title: Suicide attempts among substance use disorder patients: an initial step toward a decision tree for suicide management.
abstract: BACKGROUND
  Little empirical data are available to develop profiles of patients who attempt suicide or to formulate a decision tree for suicide management. This study identifies profiles of patients who have a high risk of suicide attempt and takes a first step toward developing a decision tree to classify high-risk patients.
  
  
  METHODS
  Based on a cross-sectional, nationwide cohort of substance use disorder patients (N=34,251) in 150 Veterans Affairs (VA) facilities, a total of 5,671 patients who reported suicidal ideation in the 30 days before intake assessment were included in receiver operating characteristic (ROC) analyses to identify the 30-day risk of an actual suicide attempt. Clinical diagnostic and Addiction Severity Index interview data were used.
  
  
  RESULTS
  Results provide an initial decision tree to classify high-risk patients with sensitivity ranging from 0.33 to 0.89, and specificity, from 0.42 to 0.87. The factors included in the decision tree encompass history of prior suicide attempts, current drinking to intoxication, current cocaine use, first occasion of suicidal ideation, and difficulty controlling violent behavior.
  
  
  CONCLUSIONS
  To our knowledge, this is the first attempt to use empirical data to provide information to eventually establish a decision tree for clinical management of patients with suicidal ideation. The findings show that profiles of patients who are at high risk of suicide attempts can be effectively identified using ROC, with relatively good sensitivity and specificity.
authors.affiliation: Center for Health Care Evaluation, VA Palo Alto Health Care System, Menlo Park, California 94025, USA. Quyen.Tiet@va.gov
authors.forename: Quyen Q
authors.initials: QQ
authors.lastname: Tiet
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ilgen
authors.forename: Hilary F
authors.initials: HF
authors.lastname: Byrnes
authors.forename: Rudolf H
authors.initials: RH
authors.lastname: Moos
mesh_terms: D000328:Adult; D000435:Alcoholic Intoxication; D019970:Cocaine-Related Disorders; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003663:Decision Trees; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000150:complications*; D013405:Suicide / Q000145:classification; D013406:Suicide, Attempted / Q000145:classification / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014754:Violence; D000092864:Suicide Prevention