Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence and risk factors.
OBJECTIVE
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.


METHODS
Cross-sectional structured interview.


METHODS
Sydney, Australia.


METHODS
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).


RESULTS
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.
Darke
Shane
S
National Drug and Alcohol Research Centre, University of New South Wales, NSW 2052, Australia
Ross
Joanne
J
Lynskey
Michael
M
Teesson
Maree
M
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000553:Ambulatory Care / Q000706:statistics & numerical data; D000987:Antisocial Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D001883:Borderline Personality Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D002047:Buprenorphine / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D062787:Drug Overdose / Q000453:epidemiology / Q000517:prevention & control; D004359:Drug Therapy, Combination; D005260:Female; D003932:Heroin / Q000506:poisoning; D006556:Heroin Dependence / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D008403:Mass Screening; D008691:Methadone / Q000008:administration & dosage*; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage*; D018671:Needle-Exchange Programs / Q000706:statistics & numerical data; D009517:New South Wales; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data*; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012307:Risk Factors; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000534:rehabilitation; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D013406:Suicide, Attempted / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*
D009294:Narcotics; D002047:Buprenorphine; D003932:Heroin; D008691:Methadone