prison inmates. ...
... In this study, age represented a small protective factor, as it has an inverse relation with DSH. Both DSH and poly-drug use are strongly associated with younger age (Darke et al., 2010). It can be speculated that this tryad may be underpinned by a shared role of impulsivity, which is known to be related with younger age, substance use disorders and DSH but not SA in a sample of inmates (Carli et al., 2010). ...
Acts of self-harm cover a wide range of behaviors that mainly differ in severity, from minor cuts to violent suicides (Fulwiler et al., 1997).
Despite some authors suggest that both the phenomena could be understood as lying on a continuum of lethality and consider a differentiation as irrelevant or even confusing and dangerous (Haycock, 1989; Verona et al., 2004), deliberate self-harm (DSH) and suicide attempt (SA) could be better identified as distinct phenomena because they differ with regard to lethality, the presence of suicidal intent and general clinical characteristics (Fulwiler et al., 1997; Lohner and Konrad, 2006). Unfortunately, there are only few empirical studies supporting either argument or providing specific risk factors for both behaviors, particularly in prison settings (Lohner and Konrad, 2006).
Nonetheless, maladaptive responses such as DSH and SA are among the most widespread self-injuring behaviors in prisons (Carli et al., 2011), and represent a major concern for prisons and jails because of the legal obligation for suicide prevention, the stress for officers (Lohner and Konrad, 2006) and the significant costs to institutional resources (Dixon-Gordon et al., 2012).
In prisons, DSH has been seen to increase an individual’s risk for suicide (Hawton et al., 2015a, 2014), particularly when underlying psychiatric conditions are present (Fazel et al., 2008). In addition, SA was found to be the best predictor of a later potentially lethal attempt (Cooper et al., 2005).
As a consequence, detecting and treating those who committed DSH and inmates with previous SA may reduce the overall rate of suicide in prisoners (Mann et al., 2005). With this objective in mind, the assessment of DSH appears to be one of the most problematic aspects in prisons.
The U.K.’s National Institute for Clinical Excellence (“Self-Harm: The Short-Term Physical and Psychological Management and Secondary Prevention of Self-Harm in Primary and Secondary Care - PubMed - NCBI,” n.d.) prepared clinical guidelines for the management of DSH, suggesting to conduct an assessment of needs and risks addressing features related to DSH and suicide. The type and function of DSH, past and present mental health treatment, history of SA and DSH, family history of suicide, significant life events, present suicide ideation and planning should be assessed. Despite this, very few studies (Daffern and Howells, 2007; Gray et al., 2003; Perry and Gilbody, 2009; Perry and Olason, 2009) evaluated DSH in prisoners by the means of self-reported measures together with underlying clinical correlated features. In
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addition, the majority of the studies were record-based (Hawton et al., 2014; Ireland, 2000) or subjected to limitations, such as the lack of a clinical assessment of PD by the means of a diagnostic tool (Carli et al., 2011; Kirchner et al., 2008).
Finally, very few studies (Carli et al., 2011; Gunter et al., 2013; Sarchiapone et al., 2009; Young et al., 2006) investigated the specific risk factors associated with both DSH and SA.
The present study was developed by the Psychiatric Functional Area (which includes the Division of Psychiatry of the University of Perugia and the Mental Health Department (DSM) of the USL n. 2 of Umbria, Italy) in collaboration with the Prof. Karen M. Abram of the Department of Psychiatry and Behavioral Sciences, Health Disparities and Public Policy Program of the Northwestern University Feinberg School of Medicine of Chicago (US). The last part of the study was completed under the supervision of Dr. Andrea Murru at the Bipolar Disorder Unit of the Hospital Clinic of Barcelona (S), directed by Prof. Eduard Vieta.
The research project sought to identify the prevalence and risk factors of self-injurous behaviors within the correctional setting of the Spoleto Prison, Umbria, trying to overcome the limitations of previous studies.
The Spoleto Prison is a District Penitentiary as well as a Penal Home, consequently holding both offenders awating trial and already convicted felons. It processes about 700 male detainees each year and the sociodemographic characteristics of the detainees are representative of other medium and maximum security prisons in Umbria and Italy (ProvveditoratoRegionale Amministrazione Penitenziaria Regione Umbria, Italia)*.
The authors of this research project considered DSH and SA as linked conditions presenting underlying clinical factors that they sought to understand, searching for specific risk factors related with the clinical presentation of the two behaviors. For example, Axis I disorders could relate with SA whilst PD may precipitate DSH as well as drug related disorders, comorbid physical conditions and traumatic life events may play an important additional role in predicting DSH and SA.
The inmates considered as eligible for the study were assessed by doctors with at least three years of experience in psychiatric practice by means of a structured clinical interview combined with tools that assess DSH, the history of SA as well as other clinical features such as the presence of psychiatric disorders, the co-occurrence of drug-related problems or medical conditions. Furthermore, an evaluation of the needs for treatment was performed both from the interviewers’ and the inmates’ point of view.
The study has been developed not only in the perspective of a clinical research but also with the aim of helping clinicians and health providers, both in Umbria and worldwide, in
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preventing and managing inmates with specific clinical conditions that can lead to a higher risk of both DSH or SA.
... The prevalence of suicidal behavior is still higher among adolescents hospitalized in psychiatric wards [14,26]. Suicidal behaviors appears to progress over time: suicidal ideation is more common at the beginning of adolescence [13,25,27], the incidence of suicide attempts highest at the end of adolescence [13,25,28], and the number of suicide deaths increases as adulthood begins [13,25,27]. Although suicide attempts are more frequent among young girls than boys, a gender difference in the suicide mortality rate is less clear in this age group than among adults [2,25,27,29]. ...
... From another perspective, numerous works have studied the correlations between NSSI and suicidal behaviors. Some authors treat NSSI as an important risk factor predictive of concomitant or subsequent suicidal behavior or ideation [26,28,31,44,57,58]. Recent studies have made it possible to rank risk factors for suicide according to their level of correlation with attempted suicide. ...
... This analysis is based on one of the first models for understanding the association between NSSI and suicide: the gateway theory [3,13,70]. As seen above, NSSI is a highly predictive risk factor for suicidal behavior [26,28,54,57,72]. This theory is supported by both retrospective and prospective studies, after adjustment for other risk factors [13,31,44,54]. ...
Nonsuicidal self-injury (NSSI) and suicidal behaviors, both important issues in adolescent health care, are frequently associated and possibly clinically related. Our objective was to explore the views of relations between nonsuicidal self-injury and suicidal behaviors during adolescence and young adulthood (11-25 years) expressed in the scientific (medical and psychological) literature. We adopted a textual approach to the process of synthesis to tell the story of the findings from the included studies. Our narrative systematic review of 64 articles found that they share the same risk factors. Integrated models envision nonsuicidal self-injury as a gateway enabling teens to acquire the capability for suicide. Because suicidal behavior short-circuits thought, it is difficult to conceive an intention to die during adolescents' acts of self-injury. Intention is constructed by the narrative of the act, influenced by numerous elements from the psychopathologic, cultural, religious, and philosophic context. Techniques of mentalizing-based treatments and work on the meaning that adolescents attribute to their behaviors might improve care.
... There is some evidence that NSSI is more prevalent among females than males in adolescence (Baetens et al., 2011;Muehlenkamp & Gutierrez, 2007;Plener, Libal, Keller, Fegert, & Muehlenkamp, 2009;Prinstein et al., 2008;Ross & Heath, 2002;Yates, Tracy, & Luthar, 2008), although other researchers have found no sex differences in the prevalence of NSSI (Andover, Primack, Gibb, & Pepper, 2010; Asarnow et al., 2011;Jacobson et al., 2008;Muehlenkamp & Gutierrez, 2004;Nock & Prinstein, 2004;Nock et al., 2006). It is interesting to note, however, that researchers assessing NSSI among early and late adults do not find gender differences in the prevalence of NSSI in clinical or communitybased samples (Bureau et al., 2010;Claes et al., 2010;Darke, Torok, Kaye, & Ross, 2010;Gratz et al., 2002;Heath et al., 2008), suggesting that gender differences may be more pronounced in early adolescence. In one study on gender differences in NSSI, it was found that female adolescents reported a significantly earlier age of NSSI onset than boys, which may help to account for why some researchers find that females engage in more NSSI than boys during the adolescent period see Nixon, Cloutier, & Aggarwal, 2002 for a similar finding). ...
... Researchers have also shown that NSSI occurs in various parts of the world, including the United States Brausch & Gutierrez, 2010;Dougherty et al., 2009;Muehlenkamp & Gutierrez, 2004), Canada (Bureau et al., 2010;Heath et al., 2008), Australia (Darke et al., 2010;Maddock, Carter, Murrell, Lewin & Conrad, 2011), China (Tang et al., 2011), Germany ) Scotland (Young, Sweeting, & West, 2006), Turkey (Zoroglu et al., 2003), Belgium (Claes et al., 2010) and Britain (Bebbington et al., 2010). There is some evidence to suggest that Caucasians may be at increased risk for NSSI as compared to other ethnicities (Muehlenkamp & Gutierrez, 2004, 2007; see Jacobson & Gould, 2007 for a review); however, other researchers have reported no differences in NSSI prevalence among varying ethnicities (Brausch & Gutierrez, 2010;Jacobson et al., 2008;Plener et al., 2009). ...
... According to a recent report from the World Health Organization, the global mortality rate for death by suicide is 14.5/100,000, making suicide the fourth leading cause of death among individuals aged 15-44 years (Krug, Dahlberg, Mercy, Zwi, & Lozono, 2002). Suicidal behavior tends to have its onset in late adolescence (Darke et al., 2010;Nock et al., 2008) and statistics indicate that adolescents report higher levels of suicidal ideation than any other age group (Krug et al., 2002;Nock et al., 2008). The greatest number of deaths by suicide, however, occurs in middle adulthood (Krug et al., 2002;Nock et al., 2008;Stats Canada, 2008), suggesting that although suicidal behavior may have its onset in adolescence, middle adulthood represents the period of greatest risk for death by suicide. ...
Self-injurious behaviors (SIB) refer to behaviors that cause direct and deliberate harm to oneself, including nonsuicidal self-injury (NSSI), suicidal behaviors, and suicide. Although in recent research, NSSI and suicidal behavior have been differentiated by intention, frequency, and lethality of behavior, researchers have also shown that these two types of self-injurious behavior often co-occur. Despite the co-occurrence of NSSI and suicidal behavior, however, little attention has been given as to why these self-injurious behaviors may be linked. Several authors have suggested that NSSI is a risk factor for suicidal behavior, but no comprehensive review of the literature on NSSI and suicidal behavior has been provided. To address this gap in the literature, we conducted an extensive review of the research on NSSI and suicidal behavior among adolescents and adults. First, we summarize several studies that specifically examined the association between NSSI and suicidal behavior. Next, three theories that have been proposed to account for the link between NSSI and suicidal behavior are described, and the empirical support for each theory is critically examined. Finally, an integrated model is introduced and several recommendations for future research are provided to extend theory development.
... Most relevant to the current study, the relationship between victimization and subsequent substance use and/or suicidality is well-established in the literature (Dansky et al. 1995;Darke et al. 2010;Moran, Vuchinich, and Hall 2004). Studies consistently show that individuals who have experienced victimization are more susceptible to subsequent substance abuse problems. ...
... Additionally, a large proportion of individuals seeking treatment for substance abuse have a history of victimization. To illustrate this, Darke et al. (2010) surveyed 400 individuals who reported regular drug use and found an alarming 95% reported histories of violent victimization. Similarly, in a sample of 143 women who had received treatment for a substance use disorder, Dansky et al. (1995) found that 57.3% had been victims of rape, 30.8% had been victims of attempted sexual assault, and 56.6% reported being physically assaulted. ...
Drug overdoses in the United States have been dramatically increasing since the late 1990 s. Research has been successful in identifying individual-level correlates of overdoses, but often fails to examine contextual effects. Using data from one police department, the U.S. Census, and ReferenceUSA, we test the effects of block group (N = 34) and parcel (N = 21,489) variables reflective of social disorganization and availability-proneness theories on drug overdoses taking place in one non-urban jurisdiction over four years (N = 396). Furthermore, we test the ability of mental health and social-community service providers to mitigate the harmful effect of poverty. Because effects may vary across intent or outcome, accidental, intentional, and fatal overdoses were modeled independently. Based on multilevel analysis (HLM7), several variables were positively associated with overdoses; however, service providers in high poverty areas, as well as bars in general, elicited negative associations. Lastly, contextual effects varied based by type of overdose.
... Data found to date show some differential characteristics. Patients with drug use problems who make suicide attempts are more frequently women (Ashrafioun et al., 2016;Darke et al., 2010;Fernández-Montalvo et al., 2014;Roy, 2003aRoy, , 2009Roy, , 2010Roy and Janal, 2007); have a family history of suicide (Roy, 2009(Roy, , 2010Roy and Janal, 2007); report adverse childhood experiences (Fernández-Montalvo et al., 2015;Hung et al., 2013;Roy, 2010;Roy and Janal, 2007;Vaszari et al., 2011); show specific personality traits related to introversion, neuroticism and hostility (Roy, 2001(Roy, , 2003a; and present a high comorbidity rate with other mental conditions (Carra et al., 2014;Petry and Kiluk, 2002;Vaszari et al., 2011). Moreover, from the perspective of substance use disorders treatment, a recent study has shown that women with both substance use disorders and suicidal ideation or attempts show worse therapeutic progression, with higher rates of treatment dropout . ...
... ISR = Interviewer Severity Rating; SCL-90-R = Symptom Checklist ⁎ Lifetime abuse: psychological, physical and/or sexual abuse. (Carra et al., 2014;Darke et al., 2010;Roy, 2001Roy, , 2003a, patients with suicidal ideation and/or attempts present with more severe substance use disorder and more psychopathological comorbidity. Although this cross-sectional study does not allow for establishing causal relationships, the results obtained show the link between addiction severity, psychopathological symptoms and suicidal ideation and/or attempts. ...
Patients with substance dependence have a great risk of suicidal ideation and attempts. The study of the specific risk characteristics of patients with substance use disorders who present with suicidal ideation and/or attempts becomes a crucial clinical issue in order to develop prevention strategies. The main goals of this study were to determine the prevalence rate of both suicidal ideation and attempts among patients receiving treatment for substance use disorder and to analyse the differential characteristics between these patients with and without suicidal behaviours. A sample of 334 patients (263 men-71 women) who sought treatment for substance use disorder in a Spanish clinical centre was assessed. In total, 43.7% of the patients presented with lifetime suicidal ideation (8.7% in the last month) and 17.7% with suicide attempts (1.5% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI), and more psychopathological symptoms (assessed by the SCL-90-R). Moreover the rate of suicidal ideation and attempts was significantly higher in inpatients than in outpatients. According to these results, systematic screening of suicidal risk in patients seeking treatment for substance use disorders is recommended, especially in those with a greater addiction severity.
... The dearth of research examining SIB from a general strain theory perspective has provided evidence that the posited strain-response process does indeed help to better understand why people engage in SIB (Hay & Meldrum, 2010;Posick, Farrell, & Swatt, 2013;Wojciechowski, 2017). Research on stress, victimization, and coping also provides additional, albeit indirect, support for the strain-response process as having utility for explaining why individuals choose to engage in SIB (Chapman, Gratz, & Turner, 2014;Cyr, McDuff, Wright, Theriault, & Cinq-Mars, 2005;Darke, Torok, Kaye, & Ross, 2010;Lauscher & Schulze, 1998). I seek to elucidate greater understanding regarding ways in which changes in exposure to risk and protective factors throughout childhood, adolescence, and early adulthood may result in changes in SIB habits. ...
... Research has shown that victims of sexual abuse in childhood or adolescence engage in SIB at high rates (Cyr et al., 2005;Maniglio, 2011;O'Connor, Rasmussen, & Hawton, 2014). Other types of victimization, like being the victim of bullying, sexual assault, and childhood physical abuse have also been found to be associated with SIB outcomes (Darke et al., 2010;Hay & Meldrum, 2010;O'Connor et al., 2014). Wojciechowski (2017) again also found that individuals used SIB as a coping response for mitigating negative affect stemming from strain. ...
Self-injury is typically defined as the intentional harm caused to one’s own body. This phenomenon has historically been studied mainly from a psychological perspective and has focused less on social forces related to engagement in this behavior. While research on self-injury has examined etiology extensively, there has yet to be an examination of how changes in exposure to risk and protective factors may lead to changes in self-injury habits. This research uses qualitative interview data from 16 former and current selfinjurers to examine self-injury from a life-course criminological perspective (Cullen, Agnew, & Wilcox, 2014). These data allowed for identification of concepts associated with social learning theory, general strain theory, social control theory, and social support theory as important risk and protective factors associated with self-injury. Further, this identification allowed for an examination of how the application and withdrawal of these risk and protective factors led to changes in self-injury habits. Future research should seek to generalize these results and further clarify the impact of risk and protective factors across the life-course. © 2018: Thomas W. Wojciechowski and Nova Southeastern University.
... prisoners; 58 to explore whether DSH and suicide attempts lie on a same 59 continuum, or otherwise might be more accurately character- 60 ized as separated psychopathological entities; 61 to investigate socio-demographic, clinical, and treatment-related 62 variables independently associated with DSH in this sample. Table 1 for additional information on the type of DSH). ...
... age. Both DSH and the misuse of multiple substances are strongly 338 associated with younger age [61], and in the present study, an older 339 ...
Background
Deliberate self-harm (DSH) causes important concern in prison inmates as it worsens morbidity and increases the risk for suicide. The aim of the present study is to investigate the prevalence and correlates of DSH in a large sample of male prisoners.
Methods
A cross-sectional study evaluated male prisoners aged 18+ years. Current and lifetime psychiatric diagnoses were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders - DSM-IV Axis I and Axis II Disorders and with the Addiction Severity Index-Expanded Version. DSH was assessed with The Deliberate Self-Harm Inventory. Multivariable logistic regression models were used to identify independent correlates of lifetime DSH.
Results
Ninety-three of 526 inmates (17.7%) reported at least 1 lifetime DSH behavior, and 58/93 (62.4%) of those reported a DSH act while in prison. After multivariable adjustment (sensitivity 41.9%, specificity 96.1%, area under the curve = 0.854, 95% confidence interval CI = 0.811–0.897, P < 0.001), DSH was significantly associated with lifetime psychotic disorders (adjusted Odds Ratio aOR = 6.227, 95% CI = 2.183–17.762, P = 0.001), borderline personality disorder (aOR = 6.004, 95% CI = 3.305–10.907, P < 0.001), affective disorders (aOR = 2.856, 95% CI = 1.350–6.039, P = 0.006) and misuse of multiple substances (aOR = 2.024, 95% CI = 1.111–3.687, P = 0.021).
Conclusions
Borderline personality disorder and misuse of multiple substances are established risk factors of DSH, but psychotic and affective disorders were also associated with DSH in male prison inmates. This points to possible DSH-related clinical sub-groups, that bear specific treatment needs.
... However, researchers have found nuances when further exploring the relationship between suicidal behavior, frequency of NSSI engagement, and the severity of methods used. First, in regard to the frequency of NSSI engagement, conflicting results have emerged finding either a positive relationship (Andover & Gibb, 2010;Brunner et al., 2007;Darke et al., 2010;Prinstein et al., 2008) or no relationship with suicidal behavior. These findings may be explained by the fact that researchers who have found a positive relationship with suicidal behavior have explored the lifetime frequency of NSSI (e.g., Andover & Gibb, 2010;Brunner et al., 2007;Darke et al., 2010), whereas those assessing for more current NSSI frequency have not found a relationship with current suicidal behavior. ...
... First, in regard to the frequency of NSSI engagement, conflicting results have emerged finding either a positive relationship (Andover & Gibb, 2010;Brunner et al., 2007;Darke et al., 2010;Prinstein et al., 2008) or no relationship with suicidal behavior. These findings may be explained by the fact that researchers who have found a positive relationship with suicidal behavior have explored the lifetime frequency of NSSI (e.g., Andover & Gibb, 2010;Brunner et al., 2007;Darke et al., 2010), whereas those assessing for more current NSSI frequency have not found a relationship with current suicidal behavior. What is not understood at this point is whether the relationship between suicidal behaviors and lifetime NSSI arises because of distortions that may result because of either recall bias and errors (for more on recall bias, see Hasson [2005]) or because of a longer time engagement leading to desensitization of self-harm behaviors, as suggested Wester, Ivers, Villalba, Trepal, & Henson by Joiner (2005). ...
This correlational study was conducted with 403 undergraduate college students from 2 universities. The authors used path analysis and bootstrap regression to analyze the relationships between variables. Locus of control and family connectedness related to current nonsuicidal self-injury (NSSI) engagement. However, when entered into the same regression, the variables current NSSI engagement and current NSSI number of methods used mediated all other relationships with suicidal ideation. Implications to current theories and clinical practice are provided.
... If NSSI reduces one's hesitancy to engage in SA, then the greater frequency with which one engages in NSSI, the more powerful the erosion of the fear and pain associated with enacting a lethal SA. The majority of extant research indicates that NSSI frequency is indeed associated with SA (Andover and Gibb, 2010;Darke et al., 2010;Paul et al., 2015). However, a few studies have suggested a relationship inconsistent with these findings. ...
... Three main characteristics of NSSI have been identified that may influence the role of NSSI engagement in the habituation to the fear and pain required to carry out SAs: NSSI frequency, number of NSSI methods, and subjective pain experienced during NSSI acts. Although there is a strong literature demonstrating a predictive relationship between NSSI frequency and SA (Andover and Gibb, 2010;Darke et al., 2010;Paul et al., 2015), it does not account for all variability in the presence of SA; thus, it is important to consider the number of NSSI methods used and pain experienced during NSSI as they relate to SA (Joiner, 2005;Klonsky and Olino, 2008;Van Orden et al., 2010;Victor and Klonsky, 2014). As such, in the current study, we hypothesized that each of these three characteristics would be individually associated with SA. ...
Non-suicidal self-injury (NSSI) has been identified as a correlate and predictor of suicidal ideation and attempts. Given the high rates of NSSI presence among adolescents and young adults, it is important to identify specific characteristics of NSSI that might place individuals who engage in this behavior at highest risk for suicidal behaviors. NSSI is thought to increase the acquired capability for suicide via habituation to self-harm, though the NSSI characteristics most responsible for this relationship are unclear. The current study examined three characteristics of NSSI (frequency, number of methods, and subjective pain) that may help to elucidate this risk relationship. University students (N = 997) with a history of NSSI completed measures assessing lifetime NSSI frequency, number of NSSI methods employed, and subjective experience of pain during NSSI, as well as suicide attempt (SA) history. Results indicated that NSSI frequency, number of NSSI methods, and subjective pain experienced during NSSI were each positively associated with a SA history. Further, subjective pain experienced during NSSI moderated the relationship between NSSI frequency and SA history, such that the association between NSSI frequency and SA history was stronger for individuals who experienced lower levels of subjective pain.
... Suicide attempt history is a good proxy of psychopathology, including major depression, bipolar disorder, and personality disorders 24,25 , and can confer long-term poor prognoses such as persistent psychiatric disorders and decreased quality of life [26][27][28] . An estimated 13% to 22% of HIV/AIDS patients 29,30 and 17% to 40% of substance use disorder patients [31][32][33] report a lifetime history of a suicide attempt. We are unaware of any studies specifically addressing rates of lifetime suicide attempts in patients with both HIV/AIDS and substance use disorders. ...
... In this sample, 35.3% of HIV/AIDS patients with substance use disorders had a lifetime history of a suicide attempt. This rate is higher than HIV/AIDS population rates 29,30,48,49 and within the range of, but not higher than, rates in patients with substance use disorders alone [31][32][33]50 . ...
This cross-sectional study evaluated lifetime prevalence of suicide attempts in 170 HIV/AIDS patients with substance use disorders and the impact of suicide attempt history on subjective indices of quality of life and objective indices of cognitive and physical functioning. All patients met the diagnostic criteria for past-year cocaine or opioid use disorders and 27% of patients also had co-occurring alcohol use disorders. Compared to their counterparts without a history of a suicide attempt, patients with a history of a suicide attempt (n = 60, 35.3%) had significantly poorer emotional and cognitive quality of life scores (ps < .05), but not physical, social, or functional/global quality-of-life scores. Lifetime suicide attempt status was unrelated to objective indices of cognitive functioning, but there was a non-significant trend (p = .07) toward lower viral loads in those with a lifetime suicide attempt relative to those without. The findings indicate that suicide attempt histories are prevalent among HIV/AIDS patients with substance use disorders and relate to poorer perceived emotional and cognitive quality of life, but not objective functioning. HIV/AIDS patients with substance use disorders should be screened for lifetime histories of suicide attempts and offered assistance to improve perceived emotional and cognitive functioning.
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... People who use illicit drugs (PWUD) are known to commonly experience mental health problems, including suicidal ideation and behavior (Darke et al., 2010;Maloney et al., 2007;Marshall et al., 2013;Rossow and Lauritzen, 1999), with suicide being a leading cause of premature death among this population (Darke and Ross, 2002;Bohnert et al., 2010). A growing body of research has identified various correlates of suicidal behavior among PWUD, including substance use-related factors such as heavy illicit drug use patterns (Marshall et al., 2011), longer durations of drug use (Ilgen et al., 2007a;Landheim et al., 2006), and use of injection methamphetamine (Marshall et al., 2011) and injection cocaine (Darke and Kaye, 2004). ...
... In the adjusted recurrent event analyses, at-risk/heavy alcohol use, daily injection cocaine use, and victimization were associated with an increased hazard of suicide attempt. These findings are consistent with previous studies identifying intensive injection cocaine use (Darke and Kaye, 2004), and violent victimization (Darke et al., 2010;Lloyd et al., 2007) as risk factors for suicidal behavior among PWUD. Our findings are also in agreement with a large body of research documenting an association between heavy alcohol use and suicidal behavior among general populations (Borges et al., 2000;Borges and Loera, 2010;Kessler et al., 1999;Vijayakumar et al., 2011;Wilcox et al., 2004) and other, albeit few, studies identifying associations between alcohol use and adverse health and social outcomes among PWUD (Dietze et al., 2005(Dietze et al., , 2013Howe et al., 2011;Marshall et al., 2008). ...
... When Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/psychres operationalized continuously, two studies have found positive relationships between the frequency of self-injury without lethal intent and the number of suicide attempts (Andover and Gibb, 2010;Darke et al., 2010) as well as suicidal ideation (Prinstein et al., 2008;Whitlock et. al., 2013). ...
... This study makes several important contributions to our understanding of the relationships between NSSI and STBs. Consistent with prior work in clinical samples (Andover and Gibb, 2010;Darke et al., 2010), we found that NSSI frequency was more strongly related to suicidal ideation, plans and attempts than other risk factors. However, once these relationships were examined among those with any STBs, only problematic substance use predicted suicide attempt. ...
... In addition, in a Norwegian study examining the prevalence of vulnerability factors among young women attending a sexual assault center, 41% reported to as having mental health problem and 35 % reported one or more previous incidents of sexual assault (Vik et al., 2019). Finally, suicide attempts and nonsuicidal self-harm have also been shown to correlate with violent assaults (Darke et al., 2010). ...
This study examined the associations of psychiatric disorders, suicidal behavior and family-related characteristics during adolescence, to subsequent experiences of hospital-treated physical, or sexual assaults, among 508 young adults with a history of psychiatric inpatient care at adolescence (aged 13-17 years). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) based adolescent psychiatric disorders were assessed at index hospitalization using Schedule for Affective Disorder and Schizophrenia for School-Age children, Present and Lifetime version (K-SADS-PL). Treatment episodes for assaults were obtained from the health care register, provided by the Finnish National Institute for Health Welfare. About 14.4% of the participants had experienced physical or sexual assault during their lifetime. Results of logistic regression analysis indicated that anxiety disorder (odds ratio [OR] = 9.6) and nonsuicidal self-injury (OR = 3.7) in adolescence for males, and personality disorder (OR = 3.4) for females, were associated with increased likelihood for subsequent assault exposure leading to hospitalization. These findings can be used in targeting vulnerable adolescents and designing primary prevention strategies.
... Although there have been studies investigating the links between suicidal behaviors, mortality, and regular drug use and dependence (Darke et al., 2010;Wilcox et al., 2004), there has been limited research on acute drug use at the time of suicide and self-injury. For example, a study conducted 30 years ago found that within a sample of adolescent drug users, 40% had used drugs within eight hours of attempting suicide (Berman and Schwartz, 1990). ...
Background: Research indicates alcohol (AUD) or substance (SUD) use disorders and acute alcohol or drug use serve as risk factors for suicidal behaviors and death both distally and proximally to a suicidal event. However, limited research investigated these relationships among medically serious suicide attempters at the time of injury without relying on cohorts of substance users only or by examining suicide decedent characteristics.
Methods: Data were collected from the National Trauma Data Bank (NTDB) for 2017. The sample comprised patients who engaged in suicidal and self-injurious acts that were medically serious enough to require trauma admission and were tested for alcohol (N=9,196) or drug (N=8,121) exposure upon admission. Logistic regression determined relationships between acute alcohol/substance use, presence of AUDs and SUDs and suicide mortality risk, while linear regression evaluated substance conditions and injury severity and length of stay (LOS).
Results: AUDs (OR=0.59[0.42-0.83]) and SUDs (OR=0.66[0.48-0.90]) had reduced odds of death but increased LOS (β=1.7, p<.001; β=0.82, p=.024). Blood alcohol concentration was positively associated with reduced odds of death (OR=0.20[0.06-0.61]), injury severity (β=-5.3, p<.001), and LOS (β=-7.5, p<.001). Presence of cocaine (β=-0.80, p=.044) and opioids (β=-1.4, p<.001) were associated lower injury severity, while MDMA (β=3.6, p=.016) and methamphetamine (β=1.5, p=.025) were associated with increased injury severity.
Conclusions: To provide better support for these and other at-risk populations, intervention efforts should focus on the etiology of suicidality among substance users. Targeted interventions should be considered to interrupt and develop healthy alternatives for survivors with comorbid substance use conditions
... An additional problem is posed by the possible association between self-injurious behavior and suicide. While some research has suggested that a large proportion of self-injury cases tend to be non-suicidal in nature and that self-injurious behavior is intended to effect a change in the environment, rather than result in an individual's death (33), other studies have consistently reported that NSSI is a robust predictor of suicidality (34)(35)(36)(37) with suicidal ideation and attempts being more common among individuals with NSSI as compared to individuals without NSSI (2,38). It has also been found that NSSI predicts suicidal behavior over and above mental health problems, such as depression (35), hopelessness and borderline personality traits (34), PTSD and a history of child abuse (39). ...
Introduction: Incarcerated adolescents represent a risk group for non-suicidal self-injury (NSSI), but research on this population has been limited and no studies have been conducted in Russia. To address this deficit, this study examined NSSI and the factors associated with it among youth in a juvenile correctional facility in Russia.
Methods: NSSI and psychopathology were assessed using a psychiatric interview and self-report questionnaire in 368 incarcerated male adolescents aged 14–19 years (mean age 16.4 years, S.D. 0.9) from Northern Russia.
Results: 18.2% ( N = 67) of the study participants had a history of NSSI and also had higher rates of anxiety, post-traumatic stress disorder (PTSD), depression, community violence exposure and scored higher on most of the Youth Self-Report problem scales. In addition, 31.3% of the NSSI group reported previous suicidal ideation and had thought about a specific suicide method compared to 12.0% in the No-NSSI group. Adolescents with NSSI also differed significantly from the No-NSSI group on self-directedness (lower) and self-transcendence (higher) personality traits.
Conclusion: NSSI is common in incarcerated adolescents in Russia and is associated with extensive psychiatric comorbidity, suicidal ideation and specific personality traits.
... People who use opioids are 14 times more likely to die by suicide compared to the general population [10,142], perhaps the highest odds of all substances. Indeed, estimates of lifetime suicide attempt rates among individuals with OUD are gravely elevated, ranging between 17% and 48% [143][144][145][146][147][148][149][150][151][152]. ...
Purpose of Review
Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior.
Recent Findings
Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior.
Summary
Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
... Drug users are primarily documented as a high-risk population of suicidal behavior [5,6], since drug use can exert a negative impact on individuals' health and mental health, and can also cause problems such as cognitive neurological disorder, depression, and anxiety [7,8]. For example, previous research findings reported that the occurrence of suicidal ideation and suicide attempts among illicit drug users were as high as 55% and 32%, respectively [9,10]. Moreover, the suicide mortality rate of heroin users was found to be 16.2 fold higher than that of the general population [11]. ...
Suicidal behavior is a severe problem among drug users. This study examines influential factors related to suicide attempts and analyzes possible mediators of the relationship between perceived social support and suicide attempts amongst Chinese drug users under compulsory institutional drug treatment. Taking perceived social support as the independent variable, we found that the relationship between suicide attempts and perceived social support is mediated by self-esteem as a protective factor and depression as a risk factor. Path analysis shows that self-esteem contributes relatively more to the indirect effects than depression does, accounting for 31.1% and 24.2% of the total effect, respectively. Generally speaking, the findings of this study point to an urgent need for addressing suicide attempts among Chinese drug users while treating self-esteem as the protective factor that deserves as substantial attention as depression receives.
... However, more recent work suggests NSSI frequency may be a more salient indicator of clinical severity than number of NSSI methods (Ammerman et al. 2020). In line with theories linking NSSI frequency and suicide, research has demonstrated a robust positive relationship between the frequency NSSI acts and frequency of both SI and SAs (Schwartz et al. 1989;Andover and Gibb 2010;Darke et al. 2010;Muehlenkamp and Brausch 2019), as well as an inverse relationship between the subjective experience of pain during NSSI and history of SAs (Ammerman et al. 2016). However, some research has contrasted these findings. ...
NSSI is a robust predictor of suicidal thoughts and behaviors. Despite this close link, there is a lack of information regarding specific behavioral and psychological features of NSSI that may influence, or serve as drivers, of these relationships. Consequently, the aim of the current study was to elucidate the specific NSSI-related mechanisms that may confer risk for suicide ideation and suicide attempts. Participants having a lifetime history of NSSI (N = 659) were included in the current study and completed a series of online questionnaires. Exploratory mediation analysis was utilized to simultaneously examine 28 behavioral and psychological NSSI features as potential mechanisms of the NSSI-suicide ideation and NSSI-suicide attempt relationships. Results identified 11 NSSI features as having non-zero specific indirect effects in the NSSI-suicide ideation relationship, with the antisuicide function of NSSI having the strongest influence. In examining the NSSI-suicide attempt relationship 12 NSSI features were identified as having non-zero specific indirect effects, with endorsement of swallowing dangerous substances as an NSSI method having the strongest influence. These findings suggest psychological and behavioral features of NSSI may differentially impact risk for suicide ideation and suicide attempts, respectively.
... First, the sole reliance on national health insurance records to ascertain prior history of depressive disorder, alcohol-use problems, and suicide attempts may have led to under-estimations of the risk associations, given that a higher proportion of individuals with mental health problems or less severe suicide attempts may never reach medical attention, which is particularly true for the illegal opioid-involved population because of the concern of being arrested. Moreover, the limited variables in the health insurance data restrained our ability to explore the role of other explanatory factors documented in earlier studies, such as family support or violence victimization (Darke et al., 2010). Second, our sociodemographic variables were assessed only at the point of MMT enrollment; some did have changes throughout the follow-up -5 % became unmarried, 2 % became unemployed, and 3 % had increased income. ...
Background:
The present study aims to profile the hazard fluctuation of suicide attempts and deaths among heroin-involved women seeking methadone maintenance treatment (MMT) and to investigate sociodemographic and clinical factors predicting the time to have suicidal behaviors.
Methods:
We identified a retrospective cohort comprising 2780 women receiving methadone treatment in the period of 2012-2016. Healthcare records were obtained from Taiwan's National Health Insurance Research Database, and suicide deaths were ascertained from the national death register. Competing risk survival analyses were used to estimate the risk of suicide attempts and deaths within one year and three years of MMT enrollment.
Results:
A total of 1.2 % of MMT-treated women ever visited hospital for suicide attempt, and 0.5 % died by confirmed suicide. The risk of treated suicide attempt reached its peak at the end of the 8th month after methadone initiation, whereas the risk of confirmed suicide death was relatively stable during the first one and a half years. A history of treated depressive disorders appears to be the strongest risk predictor for treated suicide attempts (Adjusted Hazard Ratio [aHR] = 3.45; 95 % CI = 1.66-7.19) and confirmed suicide death (aHR = 3.47; 95 % CI = 1.20-10.0). Retaining in methadone treatment may significantly lower the hazard of probable suicide death by 52 %.
Conclusions:
Women with heroin use disorders should receive careful attention for suicide risk at intake assessment and over the course of treatment and recovery. Preventive strategies should target unmet clinical and social needs and evaluate gender-specific barriers for treatment engagement.
... Un risc major, care nu implică patologii somatice, este reprezentat de sevrajul la psihostimulente, deoarece în fază acută se poate prezenta sub formă de tulburare psihotică cu un grad ridicat de agitație psihomotorie și agresivitate sau sub formă de episod depresiv cu un risc crescut de suicid (16)(17)(18) . ...
The use and abuse of psychoactive substances and the complications that derive from them represent a major public health problem. An increasing numbers of new psychoactive substances (NPS) are available on the market as previous substances disappear, generating a constant flow of drugs and constant variations in psychopharmacological properties. This dynamic comes with important difficulties in identifying the substances and their psychopharmacological mechanisms and in the substance-specific treatment. The International Classification of Diseases, the 11th revision (ICD-11), reclassifies the substances and pathologies to enable a better management of the disorders. Psychiatry occupies an important role in the management of substance use disorders along with several medical specialties, psychology, psychotherapy and other fields. The pharmacological treatment of these disorders can be applied in acute states such as acute intoxication and overdose, withdrawal states, substance-induced psychosis, delirium and also in the long-term management of withdrawal. Severe cases of agitation and aggressiveness were observed in patients using especially NPS and not rarely with legal implications. One particular situation that began to emerge on a worldwide scale is the multiple-drug use where the psychoactive substances can create unpredictable and life-threatening situations. In these cases, the treatment implies advanced knowledge of pharmacology and the long-term management has poor outcomes.
... Individuals using heroin have 14 times more odds for dying by suicide than non-users (Darke & Ross, 2002). Other studies have reported that between 20 and 50% of individuals using heroin have a history of lifetime suicide attempts (Darke, Ross, Lynskey, & Teesson, 2004;Darke & Torok, 2013;Darke, Torok, Kaye, & Ross, 2010;Kazour, Soufia, Rohayem, & Richa, use is childhood trauma (CT) (Gerra et al., 2014;Ghorbani, Khosravani, Mohammadzadeh, & Shadnia, 2019;Li et al., 2012;Ompad et al., 2005;Quinn et al., 2016). CT refers to the aspects of childhood abuse and neglect (Bernstein et al., 2003). ...
Emotion dysregulation is considered as one of the factors related to suicide in individuals with childhood trauma (CT). However, no research has been performed on the role of emotion dysregulation in the relationship between perception of CT and suicidal ideation in individuals who use heroin. This study aimed to evaluate direct and indirect relationships between perception of CT and suicidal ideation through emotion regulation difficulties (ERD) and cognitive emotion regulation strategies (CERSs) in males with a DSM diagnosis of heroin dependence. In a cross-sectional design, 310 males with a DSM diagnosis of heroin dependence completed the Childhood Trauma Questionnaire-Short Form (CTQ-SF), the Difficulties in Emotion Regulation Scale (DERS), the Cognitive Emotion Regulation Questionnaire-Short version (CERQ-Short), the Obsessive-Compulsive Drug Use Scale-Form Heroin (OCDUS-Form Heroin), and the Depression Anxiety Stress Scales (DASS). The results revealed that perception of CT had no direct relation to suicidal ideation. Perception of CT was indirectly associated with suicidal ideation through some ERD dimensions [e.g., non-acceptance of emotional responses (Non-acceptance), limited access to emotion regulation strategies (Strategies), lack of emotional awareness (Awareness)] and the CERS of positive reappraisal. The findings suggest that high suicidal ideation may stem from a perception of CT and subsequently emotion dysregulation in individuals who use heroin. Also, the findings of this research may have implications for the prevention and treatment of suicidal ideation in individuals using heroin with a perception of CT. The results of the present study require further examination through longitudinal studies.
... Both epidemiological and clinical studies have reported a high prevalence of personality disorders in populations with SUD [62], particularly borderline personality disorder (BPD) and/or antisocial personality disorder (ASPD) of the B cluster [39, 54,61]. These personality disorders were found to be associated with an increased risk of having the poorest overall outcomes in patients with SUD [7], such as early onset of SUD, regular intoxication, more extensive and severe substance use problems than those without diagnoses of these personalities [6,39] Consistently with this, a majority of the studies that have evaluated SMB so far have concentrated on BPD and ASPD [11,42], and their results indicate that additional diagnoses of these personality disorders increase the risk of developing SMB among those with SUD [8,13]. Studies conducted among patients with HUD showed that SMB is related to ASPD diagnosis (12.5 times higher risk) [22] and features of borderline personality [27,46]. ...
Background: Self-mutilative behaviour (SMB) is common among patients with heroin use disorder (HUD) and poses a severe threat to the safety and well-being of these patients. Aim: The main aim of the present study was to evaluate the relationship between SMB and novelty seeking (NS), while also carefully assessing the presence of antisocial (ASPD) and borderline (BPD) personality disorders and the severity of psychopathology in a sample of patients with HUD. Methods: Participants, in a group comprising 236 patients with HUD, were evaluated by applying the Symptom Checklist-Revised (SCL-90-R) and NS subscale of the Temperament and Character Inventory (TCI). In addition, BPD and ASPD were assessed with the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Results: Age, duration of education and marital status did not differ between those with a history of SMB (n=116, 49.1%) and those without (n=120, 50.9%). Age at first heroin use and percentage of those who were employed were lower among those with a history of SMB. Severity of psychopathology, ASPD, BPD and NS scores were higher among those with a history of SMB. In logistic regression analysis, high NS, together with the presence of both BPD and ASPD, together with severity of general psychopathology, in particular hostility, predicted patients’ history of SMB. Conclusions: These findings suggest that the history of SMB is related to the severity of NS, while the severity of psychopathology, particularly the hostility dimension, and the presence of BPD and ASPD may have additional effects on SMB among male patients with HUD.
... The results of these studies show that the prevalence rates of suicidal behaviours in patients with addiction problems are higher than those of the general population, especially in patients with greater associated problems, as, for example, psychopathological comorbidity, lifetime abuse, or childhood traumatic events (Arribas-Ibar, Suelves, Sanchez-Niubo, Domingo-Salvany, & Brugal, 2017;Fernández-Montalvo, López-Goñi, & Arteaga, 2015;Rodriguez-Cintas et al., 2018;Roy, 2010). Moreover, recent studies in the addiction field show that patients with suicidal behaviours present a more severe clinical profile (Darke, Torok, Kaye, & Ross, 2010;Fernández-Montalvo, López-Goñi, Arteaga, & Haro, in press). ...
Background and aims:
Patients with addictions have a great risk of suicidal ideation and attempts. Suicidal behaviour is a continuum that begins with ideation and may continue with planning, attempts and suicide completion. Investigating the specific risk characteristics for suicidal attempts in patients with addiction problems who present with suicidal ideation is crucial for developing prevention strategies. The main aims of this study were to determine the prevalence rate of suicide attempts among patients with lifetime suicidal ideation receiving treatment for addiction, and to explore the differential characteristics for suicide ideators with and without suicide attempts.
Methods:
A sample of 149 patients with suicidal ideation (110 male and 39 female) who sought treatment for addiction in a Spanish clinical centre was assessed.
Measurements:
Information concerning socio-demographic characteristics, addiction severity, and psychopathological symptoms was obtained.
Results:
In total, 39.6% of the patients had attempted suicide (95% Confidence Interval: 32.1%-47.6%). Although all patients with suicidal behaviours presented a high severity in their addiction, patients with both suicidal ideation and suicide attempts showed a more severe addiction profile and more maladjustment to everyday life than patients with only suicidal ideation. Specifically, three psychopathological variables were related to suicide attempts: worse psychiatric state, previous hospitalization for psychological problems, and history of delirium.
Conclusions:
According to the results, a systematic screening of suicidal risk in patients seeking treatment for addiction problems is recommended. Addiction treatment centres should develop treatment strategies to prevent suicidal ideators from attempting suicide, mainly in those cases with a worse lifetime psychiatric condition.
... Eroin kullanýmý ile intihar davranýþý riski literatürde üzerinde tartýþýlmýþ ve eroin kullanýmýnýn intihar eðilimi riskini artýrdýðý belirtilmiþtir (5,6,38,39,40). Eroin kullanýcýlarýnda intihar giriþim sýklýðýný Roy %39,3 (40), Ögel ve arkadaþlarý %35 (41), Darke ve arkadaþlarý farklý çalýþmalarýnda %32 (6) ve %42,2 (39) gibi yüksek oranlarda saptamýþlardýr. Bu çalýþmalara benzer bir þekilde örneklemimizin üçte birinde en az bir defa intihar giriþimi saptadýk. ...
Objective: In this study, it was aimed to investigate the
relationship between stress coping styles and story of
suicide attempt among a group of patients with
buprenorphine maintenance treatment. Method: This
study evaluated 90 patients who were hospitalized in the
Alcohol and Substance Research Treatment and Training
Center. All patients were evaluated using a semi-structured
sociodemographic and clinical information form.
At the same time with this form, substance abuse patterns
and some clinical variables such as story of suicide
attempt were also questioned. In addition, each patient
was given State- Trait Anxiety Inventory, Beck Depression
Ýnventory and the Coping Inventory for Stressful
Situations. Results: The mean age of the patients was
26.3, duration of training was 9.45, age of first drug use
was 16.1 years, duration of heroin use was 6.4 years.
33.3% of the patients had attempted suicide at least
once. Patients who had a suicide attempt story had significantly
lower age at onset (16.8 versus 14.8, p =
0.035, respectively). There was no statistically significant
difference in emotion-oriented coping and avoidanceoriented
coping scores while the task-oriented coping
score was lower in those who had suicide attempt stories
(25.33 versus 22.37, p = 0.019, respectively). The
STAI-II scale score was significantly higher in those who
had suicide attempt stories (43.4 versus 50.1, p
... In summary, patients with suicidal behaviours present with greater severity of addiction problems. Therefore, these findings are in line with those found in general samples of patients with addiction problems, in which physical and/or sexual abuse was not taken into account (Roy 2001(Roy , 2003aDarke et al. 2010;Carra et al. 2014;Simoneau et al. 2017). ...
Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in patients seeking treatment for substance use disorder. The prevalence rate of suicidal ideation and/or suicide attempts was explored among lifetime physically and/or sexually abused patients receiving treatment for drug addiction. The differential characteristics between these patients and those without suicidal behaviours were studied.
Method: Three hundred and seventy-five patients were assessed. Socio-demographic characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and psychopathological symptoms were explored.
Results: Eighty-two patients (21.9%) presented with a history of lifetime abuse and were included in the study (37 men and 45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2% in the last month), and 30.5% with suicide attempts (1.2% in the last month). Patients with suicidal ideation or attempts showed a more severe addiction profile (assessed by the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R).
Conclusion: This study highlights the relationship between previous traumatic experiences and suicidal behaviours. According to these results, systematic screening of suicidal risk in patients seeking treatment in addiction centres with histories of abuse is recommended.
... Deliberate self-harm (DSH) is a health risk behavior defined as an act of intentional bodily harm without apparent suicidal intent (1). DSH is one of the most common self-destructive behaviors in patients with substance use disorders such as alcohol dependence, cannabis abuse, and other illicit drug use (2)(3)(4)(5). In addition to injuries, infections, and tissue damage resulted from DSH, studies have demonstrated that DSH is significantly associated with a variety of psychosocial problems such as depression, anxiety, and loneliness, functional impairment, poor quality of life, premature death, later attempted suicide, and subsequent suicide (6)(7)(8)(9)(10). ...
Background: There is paucity of data regarding the prevalence and methods of deliberate self-harm (DSH) in patients with heroin dependence in international literature. In China, there have been a few studies investigating the prevalence of DSH in heroin-dependent patients (HDPs), but their rates varied widely. We thus conducted a meta-analysis of studies assessing the prevalence of DSH among Chinese HDPs.
Methods: Relevant studies were retrieved from major Chinese databases (China National Knowledge Infrastructure, Wanfang data, and SinoMed) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently identified eligible studies and extracted data. Studies that included a representative sample of Chinese HDPs and ascertained DSH caseness in a reliable way were considered as high quality. Statistical analysis was performed using R software.
Results: In total, 15 eligible studies with a total of 37,243 Chinese HDPs were included. All included studies were conducted in heroin detoxification settings. Only two studies were rated as high quality. The pooled prevalence of DSH in Chinese HDPs was 4.4% (95%CI: 2.9, 6.2%), but the heterogeneity of prevalence rates across studies was significant (I² = 98%, P < 0.001). Studies rated as high quality had significantly higher prevalence of DSH than those rated as low quality (13.2 vs. 3.4%, P < 0.001). Swallowing foreign objects was the most common method of DSH, with a combined prevalence of 2.7% (95%CI: 1.6, 4.4%). Extreme DSH methods such as cutting off fingers and jumping from height were also not uncommon in this patient population.
Conclusion: Due to methodological problems in available studies, we find a relatively low prevalence of DSH among Chinese HDPs receiving detoxification treatment. Nevertheless, the self-harmers of Chinese HDPs are more likely to harm themselves in a dangerous or life-threatening way. Restricting the availability of DSH methods may be an effective way to prevent or reduce DSH in China's detoxification treatment settings.
... Approximately 13.5% of adults in a nationally-representative survey reported lifetime SI and 4.6% reported lifetime SA (Kessler et al. 1999). Similar to NSSI, STBs often begin in adolescence (Darke et al. 2010;Nock et al. 2008), and women are more likely to attempt suicide than men (Nock et al. 2008). STBs are differentiated from NSSI in terms of the frequency and lethality of the behaviors, feelings of hopelessness, and attitudes about life (Guertin et al. 2001;Muehlenkamp & Gutierrez, 2004;Muehlenkamp & Gutierrez, 2007). ...
Background
Prior research has documented shared heritable contributions to non-suicidal self-injury (NSSI) and suicidal ideation (SI) as well as NSSI and suicide attempt (SA). In addition, trauma exposure has been implicated in risk for NSSI and suicide. Genetically informative studies are needed to determine common sources of liability to all three self-injurious thoughts and behaviors, and to clarify the nature of their associations with traumatic experiences.
Methods
Multivariate biometric modeling was conducted using data from 9526 twins [59% female, mean age = 31.7 years (range 24–42)] from two cohorts of the Australian Twin Registry, some of whom also participated in the Childhood Trauma Study and the Nicotine Addiction Genetics Project.
Results
The prevalences of high-risk trauma exposure (HRT), NSSI, SI, and SA were 24.4, 5.6, 27.1, and 4.6%, respectively. All phenotypes were moderately to highly correlated. Genetic influences on self-injurious thoughts and behaviors and HRT were significant and highly correlated among men [ rG = 0.59, 95% confidence interval (CI) (0.37–0.81)] and women [ rG = 0.56 (0.49–0.63)]. Unique environmental influences were modestly correlated in women [ rE = 0.23 (0.01–0.45)], suggesting that high-risk trauma may confer some direct risk for self-injurious thoughts and behaviors among females.
Conclusions
Individuals engaging in NSSI are at increased risk for suicide, and common heritable factors contribute to these associations. Preventing trauma exposure may help to mitigate risk for self-harm and suicide, either directly or indirectly via reductions in liability to psychopathology more broadly. In addition, targeting pre-existing vulnerability factors could significantly reduce risk for life-threatening behaviors among those who have experienced trauma.
... Rates of suicide and suicide attempts among individuals with substance use disorders have far exceeded rates found among those without such disorders (Darke, Torok, Kaye, & Ross, 2010;Wilcox, Conner, & Caine, 2004). Evidence from the NCS (N = 5,877) suggests that individuals diagnosed with substance abuse or dependence on alcohol or drugs were nearly six times more likely to have reported a doi: 10.1093/hsw/hly004 © 2018 National Association of Social Workers lifetime suicide attempt (Kessler, Borges, & Walters, 1999). ...
Substance use disorders and posttraumatic stress disorder have been associated with suicide. Through secondary analysis of the screening data from the Women and Trauma Study conducted by the National Institute on Drug Abuse Clinical Trials Network, the present study examined rates and correlates of suicidal ideation and suicide attempts among women who sought treatment for substance use and trauma at seven outpatient substance use programs. The sample included women between the ages of 18 and 65 years (M = 39.2; SD = 9.3) and was 44 percent white, 33 percent African American, 8 percent Latina, and 15 percent other races or ethnicities. Logistic regression was used to examine factors associated with a lifetime history of recurrent suicidal ideation and a serious suicide attempt. Findings highlight the need for social workers to address elevated risk levels for suicidal thoughts and behaviors when working with women with histories of substance use and trauma.
... In Europe, between 10% and 23% of mortality among those aged 15 to 49 might be attributed to opiate use (Bargagli et al., 2006, Bloor et al., 2008, EMCDDA, 2010. Heroin users have a death rate 13-17 times that of their agematched peers, and a 14-fold risk of suicide (Darke et al., 2007b, Darke et al., 2010, Hickman et al., 2003, Lind et al., 1999, Sporer, 1999. Between 10% and 35% of deaths in heroin-dependent individuals are due to suicide. ...
Physical damage due to drug dependence
Excessive use of alcohol, tobacco and illicit drugs cause long term physical health damage. Smoking can cause lung cancer, and alcohol abuse may lead to liver cirrhosis and tumors in the oral cavity, esophagus and liver. The medical treatment of the diseases leads to financial costs. The health effects and treatment of alcohol and tobacco use are higher in comparison to those of illicit drugs use. This is mainly due to the relatively large number of people smoking (27 percent of the Dutch population) or excessive alcohol use (84 percent drink, of which 10 percent drink excessively). Illicit drugs are, however, used by relatively few people (recent use is 0.1 to 4.2 percent) and mostly used for only a few years. At the individual level, the physical health effects of alcohol and tobacco use are similar to those of recreational use of hard drugs heroin and crack. In general, only the intensive use of illicit drugs, i.e. the abuse of drugs, leads to great physical health damage.
Physical effects of drugs are limited
This emerged from a literature review of the RIVM, which gives an overview of the physical health damage of seventeen recreational drugs, alcohol and tobacco. The study was commissioned by ZonMw. ZonMw has also initiated research into the psychological and social effects of illicit drugs. The latter consequences are often greater than the physical health damage.
Physical effects of the four most commonly used drugs
Of the four most commonly used illicit drugs (ecstasy, cocaine, cannabis, amphetamine) it seems that ecstacy is the only one that does not to lead to serious physical health damage. Cannabis smoking can cause lung cancer and COPD. The use of heroin, cocaine and crack can cause infectious diseases, AIDS and tuberculosis; the use of dirty needles caused the most problems here. Cocaine, crack and (repeated) amphetamine use is related to heart disease. Of all illicit drugs, the risk of (fatal) heart attack is greatest when snorting cocaine. The use of khat and anabolic steroids is associated with cardiovascular disease, but the evidence is fairly weak. Urological complications from regular use of the anesthetic ketamine are reported in the literature, but they are rare. Oral cancers can be caused by the intensive use of khat. Finally, almost all problematic hard drug users suffer from dental disease.
For most illicit drugs, it is difficult to indicate the association between the use and the diseases caused by them, because the drugs are frequently combined with other drugs, tobacco and alcohol (poly drug use). In particular, very little is known about the extent to which and how the illicit drugs have been used in the past. This knowledge is necessary if a link is to be made between the disease and the use of various drugs.
Keywords:
ilicit drugs, physical effects, disease, relative risk, alcohol, tobacco
... Ce délai se raccourcit lorsque ces pensées deviennent récurrentes. À l'instar de ce qui a été observé parmi les jeunes adultes [12], de nombreuses études soulignent les cooccurrences des troubles dépressifs [13][14][15][16] et d'une consommation importante de substances psychoactives à l'adolescence [17][18][19][20], période de profondes remises en question et de désirs de transgression propices aux expérimentations en tous genres. L'objet de cet article est d'évaluer l'importance relative de ces trois facteurs afin de mieux envisager leurs interactions chez les jeunes de 17 ans. ...
Background:
The aim of this study was to describe potential associations between suicidal behaviors and psychoactive substance uses among adolescents.
Methods:
A cross-sectional, national survey representative of adolescents aged 17, living in continental France, was conducted in 2014. A total of 22,023 adolescents answered an anonymous, self-administered questionnaire about their health and their use of psychoactive substances. Suicidal risk was assessed by means of a 4-level indicator [1. No depression, as stipulated by the Adolescent Depression Rating Scale (ADRS); 2. Depression, no suicidal ideation, no suicidal attempts; 3. Depression with suicidal ideation; 4. Depression with suicidal attempts]. Multivariate logistic regressions were conducted to identify the factors significantly related to frequent substance uses.
Results:
Three percent of adolescents (1.8% of boys vs. 3.7% of girls) were labeled as suffering from severe depression, 10% stated they had suicidal thoughts during the last year and 3% attempted to commit suicide at least once in their lifetime. The results support the view of a gradient between suicidal risk severity and regular use of tobacco and cannabis. The association with regular alcohol use appears somewhat weaker.
Conclusion:
Suicidal behaviors and regular substance uses are significantly related but also mediated by adolescents' mental health.
... times greater for those with a diagnosis of drug dependence (Kessler et al., 1999). In addition, a study of regular users of heroin and/or psychostimulants indicates that suicidal behaviors are reported in almost one in three of these individuals (Darke, Torok, Kaye, & Ross, 2010). Data from SUD treatment settings also indicate that individuals treated for cocaine dependence (Roy, 2001), opiate dependence (Darke, Ross, Lynskey, & Teesson, 2004), and a mixture of SUDs (Ilgen, Jain, Lucas, & Moos, 2007;Wines, Saitz, Horton, Lloyd-Travaglini, & Samet 2004) have high lifetime prevalence rates of suicide attempts. ...
This chapter reviews evidence linking the presence of alcohol use disorders (AUDs) and some drug use disorders (DUDs) to suicide attempts and suicide. It focuses on key distal risk factors like severity of substance use disorder (SUD), aggression/impulsivity, negative affectivity and proximal risk factors like active substance use and symptoms, interpersonal stress, depressive symptoms for suicidal behavior within SUD populations. A theoretical model is presented that posits that the distal risk factors, for example, negative affectivity, increase the probability for the proximal risk factors, which in turn increase the likelihood of suicidal behavior. The proximal risk factors are conceptualized as partial mediators of the relationship between the distal variables and suicidal behavior. Key decisions that informed the development of the model along with limitations and caveats are explained. The chapter concludes with a discussion of ways to test the conceptual framework, directions for future studies, and resources pertaining to SUDs and suicidal behavior.
... Gender was a significant predictor of lifetime attempts but not suicidal ideation. Compared to males, females were almost twice as likely to have attempted suicide which confirms previous observations in addiction populations (Cottler et al., 2005;Tsirigotis et al., 2011;Darke et al., 2010). For female addiction patients (who constitute only 13% of the patient population), it is likely to reflect the severity of their problems/situation (e.g. higher rates of axis-1 co-morbidity, which contribute to their decision to seek treatment). ...
Suicidality is more commonly reported among individuals with addictions relative to the general population, though data from Asian countries remain scarce. The medical records of 2187 Singaporean patients with drug (n=879), alcohol (n=754) or gambling (n=554) disorders entering an outpatient treatment service were examined to explore differences in suicidal ideation and lifetime attempts between substance and gambling addictions. The relationship between suicidality, co-morbidity and addiction severity were also examined. 25.0% reported thoughts of suicide in the past month, 11.8% had a suicide plan and 12.2% reported lifetime attempts. Rates of suicidal ideation (thoughts, and plan) but not lifetime attempts were significantly higher among gambling than substance use patients. Co-morbid (DSM-IV axis-1) disorders were found among 32.5%, 38% and 40% of those reporting thoughts, plan and lifetime attempts respectively. Addiction severity was higher and quality of life lower among those reporting suicidal behaviors. Logistic regression revealed co-morbidity, debt, gender (being female) and being a gambling patient as significant predictors of suicidal behaviors. The findings highlight the importance of screening for suicidality, even in the absence of co-morbidity, particularly among gambling disorder patients with debts. Suicide risk should be assessed periodically and referral to suicidal prevention interventions routinely offered to this vulnerable population.
Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
... In addition to polydrug use, violence exposure is nearly universal in heroin users. As a result, up to 50% of opioid-dependent individuals meet criteria for post-traumatic stress disorder (PTSD), which can also compromise neuropsychological functioning (Darke et al., 2010; Horner & Hamner, 2002; Mills et al., 2005). Violent traumatic events may result in traumatic brain injury, which is also associated with long-term cognitive impairment (Khan et al., 2003 ). ...
With increases over the past decade in the abuse of both heroin and prescription opioids (e.g., OxyContin'), opioid abuse is a significant public health problem. Acute and chronic opioid use affects multiple levels of functioning by changing neurophysiological structure and function, modulating perception and cognition, and compromising physical and mental health. Comorbid psychiatric disorders and health conditions, predating or resulting from opioid use and dependence, complicate the success of current treatment interventions. Comprehensive research that considers these complexities is needed to optimize opioid dependence interventions and develop effective public health policies.
... The onset of NSSI is commonly between 12 and 16 years of age [6•, 8]. While NSSI is more prevalent among females in adolescence [9], no gender separation is observed in adult community [10] and clinical [11] samples. ...
Nonsuicidal self-injury (NSSI) evaluation and treatment are critical for comprehensive patient care. A thorough assessment of nonsuicidal self-injury(NSSI) following DSM-5-proposed criteria is critical in understanding and treating NSSI and should be informed based upon past and current self-harm behaviors, including self-injury methods, frequency, severity, and intent, along with a comprehensive suicide risk assessment. After NSSI is diagnosed, patients should be offered proper management of co-occurring psychiatric illnesses, if applicable, enhanced by an 8 – 12 week trial of cognitive behavior therapy (CBT) focusing on NSSI. Cognitive strategies to be used include Socratic questioning, keeping thought records, and addressing self-derogatory and distorted beliefs about NSSI. Behavioral strategies include contingency management, behavioral activation, and addressing environmental factors maintaining NSSI. In adolescents, individual CBT work might be supplemented with family-based therapy. Dialectical strategies (acceptance and distress tolerance) and skills training (focus on improving emotion regulation, problem-solving, interpersonal, and communication skills) can be used to enhance CBT, but in some cases DBT can be cost prohibitive. If adequate psychotherapy trials are ineffective, a pharmacotherapy trial of emerging drug therapies for NSSI, e.g. naltrexone, N-acetylcysteine, or topiramate to enhance supportive psychotherapy would be recommended. We would encourage patients to continue effective treatment for at least 6 months and would continuously assess for self-harm urges and behaviors. Psychoeducation and adequate treatment of comorbid conditions should be provided on an ongoing basis along with attention to physical self-care and regular exercise.
... Similarly, college students who drink to cope with negative emotions are more likely to report suicidal ideation (Gonzalez & Hewell, 2012). Rates of suicide attempts also are higher among inhalant abusers (Howard et al., 2010), cannabis and cigarette users (Moran et al., 2012), and heroin and methamphetamine users (Darke, Torok, Kaye, & Ross, 2010). ...
Drug poisoning is the leading method of suicide-related deaths among females and third among males in the United States. Alcohol can increase the severity of drug poisonings, yet the prevalence of alcohol overdoses in suicide-related drug poisonings (SRDP) remains unclear. Data from the Nationwide Inpatient Sample was examined to determine rates of inpatient hospital stays for SRDP and co-occurring alcohol overdoses in adolescents (ages 12-17) and young adults (ages 18-24) between 1999 and 2008. Among adolescents, there were 14,615 hospitalizations for drug poisonings in 2008, of which 72% (10,462) were suicide-related at a cost of $43 million. Rates of SRDP in this age group decreased between 1999 and 2008. The prevalence of co-occurring alcohol overdoses increased from 5% in 1999 to 7% in 2008. Among young adults, there were 32,471 hospitalizations for drug poisonings in 2008, of which 64% (20,746) were suicide-related at a cost of $110 million. Rates of SRDP did not change significantly between 1999 and 2008. The prevalence of co-occurring alcohol overdoses increased from 14% in 1999 to 20% in 2008. Thus, while rates of SRDP decreased for adolescents and remained unchanged for young adults, the prevalence of co-occurring alcohol overdoses increased for both age groups. Such hospitalizations provide important opportunities to employ intervention techniques to prevent further suicide attempts.
Objectives
Information on emergency department (ED) visits for mental and substance use disorders (MSUDs) is important for planning services but has not been explored in British Columbia (BC), Canada. We describe all MSUD ED visits for people ages 15 and older in the province of BC in 2017/2018 and document trends in MSUD ED visits between 2007/2008 and 2017/2018 by disorder group.
Design
Population-based linked administrative data comprised of ED records and physician billings capturing all MSUD ED visits in BC.
Setting
BC is Canada’s westernmost province with a population of approximately 5 million. Permanent residents receive first-dollar coverage for all medically necessary services provided by licensed physicians or in hospitals, including ED services.
Population
All people age >15 with MSUD ED visits during the study period.
Measures
All claims with a service location in the ED or corresponding to fee items billed only in the ED were examined alongside ED visits reported through a national reporting system. Patient characteristics (sex/gender, age, location of residence, income, treated disorders and comorbidities) and previous outpatient service use for all ED visits by visit diagnosis are also described.
Results
A total of 72 363 people made 134 063 visits to the ED in 2017/2018 for needs related to MSUD. MSUD ED visits have increased since 2010, particularly visits for substance use and anxiety disorders. People with more frequent visits were more likely to be male, on public prescription drug plans for income assistance, prescribed psychiatric medications, and living in lower-income neighbourhoods. They used more community-based primary care and psychiatry services and had lower continuity of primary care.
Conclusions
MSUD ED visits are substantial and growing in BC. Findings underscore a need to strengthen and target community healthcare services and adequately resource and support EDs to manage growing patient populations.
Highlights
•Suicidality rates are high among adults seeking substance use disorder treatment.
•Suicidality groups differed in demographics, substance use, and health indicators.
•Suicidality groups did not differ in drug/alcohol toxicology outcomes throughout treatment.
•Adults with recent suicidal ideation did not maintain reductions in severity of alcohol problems at 6-months post-treatment.
•Adults with past suicide attempts showed less improvement in drug use severity from post-treatment to 6 months post-treatment.
Nonsuicidal self-injury (NSSI) and suicidal thoughts and behavior often co-occur, representing a growing public health concern. Despite extensive research examining suicidal thoughts and behavior among those who engage in NSSI, there is a lack of research investigating factors that, when considered together, can differentiate individuals along the continuum of suicidal thoughts and behavior (no history, suicidal ideation, suicide plan, suicide attempt). This study sought to address this question using a sample of 1178 college students with NSSI history (68.70% female). Discriminant function analysis was conducted including the following predictors: NSSI characteristics, negative affect difficulties, and behavioral and demographic risk factors for suicidal thoughts and behavior. Results suggest that self-disclosure of suicidal ideation, number of lifetime NSSI methods, NSSI frequency, depressive symptoms, and age most parsimoniously differentiate study groups. Those who use a greater number of NSSI methods and acts, paired with higher depressive symptoms and repeated self-disclosure of suicidal ideation are most likely to have a suicide attempt history; decreases in these variables suggest membership within less severe groups. Furthermore, older age may be related to greater suicidality. Findings suggest that the evaluation and co-occurrence of these variables may contribute to a more accurate suicide risk assessment.
This research examined the relationship between adult missing persons and suicide, considering a number of possible vulnerability indicators/characteristics of this group of missing persons. Implications for missing person investigations were also explored, particularly for the risk assessment process. Data was extracted for 93 (N = 93) missing persons cases from one English police force, over a 4-year period. These individuals were found dead suspected of suicide. The findings illustrate a number of vulnerability indicators/characteristics of missing persons who complete suicide. In relation to the initial risk assessment level applied to the missing person report, two vulnerability indicators, a risk of suicide and the presence of a suicide note, had an effect on predicting a higher risk assessment level. Future research, in order to overcome the present study’s limitations, should attempt to collect data from more than one police force in order to increase the sample size. In addition to this, it would be beneficial to use a sample of missing persons who are found safe and well as a comparative sample to have a better chance in understanding the examined relationship and whether the vulnerability indicators/characteristics are indicative of suicide risk. The findings of this study have practical implications for the risk assessment process and are a step forward in providing empirical evidence applicable to identifying missing persons most at risk of suicide. This research has helped to build upon and corroborate existing knowledge of missing persons who complete suicide. This study provides new empirical evidence on suicide in adult missing persons. The findings demonstrate the subjective and variable nature of the risk assessment process and highlight potential implications on missing person investigations.
Background:
To date, there have been no studies examining non-suicidal self-injury (NSSI) in Chinese heroin-dependent patients (HDPs) receiving methadone maintenance treatment (MMT). This study determined the prevalence of NSSI and its methods in HDPs under MMT as well as factors significantly associated with NSSI.
Method:
We recruited a cross-sectional sample of 652 HDPs from three MMT clinics in Wuhan, China. In total, 603 HDPs (92.5%) completed standardized questionnaires concerning demographic, clinical, and psychosocial data. The presence and methods of NSSI were assessed with two standardized questions.
Results:
The one-month prevalence of NSSI in Chinese HDPs receiving MMT was 13.8%. The most common three methods of NSSI were burning (59%), cutting (19.3%), and hitting (9.6%). Significant factors associated with NSSI in multiple logistic regression analysis were unemployment (OR [95%CI] = 2.54 [1.26, 5.10], P = 0.009), a short duration of MMT (OR [95%CI] = 1.04 [1.01, 1.09], P = 0.034), pain (OR [95%CI] = 2.31 [1.05, 5.35], P = 0.028), depression (OR [95%CI] = 4.32 [2.09, 9.00], P < 0.001), anxiety (OR [95%CI] = 3.74 [1.61, 8.70], P = 0.002), and loneliness (OR [95%CI] = 3.04 [1.27, 7.26], P = 0.012).
Conclusions:
NSSI is common among Chinese HDPs of MMT clinics. Services for HDPs in MMT settings should include periodic screening for NSSI, adequate pain treatment, and appropriate psychosocial treatment for depression, anxiety, and loneliness.
Suicide prevention policy in Australia has had an increasing focus on building the evidence base to address this major public health concern. In recent times, the Australian Government has increased its investment in suicide prevention research. It has provided support for several initiatives in this area, including funding Suicide Prevention Australia to act as the lead agency for a $12 million national Suicide Prevention Research Fund, and funding the Centre for Mental Health at the University of Melbourne to play a national leadership role in suicide prevention research. The current project aims to assist these agencies to identify priority research areas to be addressed in suicide prevention.
Previous studies in Nigeria have associated alcohol and tobacco use among students with
certain socioeconomic and educational achievement variables, albeit its determinants
among university students remain largely unknown. This study examined current patterns
and predictors of alcohol and tobacco use with a model involving socio-demographic
factors among 708 undergraduate students. Participants included 280 males and 428
females; mean age was 21.4±4.4. The students were assessed with a questionnaire
including living arrangement, satisfaction with course of study, current alcohol and
tobacco use and parental educational levels. Overall, the prevalence of alcohol and
tobacco use was 24.0% and 5.5% respectively. Inter-correlation of discrete variables
with Cramer’s V showed: gender (φc =.23, p<.000); level of study (φc =.16 p<.01); father
education φc =.11, p<.02); satisfaction with course of study (φc =.11, p<.01); having sex in
the last three months (Cramer, =.26, p<.000) were associated with alcohol use. Gender
(φc =.20, p<.000); polygamous family structure (φc =-.074, p<.06); satisfaction with course
of study (φc =.09 p<.04); having sex in the last three months (φ =.11, p<.005 and mothers
higher education (φc =.12, p<.004) were associated with tobacco use. Binary logistic
regression analysis revealed two variables: male gender (OR= 2.93; 95% CI = 1.95 – 4.42),
level of study (OR= 0.82; 95% CI = 0.67-0.98), ethnicity (OR= 0.76; 95% CI = 0.62-0.92)
satisfaction with course of study (OR= 0.65; 95% CI = 0.43-0.97), father education (OR=
1.5; 95% CI = 1.10.-2.06) and having sex 3 months prior survey (OR= 2.96; 95% CI = 1.93 –
4.54) significantly predicted alcohol use. Similarly male gender (OR= 7.71; 95% CI = 3.27
– 18.1), polygamous family structure (OR= 0.40; 95% CI = 0.97 – 0.92), satisfaction with
course of study (OR= 0.54; 95% CI = 0.29 – 0.99) and increased mother education (OR=
3.33; 95% CI = 1.76 – 5.92) significantly predicted tobacco use. These data underscore the
role of gender, sexual activity and mother’s educational level in drug use among Nigerian
students. It also highlights the need for continuous drug education.
Key words: Alcohol use, tobacco use, university students, Nigeria
Background. Suicide risk is challenging to quantify due to reliance on self-report, which is limited by individuals’ lack of insight and the desire to conceal such intentions. Non-suicidal self-injury (NSSI) is one of the most robust predictors of suicidal ideation (SI) and suicide attempts (SA). Although NSSI often leads to permanent scarring, which can be assessed by objective physical examination, no research has examined whether scarring denotes tangible risk for SI and SA. The present study examined whether NSSI scar presence and number predict current SI and SA history. Further, we examined whether brooding would exacerbate the effects of NSSI scarring on SI or SA.
Methods. Young adults (N = 231; M = 21.24 years; 78% female) completed self-report questionnaires assessing SA history, frequency of NSSI, presence/number of NSSI scars, brooding, current depressive symptoms, and SI. Results. NSSI scar presence and number predicted current SI and SA history after controlling for current depressive symptoms. Moreover, scar presence and number predicted current SI over and above the effects of SA history and NSSI frequency, method, and medical severity. Further, NSSI scar presence and number predicted SI more strongly among individuals with greater levels of brooding than among individuals with lower levels of brooding.
Conclusions. The presence and number of NSSI scars are objective physical indicators of risk for SI and SAs. Brooding may further heighten the risk of SI for individuals bearing NSSI scars.
To estimate associations between recent licit and illicit substance use and subsequent suicide attempt among people who inject drugs (PWID).
Secondary analysis of longitudinal data from a prospective cohort study of PWID followed bi-annually between 2004 and 2011.
Montréal, Canada.
Seven-hundred and ninety-seven PWID who reported injection drug use in the previous six months, contributing to a total of 4,460 study visits. The median number of visits per participant was 5 (Interquartile range: 3-8).
An interviewer-administered questionnaire eliciting information on socio-demographic factors, detailed information on substance use patterns and related behaviours, mental health markers and suicide attempt. The primary exposure variables examined were past-month use of alcohol [heavy ((3) 60 drinks); moderate (1-59 drinks); none], sedative-hypnotics, cannabis, cocaine, amphetamine and opioids [regular ((3) 4 days); occasional (1-3 days); none]. The outcome was a binary measure of suicide attempt assessed in reference to the previous six months.
In multivariate analyses, among licit substances, a positive association was found between heavy alcohol consumption [adjusted odds ratio (AOR): 2.05; 95% confidence interval (CI): 1.12-3.75], regular use of sedative-hypnotics (AOR: 1.89; 95% CI: 1.21-2.95) and subsequent attempted suicide. Among illicit substances, occasional use of cannabis (AOR: 1.84; 95% CI: 1.09-3.13) had a positive association with subsequent suicide attempt. No statistically significant association was found for the remaining substances.
Among people who inject drugs, use of alcohol, sedative-hypnotics and cannabis, but not cocaine, amphetamine or opioids, appears to be associated with increased likelihood of later attempted suicide. This article is protected by copyright. All rights reserved.
This article is protected by copyright. All rights reserved.
Lifetime and recent rates of attempted suicide and suicidal ideation amongst the Australian Treatment Outcome Study cohort of heroin users at 11-year follow-up were examined. The mean elapsed time since heroin initiation was 20.4 years. At 11-year follow-up, 42.2% of the cohort reported ever having made a suicide attempt, 11.1% having made a first attempt subsequent to baseline. In the year preceding 11-year follow-up, 1.6% had made an attempt, suicidal ideation was reported by 10.4%, and 4.2% had a current suicide plan. After controlling for other variables, past 12 month attempts, current ideation or plans were independently associated with a current diagnosis of Major Depression (odds ratios (OR) 1.67) and more extensive polydrug use (OR 1.39), while each standard deviation higher on the SF12 physical health scale (reflecting better health) was associated with reduced odds (OR 0.66). Suicide and suicidal ideation remained a significant clinical issue for heroin users, some 20 years after their heroin use commenced.
Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
To determine whether childhood physical abuse (CPA) histories were associated with age of onset of psychoactive substance use and injecting, and the extent of polydrug use among injecting drug users (IDU).
Cross-sectional.
Sydney, Australia.
300 IDU were administered a structured interview examining the prevalence and severity of CPA, and drugs use histories.
40.3% of participants had experienced severe abuse (SA), 34.0% Mild-Moderate abuse (MMA), and 25.7% no abuse history (NA). After controlling for other variables, a history of severe CPA was a significant independent correlate of an earlier age at first alcohol intoxication compared to both the NA (β=-.23, p<.01) and MMA (β=0.20, p<.01) groups. Severe CPA was also a significant independent correlate of an earlier age at first illicit drug use compared to both the NA (β=-0.16, p<.05) and MMA (β=-0.15, p<.05) groups. In contrast, CPA histories were not independently associated with the onset of injecting drug use. After controlling for potential confounders, both the MMA (β=0.28, p<.001) and SA (β=.28, p<.001) groups were associated with more extensive lifetime polydrug use, but did not differ from each other (p=.82). After controlling for potential confounders, both MMA (β=0.23, p<.01) and SA (β=0.33, p<.001) group membership were associated with more extensive recent polydrug use but, again, did not significantly differ from each other (p=0.08).
Severe childhood physical abuse severity is associated with an earlier initiation into drug use. Any level of abuse is associated with more extensive lifetime and recent polydrug use.
Childhood physical abuse (CPA), non-suicidal self-harm and attempted suicide are all highly prevalent amongst injecting drug users (IDU). This paper reported on the association of CPA with self-harm and attempted suicide.
Cross-sectional study, with 300 IDU administered a structured interview examining the prevalence of CPA, non-suicidal self-harm and suicide attempts.
CPA was reported by 74.3%, and severe CPA by 40.3%. A history of non-suicidal self-harm was reported by 23.7%, and 25.7% had attempted suicide. Non-suicidal self-harm preceded the suicide attempt in 83.3% of cases where both had occurred. Independent correlates of non-suicidal self-harm were: female gender (OR 3.62), avoided home due to conflict (OR 2.28) and more extensive polydrug use (OR 1.32). Independent correlates of attempted suicide were: severe CPA (OR 3.18), frequent CPA (OR 2.54), avoided home due to conflict (OR 3.95), female gender (OR 2.99), a positive screen for Conduct Disorder (OR 3.53), and more extensive polydrug use (OR 1.52).
Those presenting to treatment agencies are highly likely to have a history of CPA, that may still influence their behaviours. Screening for histories of CPA and non-suicidal self-harm appears warranted when determining suicide risk for this population. At the population level, reductions in the rate of CPA, could possibly reduce the rate of subsequent suicidality.
The aims of this study were to characterize trauma exposure and posttraumatic stress disorder (PTSD) in female drug court participants and test for differences in socioeconomic status and familial status between women with: (i) no trauma exposure, (ii) trauma exposure without PTSD, and (iii) trauma exposure resulting in PTSD. Three hundred and nineteen women were recruited from drug courts. Rates of exposure and likelihood of traumatic events leading to PTSD were examined, sociodemographic characteristics were compared across groups, and a logistic regression analysis was conducted to test for differences in PTSD risk for assaultive vs. non-assaultive events. Twenty percent of participants met PTSD criteria, 71% had trauma exposure without PTSD, and 9% did not endorse any traumatic events. Prostitution and homelessness were more prevalent in women with vs. without a history of trauma, but among trauma-exposed women prevalences did not vary by PTSD status. No differences in risk for PTSD were found between assaultive and non-assaultive events (OR=0.91; 95%CI: 0.48-1.75). Women sentenced to drug court represent a heavily trauma-exposed population, for whom risk for PTSD is not limited to assaultive events. Within this high-risk population, trauma is associated with elevated rates of homelessness and prostitution, even in the absence of PTSD.
The purpose of the study was to evaluate the prevalence of posttraumatic stress disorder (PTSD) among substance users in the general population.
The St. Louis Epidemiologic Catchment Area study, a survey of psychiatric illness in the general population, collected data on PTSD and substance use with the Diagnostic Interview Schedule. Among the 2,663 respondents, 430 reported a traumatic event that could qualify for PTSD; however, the rate of PTSD was low, 1.35% overall. To evaluate the relationship between PTSD and substance use, respondents were hierarchically classified into one of four substance use categories ranging from polydrug use to alcohol use only. Substance users from each category as well as substance users in general were compared with persons who did not meet the substance use threshold (comparison subjects).
Findings indicate that cocaine/opiate users are over three times as likely as comparison subjects to report a traumatic event, report more symptoms and events, and are more likely to meet diagnostic criteria for PTSD. Physical attack, but not combat-related events, was the most prevalent event reported among cocaine/opiate users. Onset of substance use preceded onset of posttraumatic symptoms, suggesting that substance use predisposes the individual to exposure to traumatic events. When other variables--including antisocial behavior--were controlled, female gender and use of cocaine/opiates predicted PTSD.
These analyses of the co-occurrence of substance abuse and PTSD warrant further study and suggest that PTSD is much more common among substance abusers than was previously known.
General population survey data are used to disaggregate the associations of substance use disorders with suicide attempts in order to evaluate a number of hypotheses about the processes leading to these associations. Data are from the US National Comorbidity Survey (1990-1992). Discrete-time survival analysis is used to study the effects of retrospectively reported temporally prior substance use, abuse, and dependence in predicting first onset of suicidal behavior. Alcohol and drug use predict subsequent suicide attempts after controlling for sociodemographics and comorbid mental disorders. Previous use is not a significant predictor among current nonusers. Abuse and dependence are significant predictors among users for three of the 10 substances considered (alcohol, inhalants, and heroin). The number of substances used is more important than the types of substances used in predicting suicidal behavior. Disaggregation shows that the effects of use are largely on suicidal ideation and nonplanned attempts among ideators. In comparison, the effects of use on suicide plans and planned attempts among ideators are not significant. Clinicians need to be aware that current substance use, even in the absence of abuse or dependence, is a significant risk factor for unplanned suicide attempts among ideators.
Postmortem toxicology can be useful for reconstructing some clinically important events occurring before a suicide. Its utility may be improved by examining patterns of detected substances in a population over time.
Toxicology was performed for 333 (96%) of the 346 suicides occurring in Mobile County, Alabama, between October 1990 and September 1998. Detected psychoactive substances were grouped in three categories: alcohol, cocaine, and cannabis; abusable prescription medications; and non-abused psychotropic medications. The overlap between these three categories was assessed.
Psychoactive substances were detected in 227 (68%) of 333 suicides. Of the cases positive for any prescription psychoactive medication, 2/3 were positive for an abusable medication. An abusable substance was found in 56% of cases positive for non-abused psychotropic medication. Alcohol, cocaine and/or cannabis were found in 34% of cases with abusable prescription medications and in 33% with non-abused psychotropics.
Clinicians must be aware of a number of methodological realities when interpreting routine postmortem toxicology results.
Routine surveillance of psychoactive substances among suicides can provide useful data for directing and monitoring strategies for suicide prevention in clinical practice.
The focus of this study was to identify factors that differentiate women drug abusers who had experienced suicidal ideation from those who did not. Face-to-face interviews were conducted with 221 cocaine-using women in Atlanta, GA, 88 (39.8%) of whom reported thinking about committing suicide at least once during the 90 days prior to interview and 133 (60.2%) of whom did not. Multivariate logistic regression was used to identify predictors of suicidal ideation, and post hoc goodness-of-fit tests were conducted to assess the robustness of final models derived. Model 1 excluded all psychosocial functioning measures and Model 2 included these items. Both models showed that suicidal ideation was more common among women who were unemployed, had been abused sexually, engaged in sexual relations to cope with stresses, or had less helpful relatives. In addition, Model 1 revealed a heightened risk for women experiencing financial problems and those who had a previous mental health diagnosis, whereas Model 2 showed an elevated risk among women who experienced anxiety and those who had lower levels of self-esteem. These findings suggest the need for prevention and intervention programs that target at-risk women, and for such programs to include an emphasis on suicidal ideation in addition to focusing on risk factors that are addressed more commonly.
Aims: To determine the lifetime and recent histories of attempted suicide among entrants to treatment for heroin dependence in three treatment modalities and a non-treatment comparison group; and to ascertain factors associated with a recent history of attempted suicide. Design: Cross-sectional structured interview. Setting: Sydney, Australia. Participants: Six hundred and fifteen current heroin users: 201 entering methadone/buprenorphine maintenance (MT), 201 entering detoxification (DTX), 133 entering drug free residential rehabilitation (RR) and 80 not in treatment (NT). Findings: A lifetime history of attempted suicide was reported by 34% of subjects, 13% had attempted suicide in the preceding year and 5% had done so in the preceding month. Females were more likely to have lifetime (44% versus 28%) and 12 month (21% versus 9%) suicide attempt histories. The 12 month prevalence of attempted suicide among treatment groups ranged between 11% (MT, NT) and 17% (RR). Factors associated with recent suicide attempts were: being an RR entrant, female gender, younger age, less education, more extensive polydrug use, benzodiazepine use, recent heroin overdose, Major Depression, current suicidal ideation, Borderline Personality Disorder (BPD)and Post-Traumatic Stress Disorder. Conclusions: Recent suicidal behaviour is a major clinical problem for heroin users, and for females and RR entrants in particular. An essential adjunct to treatment for heroin dependence is routine screening for depression and suicidal ideation, with the provision of appropriate treatment where needed.
Objectives: The validity of self-reports of drug use from individuals who abuse substances has been questioned. Results from studies examining the accuracy of such self-reports have been mixed, indicating the need for closer examinations of the factors associated with concordance between self-reported drug use and results of urine screens.Methods: As part of a larger study examining the effectiveness of interventions for people with co-occurring mental health and substance use disorders, we examined the agreement between self-report and urine screens for recent drug use.Results: Overall, the concordance between self-report and results from urine screens was high (80-84% agreement overall and 75–79% for the subset where the urine screen indicated recent drug use). Estimates for the likelihood of use of marijuana and cocaine within the past 30 days were 15% and 32%, respectively, based on urine screens, 25% and 35% based on self-report, and 28% and 43% based on information from both sources combined. About 1/3 of individuals who had at least one positive urine screen misrepresented their drug use at least once. Such misrepresentation tended to increase with time in the study.Conclusions: The relatively high concordance rates between self-report and urine screens indicate that situations can be structured so that individuals with co-occurring mental health and substance use disorders report instances of substance use accurately most of the time. Given the observed increase in failure to report use through time, the utility of biological markers may be more valuable as clients develop relationships with clinicians.
This article presents the current state of knowledge in deliberate-self harm (DSH). DSH presents as a comorbidity with a number of personality disorders and psychopathologies, but is also relatively common in the psychologically healthy population. Over the past 10 years, attention has shifted from the investigation of DSH as a cardinal or comorbid symptom of psychopathology to an attempt to understand the behaviour itself, without reference to other psychopathological processes. It is argued that this development in understanding the aetiology of DSH has not been matched by developments in treatment or management of DSH, with the majority of treatment programs targeting larger syndromes of which DSH is a symptom. Treatment regimes aimed at reducing DSH appear to be either untested or demonstrably unsuccessful.
The National Treatment Outcome Research Study (NTORS) is a longitudinal, multisite, prospective cohort study that assesses changes in illicit drug use and other problems after treatment in national (UK) drug misuse treatment programmes. Clients were recruited from 54 residential and community-based drug treatment programmes throughout England. Four modalities were studied: inpatient drug dependence units, residential/rehabilitation programmes, methadone maintenance, and methadone reduction programmes. Data on substance use behaviours and physical and psychological health were collected by structured face-to-face interviews at intake, 1- and 2-year follow-up. Data are presented for 549 clients. A majority of clients achieved widespread improvements across a range of outcome measures after treatment in existing treatment services. For most outcomes, reductions in problem behaviours at the group level occurred within the first year and were maintained at 2 years. Considerable stability of outcomes at the individual level was also found. Abstinence from illicit drugs was substantially increased among clients from both residential and community programmes, and there were also substantial reductions in frequency of use of heroin, nonprescribed methadone, benzodiazepines, and crack cocaine. Injecting and shared use of injecting equipment was also reduced. Heavy drinking was common at intake and was not reduced at follow-up. Psychological and physical health problems were reduced on both groups at follow-up. These changes represent important clinical benefits to the individual clients, to their families, and to society.
The Drug Abuse Treatment Outcome Study (DATOS) collected 1-year follow-up outcomes for 2,966 clients in outpatient methadone (OMT), long-term residential (LTR), outpatient drug-free (ODF), and short-term inpatient (STI) programs in 1991-1993. LTR, STI, and ODF clients reported 50% less weekly or daily cocaine use in the follow-up year than in the preadmission year. Reductions were greater (p < .01) for clients treated for 3 months or more. Clients still in OMT reported less weekly or daily heroin use than clients who left OMT. Multivariate analysis confirmed that 6 months or more in ODF and LTR and enrollment in OMT were associated with the reductions. Reductions of 50% in illegal activity and 10% increases in full-time employment for LTR clients were related (p < .01) to treatment stays of 6 months or longer. The results replicated findings from 1979-1981 for heroin use in OMT and illegal activity and employment for LTR but not for illegal activity in OMT and ODF.
Aims. To examine the relationship between attempted suicide and non-fatal heroin overdose among methadone maintenance patients. Design. Cross-sectional survey. Setting. Sydney, Australia. Participants. Two hundred and twenty-three methadone maintenance patients. Findings. Forty per cent of participants reported a history of at least one suicide attempt. Females were significantly more likely than males to have attempted suicide (50% vs. 31%), and to have done so on more than one occasion (28% vs. 15%). There was a large difference between males and females in the onset of attempted suicide. Females reported an initial attempt, on average, 6 years earlier than males (18.3 vs. 24.7 years), and were significantly more likely than males to have attempted suicide prior to the onset of heroin use (69% vs. 11%). While heroin overdose was common among the sample (66%), the most common methods employed for suicide attempts were overdose of a non-opioid drug (21%) and slitting of wrists (20%). A deliberate heroin overdose as a means of attempted suicide was reported by 10% of participants. Heroin overdoses appeared overwhelmingly to be accidental. Ninety-two per cent of those who had overdosed reported that their most recent overdose was accidental. Conclusions. Attempted suicide presents a major clinical problem to staff at drug treatment programmes, but one distinct from heroin overdose. While both overdose and suicide present increasing clinical problems, they are separate problems, and require different responses.
Deliberate self-harm has recently begun to receive more systematic attention from clinical researchers.
However, there remains a general lack of consensus as to how to define and measure this important
clinical construct. There is still no standardized, empirically validated measure of deliberate selfharm,
making it more difficult for research in this area to advance. The present paper provides an
integrative, conceptual definition of deliberate self-harm as well as preliminary psychometric data on a
newly developed measure of self-harm, the Deliberate Self-Harm Inventory (DSHI). One hundred and
fifty participants from undergraduate psychology courses completed research packets consisting of the
DSHI and other measures, and 93 of these participants completed the DSHI again after an interval of
2–4 weeks (M D3:3 weeks). Preliminary findings indicate that the DSHI has high internal consistency;
adequate construct, convergent, and discriminant validity; and adequate test-retest reliability.
The prevalence and risk factors associated with self-mutilation among opioid dependent cases and controls were determined, and the co-occurrence of self-mutilation and attempted suicide was examined. The prevalence of self-mutilation among cases and controls did not differ significantly (25% vs. 23%, respectively), with gender differences identified among cases only. A number of risk factors were found to be associated with self-mutilation, including borderline personality disorder, alcohol dependence, childhood sexual abuse, and multiple suicide attempts. Not only is self-mutilation a clinically significant problem, but when combined with a history of attempted suicide, the psychological dysfunction observed is markedly high.
Nonsuicidal self-injury (NSSI) is a prevalent but perplexing behavior problem in which people deliberately harm themselves without lethal intent. Research reveals that NSSI typically has its onset during early adolescence; most often involves cutting or carving the skin; and appears equally prevalent across sexes, ethnicities, and socioeconomic statuses. Less is known about why people engage in NSSI. This article presents a theoretical model of the development and maintenance of NSSI. Rather than a symptom of mental disorder, NSSI is conceptualized as a harmful behavior that can serve several intrapersonal (e.g., affect regulation) and interpersonal (e.g., help-seeking) functions. Risk of NSSI is increased by general factors that contribute to problems with affect regulation or interpersonal communication (e.g., childhood abuse) and by specific factors that influence the decision to use NSSI rather than some other behavior to serve these functions (e.g., social modeling). This model synthesizes research from several different areas of the literature and points toward several lines of research needed to further advance the understanding of why people hurt themselves.
To provide an overview of the lifetime and 12 month prevalence of suicidal ideation, suicide plans and suicide attempts for Australian adults as a whole and for particular sociodemographic and clinical population subgroups, and to explore the health service use of people with suicidality.
Data came from the 2007 National Survey of Mental Health and Wellbeing (2007 NSMHWB), a nationally, representative household survey of 8841 individuals aged 16-85 years.
A total of 13.3% of respondents had suicidal ideation during their lifetime, 4.0% had made a suicide plan and 3.2% had made a suicide attempt. The equivalent 12 month prevalence rates were 2.3%, 0.6% and 0.4%, for ideation, plans and attempts, respectively. In general, suicidality in the previous 12 months tended to be relatively more common in women, younger people, those outside the labour force, and those with mental disorders; and less common in those who were married or in de facto relationships, and those with moderate levels of education. A number of the differences in prevalence rates between sociodemographic and clinical subgroups did not reach statistical significance due to data availability constraints and the conservative tests of significance that were used by necessity. These patterns warrant further exploration. Service use for mental health problems was higher among people with suicidality than it was among the general population, but significant numbers of those experiencing suicidality did not receive treatment.
Suicidal thoughts and behaviours are not uncommon among the Australian adult population. These thoughts and behaviours are not only predictive of subsequent fatal suicidal acts, but are significant public health problems in their own right. They are associated with high levels of burden at an individual and societal level. Further analysis is required to assess the effectiveness of the national policy frameworks in reducing the spectrum of suicidal thoughts and behaviours.
To determine the prevalence and circumstances of psychoactive substances amongst nonoverdose completed suicide, 1436 consecutive cases autopsied at the NSW Department of Forensic Medicine over the period 1/1/1997-12/31/2006 were analyzed. Substances were detected in 67.2% of cases, and illicit drugs in 20.1%. Alcohol was present in 40.6% of cases. Males were more likely to be positive for alcohol, cannabis, and psychostimulants, and females for pharmaceuticals. Illicits were associated with younger age. Alcohol was most prominent amongst toxicity cases, as were opioids, psychostimulants amongst gunshot cases, and pharmaceuticals amongst drownings. Cases in which drug and alcohol histories were noted were more likely to have a substance detected. Alcohol was more common where a suicide note was left and where relationship problems were involved. Pharmaceuticals were more common where a previous attempt was noted. Licit and illicit substances are strongly associated with suicide, even when the method does not involve drug overdose.
There have been few studies examining risk factors for attempting suicide among cocaine dependent patients. Therefore, a large group of 406 abstinent cocaine dependent patients had a psychiatric interview and completed the Childhood Trauma Questionnaire. Patients who had or had never attempted suicide were compared on putative suicide risk factors. The results showed that 43.5% of the patients had attempted suicide. Attempters were younger; more were female; more reported childhood trauma, a family history of suicidal behavior, a history of aggression, treatment with antidepressant medication, and comorbidity with alcohol and opiate dependence. Logistic regression revealed that childhood physical abuse, childhood emotional negelect, comorbidity with alcohol dependence, and treatment with antidepressant medication were significant predictors of attempting suicide. Thus these results suggest that attempting suicide is common among cocaine dependent patients and that both distal and proximal risk factors may play a role.
Prevalence of lifetime psychiatric comorbidity and history of attempted suicide among intravenous drug users was investigated.
One thousand sixty-two relatives of hospitalized alcoholics, felons, and control subjects were administered a structured interview that gathered data on lifetime psychiatric symptoms and psychoactive drug use. Psychiatric diagnoses were based on interview information, medical records, and family history data. Comparisons were made between 411 subjects who used no illicit drugs, 329 cannabis users, 230 subjects who had used psychoactive drugs other than cannabis more than five times but had never injected drugs, and 92 intravenous drug users.
Any history of injecting drugs increased the odds of being diagnosed with antisocial personality disorder by a factor of 21.01, alcoholism by 4.42, and unipolar depression by 3.02. A diagnosis of antisocial personality disorder increased the odds of having injected drugs by a factor of 27.19, while diagnoses of alcoholism or unipolar depression conveyed odds for injecting drugs of 4.62 and 3.70, respectively. Intravenous drug use was associated with an 8.27-fold increase in odds for a suicide attempt compared with no drug use.
Rates of alcoholism, depression, and antisocial personality disorder, but not other psychiatric disorders (other than drug dependence), are significantly elevated in intravenous drug users. Moreover, among drug users, the decision to inject is differentially made by those with antisocial personality disorder. A history of suicide attempt is common among intravenous drug users, but injecting appears to convey little additional risk above substantial but non-intravenous drug use.
Suicidal behaviour includes suicidal ideation, parasuicide or attempted suicide, and completed suicide. Assessment and recording of suicidal ideation and parasuicide is most difficult, and the first internationally comparable data on parasuicide are expected from an ongoing WHO-coordinated study in 15 European centres. On the other hand, about 50% of WHO's 186 Member States report suicide as part of their mortality statistics. Although there is no uniformity in definitions of suicidal acts nor in recording procedures, certain patterns of suicidal behaviour emerge across countries. The incidence of parasuicide is 10 to 20 times higher than that of completed suicide; the male/female ratios for suicide and attempted suicide are reciprocal: 3 times more women then men commit parasuicide, while in most countries about 3 times more men than women commit suicide. From a public health point of view, suicide in adolescents and young adults is particularly important: suicide in adolescence and young adulthood ranks among the 5 leading causes of death in many countries. There have been clear and dramatic increases in suicide rates in most WHO Member States which report mortality statistics to the Organization, especially among young men. Suicide in old age, particularly among men, is about 2 to 3 times more frequent than in younger age groups. Although it is not surprising that mortality increases with age, death by suicide is considered in most cultures and by most people as particularly deplorable and unnecessary. The epidemiological analysis of suicidal behaviour globally does not identify clear-cut risk factors amenable to preventive programmes. It does, however, pinpoint countries with "unusual" suicide patterns which, it is hoped, will initiate country-specific research into causes of such behaviour. Particularly promising, from the perspective of suicide prevention, seems to be research into the methods of suicide, and the impact of publicity of suicidal acts, as it has been shown repeatedly that restricting access to the prevailing method of suicide in a country will decrease suicide rates, while wide publicity about suicidal acts will increase them.
The effect of comorbidity on rates of suicidal ideation and suicide attempts from an adult general population of former West Germany is investigated. The assessment instrument is a modified German version of the Diagnostic Interview Schedule (DIS), a fully standardized interview for the assessment of selected DSM-III lifetime diagnoses as well as suicidal ideation and suicide attempts. Of the general population 4.1% (2.2% male and 4.1% female) made suicide attempts during their lifetime. Only 2 of 18 people who attempted suicide did not meet criteria for a DSM-III-R diagnosis. Cases with pure major depression did not have an odds ratio for suicide attempts significantly higher than subjects with no DSM-III diagnosis. However, cases with both a major depression and a lifetime-anxiety-disorder diagnosis showed significantly elevated odds ratios. Therefore, it is suggested that comorbidity of anxiety and depression, and not depression itself, seems to be a risk factor for suicide attempts.
Alcohol and drugs use were assessed in a nationwide one year suicide study in Finland.
Alcohol and drugs use were analysed in 1348 suicides, 96.5% of all suicides in the study year. Relative suicide risks for drugs were defined by relating the number of suicides committed by use of various drugs to drug availability.
Alcohol was detected twice as often in men as in women; the opposite was the case with drugs. The drugs most commonly used for suicide were neuroleptics and antidepressants, which were, in 74.3% and 77.4% of the cases, respectively, the victims own prescribed drugs. Antidepressants were found in 19.0% of women and only 4.8% of men. Relative suicide risk for antidepressants varied substantially between different compounds.
Undertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.
Mental disorders have a strong association with suicide. This meta-analysis, or statistical overview, of the literature gives an estimate of the suicide risk of the common mental disorders.
We searched the medical literature to find reports on the mortality of mental disorders. English language reports were located on MEDLINE (1966-1993) with the search terms mental disorders', 'brain injury', 'eating disorders', 'epilepsy', 'suicide attempt', 'psychosurgery', with 'mortality' and 'follow-up studies', and from the reference lists of these reports. We abstracted 249 reports with two years or more follow-up and less than 10% loss of subjects, and compared observed numbers of suicides with those expected. A standardised mortality ratio (SMR) was calculated for each disorder.
Of 44 disorders considered, 36 have a significantly raised SMR for suicide, five have a raised SMR which fails to reach significance, one SMR is not raised and for two entries the SMR could not be calculated.
If these results can be generalised then virtually all mental disorders have an increased risk of suicide excepting mental retardation and dementia. The suicide risk is highest for functional and lowest for organic disorders with substance misuse disorders lying between. However, within these broad groupings the suicide risk varies widely.
The prevalence of diagnoses of substance dependence, anxiety disorders and depressive disorders were estimated in a sample of 222 heroin injectors, using the Composite International Diagnostic Interview. Subjects had a median of three lifetime substance diagnoses and two current diagnoses. A total of 60% met the criteria for a lifetime anxiety disorder, and 51% had a current anxiety disorder. A depressive disorder was diagnosed in 41% of subjects, with 30% having a current diagnosis. There were significant positive correlations between the number of lifetime drug dependence diagnoses and the number of lifetime anxiety and affective disorders (r = 0.41), and the number of current drug dependence diagnoses and the number of current comorbid diagnoses (r = 0.32). After controlling for other variables, the only significant independent predictor of the number of lifetime and current dependence diagnoses was the number of comorbid diagnoses.
A group of 125 drug abusers admitted consecutively for detoxification and short-term rehabilitation were followed up 5 years after discharge. They were asked about possible suicide attempts in a semi-structured face-to-face interview. Nearly half of the group (45%) reported having attempted suicide at some point in their life. The most common reasons given were the loss of a person whom they loved, and feelings of loneliness. Only three respondents reported using their drug of choice in the attempt(s). The suicide attempters were more often found to have been in child psychiatric treatment earlier, and to have experienced loss of significant others in childhood, than those who did not report attempting suicide. At follow-up the suicide attempters indicated that they experienced more depressive moods and more severe psychological problems than those who had never made a suicide attempt. The importance of assessing the risk of suicide attempts among drug addicts in order to be able to take measures to prevent future suicidal behaviour is emphasized.
Self-mutilation (SM), the deliberate, nonsuicidal destruction of one's own body tissue, occurs in such culturally sanctioned practices as tattooing; body piercing; and healing, spiritual, and order-preserving rituals. As a symptom, it has typically been regarded as a manifestation of borderline behavior and misidentified as a suicide attempt. It has begun to attract mainstream media attention, and many more who suffer from it are expected to seek treatment. This review suggests that SM can best be understood as a morbid self-help effort providing rapid but temporary relief from feelings of depersonalization, guilt, rejection, and boredom as well as hallucinations, sexual preoccupations, and chaotic thoughts. Major SM includes infrequent acts such as eye enucleation and castration, commonly associated with psychosis and intoxication. Stereotypic SM includes such acts as head banging and self-biting most often accompanying Tourette's syndrome and severe mental retardation. Superficial/moderate SM includes compulsive acts such as trichotillomania and skin picking and such episodic acts as skin-cutting and burning, which evolve into an axis I syndrome of repetitive impulse dyscontrol with protean symptoms.
A study was undertaken to develop demographic, toxicologic, and pathological profiles of methamphetamine-related deaths. Anatomic and toxicologic findings in 413 deaths where methamphetamine was detected were compared with findings in a control group of 114 drug-free trauma victims. The number of cases per year did not change significantly over the course of the study. Mean age was 36.8 years, but 11% were over the age of 50. Decedents were overwhelmingly male (85.2%) and Caucasian (75%). Blood concentrations of methamphetamine and amphetamine were indistinguishable in cases where methamphetamine was related to the cause of death (MR) and cases where it was not (non-MR) (2.08 vs. 1.78 mg/L, p = 0.65, and 0.217 vs. 0.19 mg/L, p = 0.82). Coronary artery disease, ranging from minimal to severe multivessel, was identified in 79 of the 413 drug users, but in only six of the 114 drug-free controls (p = 0.0004), and MR decedents had enlarged hearts compared with controls. There were also ten cases of subarachnoid and intracranial hemorrhage in the MR group. Abnormalities of the liver (34%) and lungs (24.7%) were frequent. In 65% of these cases, death was due to accidental methamphetamine toxicity. In the remaining cases, methamphetamine was an incidental finding. We conclude that, in our jurisdiction, neither the rate of detection nor the number of methamphetamine deaths has increased significantly in the past 13 years. Decedents are almost all Caucasian males, and many were approaching middle-age. Methamphetamine use is strongly associated with coronary artery disease and with subarachnoid hemorrhage.
Assessment of prevalence of non-fatal overdoses and suicide attempts and predictors of and co-variation between such behaviours among drug addicts.
Cross-sectional survey.
Inpatient and outpatient treatment units in Norway.
National sample of 2051 drug addicts admitted to treatment in Norway in 1992-93.
Self-reports of suicide attempts and of life-threatening overdoses from structured interviews with therapists.
Almost half (45.5%) the clients reported having experienced one or more life-threatening overdoses. A third (32.7%) reported one or more suicide attempts. Suicide attempts were more often reported among those who had overdosed (odds ratio (OR) = 6.3), and the number of life-threatening overdoses and number of suicide attempts were positively and moderately associated (Pearson's r = 0.39). Drug addicts who had exhibited both life-threatening behaviours were characterized by polydrug use, poor social functioning and HIV risk-taking behaviour. Suicide attempters were also characterized by psychiatric problems.
The substantial co-variation between suicide attempts and drug overdose suggests some common underlying causal factors. These seem to be related to heavy drug use and poor social integration.