The risk of repeated suicidal presentations following residential treatment for substance use disorders: A recurrent event analysis using linked administrative data

• Published in: Journal of affective disorders 2024-09, Vol.360, p.364-375
• Main Authors: Tisdale, Calvert, de Andrade, Dominique, Leung, Janni, Campbell, Gabrielle, Hides, Leanne
• Format: Article
• Language: English
• Subjects: Administrative data linkage; Adolescent; Adult; Aged; AOD; Female; Humans; Male; Middle Aged; Queensland - epidemiology; Recurrence; Recurrent events; Residential Treatment; Risk Factors; Substance use; Substance-Related Disorders - epidemiology; Substance-Related Disorders - therapy; Suicidal Ideation; Suicide; Suicide - statistics & numerical data; Suicide prevention; Suicide, Attempted - statistics & numerical data; Suicide-related events; Young Adult
• ISSN: 0165-0327; 1573-2517; 1573-2517
• DOI: 10.1016/j.jad.2024.05.129

Individuals seeking alcohol and other drug (AOD) treatment consistently experience higher rates of suicidal behaviours and death by suicide when compared to the general population. By linking residential AOD treatment data to administrative healthcare and death datasets, we aimed to examine suicide-related behaviours and identify risk and protective factors for these events following discharge from residential treatment. Participants included 1056 individuals aged 18–69 (M = 32.06, SD = 9.55, male = 696,65.9 %) admitted to three residential treatment facilities in Queensland, Australia from January 1, 2014 to December 31, 2016. Treatment data was linked to administrative hospital, emergency department (ED), mental health service, and Registry of Deaths data 2-years post-discharge. ICD-10 codes were used to identify and analyse suicide-related events. Within 2-years post-discharge, 175 (16.6 %) individuals had a suicide-related event (n = 298 episodes). The highest proportion of episodes (11.1 %) occurred within 1-month of discharge. Higher risk of a recurrent suicide-related event was associated with receiving a Disability Support Pension (aHR = 1.69 (95%CI:1.10,2.59), two or more previous episodes of residential AOD treatment (aHR = 1.49 (95%CI:1.30,2.15). Completing residential treatment was associated with a lower risk of suicide-related events (aHR = 0.54 (95%CI:0.35,0.83). The amalgamation of suicidal ideation, attempts, and death into a single outcome oversimplifies their complex nature and interplay. The exclusive focus on one service provider limits generalisability, and data constraints and missingness preclude many analyses. Understanding suicidal behaviours and critical risk periods following discharge from residential treatment is crucial for improving continuing care, developing effective suicide prevention, and implementing targeted interventions among this high-risk population. •Suicide-related events were common among individuals seeking substance use treatment.•Suicide-related events were not isolated and often indicated further suicide-related events.•Factors indicating disadvantage were associated with a greater likelihood of suicidal behaviour.•Health service presentations currently represent missed opportunities for suicide prevention.•Continuing care and targeted suicide interventions are needed following substance use treatment.