Predictors of Suicidal Ideation During Residential Substance Use Treatment

Jennifer D. Ellis, PhD^a ; Jill A. Rabinowitz, PhD^b ; Justin C. Strickland, PhD^a ; David Wolinsky, MD^a ; Andrew S. Huhn, PhD, MBA^a

J Clin Psychiatry 2023;84(4):22m14611

ABSTRACT

Background: Individuals with substance use disorders (SUDs) and co-occurring chronic health and/or psychiatric conditions face unique challenges in treatment and may be at a greater risk for suicidal ideation relative to persons with SUD alone.

Methods: In a sample of individuals entering residential SUD treatment in 2019 and 2020 (N = 10,242), we tested adjusted and unadjusted associations between suicidal ideation and (1) psychiatric symptoms and (2) chronic health conditions at treatment intake and during treatment using logistic and generalized logistic models.

Results: Over a third of the sample endorsed suicidal ideation at intake, though the prevalence of suicidal ideation decreased during treatment. In both adjusted and unadjusted models, individuals who reported past-month self-harm, those who reported a lifetime suicide attempt, and individuals who screened positive for co-occurring anxiety, depression, and/or posttraumatic stress disorder were at elevated risk of endorsing suicidal ideation at intake and during treatment (P values < .001). In unadjusted models, chronic pain (odds ratio [OR] = 1.51, P < .001) and hepatitis C virus (OR = 1.65, P < .001) were associated with an elevated risk for suicidal ideation at intake, and chronic pain was associated with elevated risk for suicidal ideation during treatment (OR = 1.59, P < .001).

Conclusions: Increasing accessibility to integrated treatments (ie, those that address psychiatric and chronic health conditions) for patients experiencing suicidal ideation may be beneficial in residential SUD treatment settings. Developing predictive models to identify those most at risk of suicidal ideation in real time remains a relevant direction for future work.

Continue Reading...

Members enjoy unlimited free PDF downloads as part of their subscription! Subscribe today for instant access to this article and our entire library in your preferred format. Alternatively, you can purchase the PDF of this article individually.

Subscribe Now

Already a member? Login

Buy PDF for $40

Please sign in or purchase this PDF for $40.

References (41)

Schneider B. Substance use disorders and risk for completed suicide. Arch Suicide Res. 2009;13(4):303–316. PubMed CrossRef
Thompson RG Jr, Alonzo D, Hu MC, et al. Substance use disorders and poverty as prospective predictors of adult first-time suicide ideation or attempt in the United States. Community Ment Health J. 2017;53(3):324–333. PubMed CrossRef
Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004;76(suppl):S11–S19. PubMed CrossRef
Faberman R. Alcohol and Drug Misuse and Suicide and the Millennial Generation - A Devastating Impact, Pain in the Nation: Building a National Resilience Strategy. Trust for America’s Health and Well Being Trust. Wellbeingtrust.org website. https://wellbeingtrust.org/wp-content/uploads/2019/06/TFAH-2019-YoundAdult-Pain-Brief-FnlRv.pdf. Published 2019.
Han B, Compton WM, Einstein EB, et al. Intentional drug overdose deaths in the United States. Am J Psychiatry. 2022;179(2):163–165. PubMed CrossRef
Poorolajal J, Haghtalab T, Farhadi M, et al. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. J Public Health (Oxf). 2016;38(3):e282–e291. PubMed CrossRef
Borges G, Bagge CL, Cherpitel CJ, et al. A meta-analysis of acute use of alcohol and the risk of suicide attempt. Psychol Med. 2017;47(5):949–957. PubMed CrossRef
Hubers AAM, Moaddine S, Peersmann SHM, et al. Suicidal ideation and subsequent completed suicide in both psychiatric and non-psychiatric populations: a meta-analysis. Epidemiol Psychiatr Sci. 2018;27(2):186–198. PubMed CrossRef
Rossom RC, Coleman KJ, Ahmedani BK, et al. Suicidal ideation reported on the PHQ9 and risk of suicidal behavior across age groups. J Affect Disord. 2017;215:77–84. PubMed CrossRef
Bassiony M, Saleem D, Khalil Y, et al. Suicide risk and ideation among patients with substance use disorders in Egypt. J Subst Use. 2022;27(6):667–673. CrossRef
Roy S, Ninkovic J, Banerjee S, et al. Opioid drug abuse and modulation of immune function: consequences in the susceptibility to opportunistic infections. J Neuroimmune Pharmacol. 2011;6(4):442–465. PubMed CrossRef
Connery H, Korte F, McHugh R. Suicide and substance use disorder. Psychiatr Ann. 2020;50(4):158–162. CrossRef
Ortíz-Gómez LD, López-Canul B, Arankowsky-Sandoval G. Factors associated with depression and suicide attempts in patients undergoing rehabilitation for substance abuse. J Affect Disord. 2014;169:10–14. PubMed CrossRef
Andersson HW, Lilleeng SE, Ruud T, et al. Suicidal ideation in patients with mental illness and concurrent substance use: analyses of national census data in Norway. BMC Psychiatry. 2022;22(1):1. PubMed CrossRef
Landheim AS, Bakken K, Vaglum P. What characterizes substance abusers who commit suicide attempts? Factors related to Axis I disorders and patterns of substance use disorders: a study of treatment-seeking substance abusers in Norway. Eur Addict Res. 2006;12(2):102–108. PubMed CrossRef
Levola K, Laine R, Pitkanen T. In-patient psychiatric care and non-substance-related psychiatric diagnoses among individuals seeking treatment for alcohol and substance use disorders: associations with all-cause mortality and suicide. Br J Psychiatry. 2022:221(1)386–393. PubMed CrossRef
Kelly LM, Rash CJ, Alessi SM, et al. Correlates and predictors of suicidal ideation and substance use among adults seeking substance use treatment with varying levels of suicidality. J Subst Abuse Treat. 2020;119:108145. PubMed CrossRef
Daray FM, Goldmann E, Gutierrez L, et al. Suicidal ideation is associated with cardiovascular disease in a large, urban cohort of adults in the Southern Cone of Latin America. Gen Hosp Psychiatry. 2019;57:34–40. PubMed CrossRef
Moazzami K, Garcia M, Young A, et al. Association between symptoms of psychological distress and cognitive functioning among adults with coronary artery disease. Stress Health. 2021;37(3):538–546. PubMed CrossRef
Moazzami K, Dolmatova EV, Feurdean M. Suicidal ideation among adults with cardiovascular disease: The National Health and Nutrition Examination Survey. Gen Hosp Psychiatry. 2018;51:5–9. PubMed CrossRef
Ashrafioun L, Saulnier KG, Allan NP, et al. Pain intensity trajectories among veterans seeking mental health treatment: association with mental health symptoms and suicidal thoughts and behaviors. J Affect Disord. 2022;297:586–592. PubMed CrossRef
Cho S, Hwang H, Lee JH. Pain intensity and suicidal ideation of people in chronic pain: mediating effects of depression. Soc Behav Personal. 2013;41(3):509–516. CrossRef
Pelton M, Ciarletta M, Wisnousky H, et al. Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis. Gen Psychiatr. 2021;34(2):e100247. PubMed CrossRef
Huhn AS, Hobelmann JG, Ramirez A, et al. Trends in first-time treatment admissions for older adults with alcohol use disorder: availability of medical and specialty clinical services in hospital, residential, and outpatient facilities. Drug Alcohol Depend. 2019;205:107694. PubMed CrossRef
Ellis JD, Rabinowitz JA, Wells J, et al. Latent trajectories of anxiety and depressive symptoms among adults in early treatment for nonmedical opioid use. J Affect Disord. 2022;299:223–232. PubMed CrossRef
Ware OD, Ellis JD, Dunn KE, et al. The association of chronic pain and opioid withdrawal in men and women with opioid use disorder. Drug Alcohol Depend. 2022;240:109631. PubMed CrossRef
Hagan H, Des Jarlais DC. HIV and HCV infection among injecting drug users. Mt Sinai J Med. 2000;67(5-6):423–428. PubMed
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613. PubMed CrossRef
Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–1097. PubMed CrossRef
Lang AJ, Stein MB. An abbreviated PTSD checklist for use as a screening instrument in primary care. Behav Res Ther. 2005;43(5):585–594. PubMed CrossRef
Posner K, Brent D, Lucas C, et al. Columbia-Suicide Severity Rating Scale (C-SSRS). New York, NY: Columbia University Medical Center; 2008:10.
Van Orden KA, Witte TK, Cukrowicz KC, et al. The interpersonal theory of suicide. Psychol Rev. 2010;117(2):575–600. PubMed CrossRef
Kelly LM, Drazdowski TK, Livingston NR, et al. Demographic risk factors for co-occurring suicidality and cannabis use disorders: Findings from a nationally representative United States sample. Addict Behav. 2021;122:107047. PubMed CrossRef
Borges G, Bagge CL, Orozco R. A literature review and meta-analyses of cannabis use and suicidality. J Affect Disord. 2016;195:63–74. PubMed CrossRef
Delforterie MJ, Lynskey MT, Huizink AC, et al. The relationship between cannabis involvement and suicidal thoughts and behaviors. Drug Alcohol Depend. 2015;150:98–104. PubMed CrossRef
Linehan M. DBT Skills Training Manual. Guilford Publications; 2014.
Riblet NB, Kenneally L, Shiner B, et al. Health care processes contributing to suicide risk in veterans during and after residential substance abuse treatment. J Dual Diagn. 2019;15(4):217–225. PubMed CrossRef
Golden J, O’Dwyer AM, Conroy RM. Depression and anxiety in patients with hepatitis C: prevalence, detection rates and risk factors. Gen Hosp Psychiatry. 2005;27(6):431–438. PubMed CrossRef
Garland EL, Thomas E, Howard MO. Mindfulness-oriented recovery enhancement ameliorates the impact of pain on self-reported psychological and physical function among opioid-using chronic pain patients. J Pain Symptom Manage. 2014;48(6):1091–1099. PubMed CrossRef
Garland EL, Roberts-Lewis A, Tronnier CD, et al. Mindfulness-oriented recovery enhancement versus CBT for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial. Behav Res Ther. 2016;77:7–16. PubMed CrossRef
Harney BL, Brereton R, Whitton B, et al. Hepatitis C treatment in a co-located mental health and alcohol and drug service using a nurse-led model of care. J Viral Hepat. 2021;28(5):771–778. PubMed CrossRef