Relapse risk factors for patients with comorbid affective disorders and substance abuse disorders from an intensive treatment unit

Objective To describe the disability associated with psychiatric disorder in a community sample in order to refine estimates of service need and identify subgroups with greater priority for intervention. Method Disability is conceptualized broadly as performance difficulties, troubled relationships, and dissatisfaction in various life domains. Data from the Mental Health Supplement are used to compare disability between those with and without disorder and among various subtypes of disorder. Results Although the majority of those with disorder do not report disability, their difficulties with functioning are far greater than for the rest of the population. Those with comorbid or affective disorders typically have more disability than those with anxiety or substance abuse disorders. Conclusions Society needs to recognize the high human and economic costs associated with the prevalence of psychiatric disorder. Assessments of service need and decisions about priorities should take both disorder and disability into consideration.

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Do risk factors for suicidal behavior differ by affective disorder polarity?

Psychological Medicine ◽

10.1017/s0033291708004078 ◽

2008 ◽

Vol 39 (5) ◽

pp. 763-771 ◽

Cited By ~ 25

Author(s):

J. G. Fiedorowicz ◽

A. C. Leon ◽

M. B. Keller ◽

D. A. Solomon ◽

J. P. Rice ◽

...

Keyword(s):

Risk Factors ◽

Substance Abuse ◽

Affective Disorder ◽

Suicidal Behavior ◽

Active Substance ◽

Affective Disorders ◽

Suicide Risk ◽

Suicide Attempts ◽

Age Of Onset ◽

Suicide Risk Factors

BackgroundSuicide is a leading cause of death and has been strongly associated with affective disorders. The influence of affective disorder polarity on subsequent suicide attempts or completions and any differential effect of suicide risk factors by polarity were assessed in a prospective cohort.MethodParticipants with major affective disorders in the National Institute of Mental Health (NIMH) Collaborative Depression Study (CDS) were followed prospectively for up to 25 years. A total of 909 participants meeting prospective diagnostic criteria for major depressive and bipolar disorders were followed through 4204 mood cycles. Suicidal behavior was defined as suicide attempts or completions. Mixed-effects, grouped-time survival analysis assessed risk of suicidal behavior and differential effects of risk factors for suicidal behavior by polarity. In addition to polarity, the main effects of age, gender, hopelessness, married status, prior suicide attempts and active substance abuse were modeled, with mood cycle as the unit of analysis.ResultsAfter controlling for age of onset, there were no differences in prior suicide attempts by polarity although bipolar participants had more prior severe attempts. During follow-up, 40 cycles ended in suicide and 384 cycles contained at least one suicide attempt. Age, hopelessness and active substance abuse but not polarity predicted suicidal behavior. The effects of risk factors did not differ by polarity.ConclusionsBipolarity does not independently influence risk of suicidal behavior or alter the influence of well-established suicide risk factors within affective disorders. Suicide risk assessment strategies may continue to appraise these common risk factors without regard to mood polarity.

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Suicidal Ideation and Suicide Attempts Among Australian Adults

Crisis ◽

10.1027//0227-5910.21.1.16 ◽

2000 ◽

Vol 21 (1) ◽

pp. 16-25 ◽

Cited By ~ 121

Author(s):

Jane Pirkis ◽

Philip Burgess ◽

David Dunt

Keyword(s):

Substance Abuse ◽

Suicidal Ideation ◽

Anxiety Disorders ◽

Marital Status ◽

Cumulative Incidence ◽

Affective Disorders ◽

Employment Status ◽

Suicide Attempts ◽

Incidence Rates ◽

Substance Abuse Disorders

Too little is known about suicidal thoughts and behaviors at a population level to recommend appropriate preventive strategies. Using data from the Australian National Survey of Mental Health and Wellbeing (NSMHWB), this study examined rates of, and risk factors for, suicidal ideation and suicide attempts. For 10,641 respondents, the 12-month and lifetime cumulative incidence rates of suicidal ideation were 3.4% and 16.0%, respectively; the 12-month and lifetime cumulative incidence rates of suicide attempts were 0.4% and 3.6%, respectively. 12-month ideation was associated with anxiety disorders (relative risk ratio [RRR] = 3.51; population attributable risk percent [PAR%] = 19.6%), affective disorders (RRR = 11.94; PAR% = 38.8%) and substance abuse disorders (RRR = 1.85; PAR% = 6.1%). Attempts in the past 12 months were also associated with anxiety disorders (RRR = 7.06; PAR% = 37.0%), affective disorders (RRR = 12.24; PAR% = 39.5%), and substance abuse disorders (RRR = 2.09; PAR% = 7.7%). Age, marital status, and disability were associated with ideation; marital status and employment status with attempts. Approximately 12% of ideators in the sample progressed to making an attempt; employment status was the only significant predictor. Reducing suicidal ideation and attempts requires a multi-faceted approach that targets those with mental illness but also adopts population-based strategies that address other factors, such as unemployment.

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Substance Abuse in Older Psychiatric Inpatients

SUCHT - Zeitschrift für Wissenschaft und Praxis / Journal of Addiction Research and Practice ◽

10.1024/0939-5911/a000476 ◽

2017 ◽

Vol 63 (2) ◽

pp. 115-121 ◽

Cited By ~ 1

Author(s):

Tilman Wetterling ◽

Klaus Junghanns

Keyword(s):

Substance Abuse ◽

Substance Abusers ◽

Psychiatric Inpatient ◽

Psychiatric Inpatients ◽

Severe Withdrawal ◽

Psychiatric Inpatient Treatment ◽

Clinical Diagnoses ◽

Multiple Substance ◽

Icd 10 ◽

Substance Abuse Disorders

Abstract. Aim: This study investigates the characteristics of older patients with substance abuse disorders admitted to a psychiatric department serving about 250.000 inhabitants. Methods: The clinical diagnoses were made according to ICD-10. The data of the patients with substance abuse were compared to a matched sample of psychiatric inpatients without substance abuse as well as to a group of former substance abusers with long-term abstinence. Results: 19.3 % of the 941 patients aged > 65 years showed current substance abuse, 9.4 % consumed alcohol, 7.9 % took benzodiazepines or z-drugs (zolpidem and zopiclone), and 7.0 % smoked tobacco. Multiple substance abuse was rather common (30.8 %). About 85 % of the substance abusers had psychiatric comorbidity, and about 30 % showed severe withdrawal symptoms. As with the rest of the patients, somatic multimorbidity was present in about 70 % of the substance abusers. Remarkable was the lower rate of dementia in current substance abusers. Conclusion: These results underscore that substance abuse is still a challenge in the psychiatric inpatient treatment of older people.

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Substance Abuse and Drug-Related Death, Suicidal Ideation, and Suicide: A Review

Crisis ◽

10.1027//0227-5910.20.1.28 ◽

1999 ◽

Vol 20 (1) ◽

pp. 28-35 ◽

Cited By ~ 29

Author(s):

Annie Mino ◽

Arnaud Bousquet ◽

Barbara Broers

Keyword(s):

Public Health ◽

Risk Factors ◽

Substance Abuse ◽

Suicidal Ideation ◽

Family Support ◽

Drug Users ◽

Suicide Attempts ◽

Public Health Problem ◽

Major Public Health Problem ◽

Hiv Epidemic

The high mortality rate among drug users, which is partly due to the HIV epidemic and partly due to drug-related accidental deaths and suicides, presents a major public health problem. Knowing more about prevalence, incidence, and risk factors is important for the development of rational preventive and therapeutic programs. This article attempts to give an overview of studies of the relations between substance abuse, suicidal ideation, suicide, and drug-related death. Research in this field is hampered by the absence of clear definitions, and results of studies are rarely comparable. There is, however, consensus about suicidal ideation being a risk factor for suicide attempts and suicide. Suicidal ideation is also a predictor of suicide, especially among drug users. It is correlated with an absence of family support, with the severity of the psychosocial dysfunctioning, and with multi-drug abuse, but also with requests for treatment. Every clinical examination of a drug user, not only of those who are depressed, should address the possible presence of suicidal ideation, as well as its intensity and duration.

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