title: A prospective cohort study of non-fatal accidental overdose among street youth: the link with suicidal ideation.
abstract: OBJECTIVE
  Drug overdose and suicide are the two leading causes of death among street youth. The literature discusses the two faces of drug overdose: accidental act and suicide attempt. Some authors have stated that accidental overdoses may be a hidden expression of suicidal ideation. This study longitudinally examined the relationship between recent suicidal ideations and non-fatal accidental drug overdoses among street youth.
  
  
  METHODS
  Between July 2001 and December 2005, 858 street youth (14-23 years old) were recruited for a prospective cohort study. Youth were eligible if, in the previous year, they had been without a place to sleep more than once or had used the services of street youth agencies on a regular basis (≥3). Participants completed baseline questionnaires and follow-up interviews were carried out every 6 months. Mixed-effect logistic regression models were conducted. Apart from suicidal ideation and accidental drug overdose, variables considered in the model were age, sex, problematic alcohol use, homelessness, injection drug use and polydrug use (≥3 drugs).
  
  
  RESULTS
  Accidental drug overdose was significantly associated with suicidal ideation (adjusted odds ratio 1.88; 95% confidence interval 1.23-2.54). Homelessness, injection drug use and polydrug use were also significant in the final model.
  
  
  CONCLUSIONS
  Results show that, during follow up, suicidal ideation independently increased risks of accidental overdose. They also underscore the need for interventions beyond educational prevention. Primary care practitioners should investigate suicidal ideations and behaviours of street youth in treatment for accidental overdose.
authors.affiliation: Department of Community Health Sciences, Addiction Services, University of Sherbrooke, Longueuil, Canada. isabelle.richer@usherbrooke.ca
authors.forename: Isabelle
authors.initials: I
authors.lastname: Richer
authors.forename: Karine
authors.initials: K
authors.lastname: Bertrand
authors.forename: Jill
authors.initials: J
authors.lastname: Vandermeerschen
authors.forename: Elise
authors.initials: E
authors.lastname: Roy
mesh_terms: D000293:Adolescent; D062787:Drug Overdose / Q000523:psychology*; D005260:Female; D018453:Homeless Youth / Q000523:psychology*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D059020:Suicidal Ideation; D055815:Young Adult
keywords: non-fatal accidental overdose; prospective cohort study; street youth; suicidal ideation