Citation

Richards JE, Shortreed SM, Simon GE, Penfold RB, Glass JE, Ziebell R, Williams EC. J. Addict. Med. 2020; ePub(ePub): ePub.

Affiliation

Kaiser Permanente Washington Heath Research Institute, Seattle, WA (JER, SMS, GES, RBP, JEG, RZ); Department of Health Services, University of Washington, Seattle, WA (JER, RBP, ECW); Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA (GES); Health Services Research & Development (HSR&D), Center of Innovation for Veteran-Centered Value-Driven Care, Veterans Affairs (VA) Puget Sound Health Care System, Seattle, WA (ECW).

Copyright

(Copyright © 2020, American Society of Addiction Medicine, Publisher Lippincott Williams and Wilkins)

DOI

10.1097/ADM.0000000000000637

PMID

32142058

Abstract

OBJECTIVE: To evaluate the association between patterns of alcohol use and short-term risk of suicide attempt among patients with and without reported suicidal ideation.

METHODS: Kaiser Permanente Washington electronic health record data were used to identify mental health visits (1/1/2010-6/30/2015) with documented assessments for unhealthy alcohol use (AUDIT-C) and suicidal ideation (PHQ-9 ninth question). Logistic regression fit using generalized estimating equations were used to conduct visit-level analyses, accounting for correlation between individuals' assessments. Separate models evaluated the association between (1) level of alcohol consumption and (2) frequency of heavy episodic drinking (HED), in combination with suicidal ideation (any vs none), with suicide attempt within 90 days following each visit. Primary models adjusted for age, gender, race/ethnicity and visit year.

RESULTS: Of 59,705 visits (43,706 unique patients), 372 (0.62%) were followed by a suicide attempt within 90 days. The risk of suicide attempt was significantly higher for patients reporting suicidal ideation across all levels of alcohol consumption compared to patients reporting low-level alcohol use and no suicidal ideation, particularly high-level use (OR 9.77, 95% CI, 6.23-15.34). Similarly, risk of suicide attempt was higher for patients reporting suicidal ideation across all levels of HED relative to those reporting no HED or suicidal ideation, particularly HED monthly or more (OR 6.80, 95% CI 4.77-9.72). Among patients reporting no suicidal ideation, no associations were observed.

CONCLUSIONS: Findings underscore the potential value of offering alcohol-related care to patient reporting suicidal ideation. Additional strategies are needed to identify suicide risk among those reporting no suicidal ideation.

Language: en