title: Suicidal behavior, drug use and depressive symptoms after detoxification: a 2-year prospective study.
abstract: BACKGROUND
  Individuals with substance-related disorders are at increased risk for suicidal behavior. Identifying those at higher risk for suicide among this population is difficult and informed mainly on the basis of cross-sectional data.
  
  
  METHODS
  We examined factors associated with drug-related suicidal behavior using multivariable regression analyses in a 2-year prospective study of 470 inpatients enrolled from an unlocked, detoxification unit. Suicidal behavior included suicidal ideation (SI) and suicide attempt (SA).
  
  
  RESULTS
  Lifetime prevalence for SI was 28.5%, and for SA, 21.9%. During the 2-year follow-up, 19.9% of the sample endorsed suicidal ideation and 6.9% reported a suicide attempt. Correlates of lifetime suicidal behavior included younger age, female, Hispanic, greater depressive symptoms, past sexual abuse, and problem sedative or alcohol use. Factors associated with suicidal behavior at follow-up included past suicidal behavior, more depressive symptoms, and more frequent benzodiazepine and alcohol use. Cocaine and heroin use did not reach statistical significance.
  
  
  CONCLUSIONS
  Suicidal behavior is common among individuals with substance-related disorders. Differences in "suicide potential" may exist between drug categories with CNS depressants increasing the risk. These findings highlight the importance of addressing the recurrent 'suicide risk' of patients with substance-related disorders and regular monitoring for changes in depressive symptoms and drug use. Based on the prevalence and severity of this problem, the role of universal suicide screening of individuals with substance-related disorders merits greater attention.
authors.affiliation: Alcohol and Drug Abuse Research Center (ADARC), McLean Hospital-Harvard Medical School, Boston, MA 02478, USA. jwines@hms.harvard.edu
authors.forename: James D
authors.initials: JD
authors.lastname: Wines
authors.forename: Richard
authors.initials: R
authors.lastname: Saitz
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Horton
authors.forename: Christine
authors.initials: C
authors.lastname: Lloyd-Travaglini
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008658:Inactivation, Metabolic; D008297:Male; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation*; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*