Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt. (1st July 2021)

• Record Type: Journal Article
• Authors: Robins, John E.; Morley, Katherine I.; Hayes, Richard D.; Ross, Kezia R.; Pritchard, Megan; Curtis, Vivienne; Kalk, Nicola J.
• Is Part Of: Drug and alcohol dependence. Volume 224(2021)
• Publication Date: 2021-07-01
• Subjects: Alcohol -- Suicide -- Mental Health Act -- Emergency psychiatric care -- Section 136 -- Latent Class Analysis; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2021.108725
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Latent Class Analysis found 3 distinct classes of alcohol users in suicidal crisis. Dependent drinkers' odds of death/repeat crisis >2-fold that of low risk drinkers. The lowest odds of death/repeat crisis were found among heavy episodic drinkers. Post-crisis care pathways should not take a 'one size fits all' view of alcohol use. Abstract: Background: Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. Methods: We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. Results: Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62–3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53−0.81, p < 0.001). Conclusions: The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.