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Research ArticleOriginal Research

Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care

Kevin A. Hallgren, Richard K. Ries, David C. Atkins, Kristin Bumgardner and Peter Roy-Byrne
The Journal of the American Board of Family Medicine March 2017, 30 (2) 150-160; DOI: https://doi.org/10.3122/jabfm.2017.02.160264
Kevin A. Hallgren
the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
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Richard K. Ries
the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
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David C. Atkins
the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
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Kristin Bumgardner
the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
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Peter Roy-Byrne
the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle.
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Article Figures & Data

Tables

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    Table 1.

    Baseline Sample Characteristics (N = 868)

    Baseline Variables
    Demographic
        Age (years), mean (SD)47.76 (10.89)
        Female sex264 (30.4)
        White386 (44.5)
        African American320 (36.9)
        Other race*162 (18.7)
        Hispanic ethnicity (any race)72 (8.3)
        High school graduate701 (80.9)
        Married or cohabitating154 (17.8)
    Employment and social
        Unemployed655 (75.7)
        Receiving welfare606 (69.9)
        Waiting legal charges54 (6.3)
        Jail in the past 90 days51 (5.9)
        Homeless in the past 90 days263 (30.4)
    Psychiatric symptoms
        Depression548 (63.1)
        Anxiety559 (64.4)
        Hallucinations80 (9.2)
        Concentration426 (49.1)
        Violent behavior134 (15.4)
    Suicidality
        Suicidal ideation in the past 30 days104 (12.0)
        Suicide attempt during lifetime345 (39.8)
    Substance use in the past 30 days
        Any alcohol598 (68.9)
        Daily alcohol67 (7.7)
        Any opiate228 (26.3)
        Daily opiate11 (1.3)
        Any sedative72 (8.3)
        Daily sedative39 (4.6)
        Any stimulant362 (41.7)
        Daily stimulant24 (2.8)
        Any marijuana656 (75.6)
        Daily marijuana145 (16.7)
        Any nicotine620 (71.6)
        Daily nicotine454 (52.4)
        Any injection drug use39 (4.5)
        Addiction Severity Index, mean (SD)0.15 (0.20)
            Alcohol score
            Drug score0.13 (0.11)
        Days using alcohol or drugs (of the past 30), mean (SD)15.39 (11.45)
    Medical and psychiatric treatment in the past 90 days
        Substance use treatment61 (7.1)
        12-Step participation146 (16.8)
        Emergency department386 (44.5)
        Medical visit701 (81.1)
        Psychiatric outpatient227 (26.2)
    Health-related quality of life
        Mobility impairment481 (55.5)
        Self-care impairment138 (15.9)
        Usual activity impairment404 (46.7)
        Pain677 (78.2)
        Anxiety or depression456 (52.7)
        Visual-Analogue Health Scale score, mean (SD)61 (22.8)
    • Data are n (%) unless otherwise indicated.

    • ↵* “Other race” included 93 participants (10.7% of sample) who were multiracial, 28 (3.2%) who were American Indian or Alaska Native, 10 (1.2%) who were Asian, 6 (0.7%) who were Native Hawaiian or Pacific Islander, and 25 (2.9%) with unknown or other race.

    • SD, standard deviation.

    • View popup
    Table 2.

    Suicidal Ideation and Suicide Attempt Incidence over 12-Month Follow-up After Screening and Brief Intervention for Substance Use

    Present (n)Absent (n)Missing Data (n)Incidence (%)
    Rate95% CI
    SI18753414725.922.8–29.3
    SA55725887.16.0–9.9
    • CI, confidence interval; SA, suicide attempt; SI, suicide ideation.

    • View popup
    Table 3.

    Univariate Predictors of Suicidal Ideation and Suicide Attempt

    Baseline VariableBy 12-Month SIBy 12-Month SA
    SI Present (n = 187)SI Absent (n = 534)ORP ValueSA Present (n = 55)SA Absent (n = 725)ORP Value
    Demographic
        Age (years), mean (SD)47.2 (10.7)48.5 (10.8)0.89.1544.8 (11.5)48.2 (10.6)0.74.03
        Female sex61 (32.6)174 (32.6)1.00.9826 (47.3)222 (30.6)1.94.02
        White90 (48.1)223 (41.8)1.34.0720 (36.4)321 (44.3)0.73.28
        African American58 (31.0)214 (40.1)0.66.0224 (43.6)268 (37.0)1.25.43
        Other race39 (20.9)97 (18.2)1.14.5311 (20.0)136 (18.8)1.15.68
        Hispanic ethnicity (any race)18 (9.6)38 (7.1)1.31.374 (7.3)61 (8.4)0.81.69
        High school graduate145 (77.5)446 (83.5)0.74.1534 (61.8)600 (82.9)0.36<.001
        Married or cohabitating36 (19.3)94 (17.7)1.02.9210 (18.2)130 (18.0)0.93.84
    Employment and social
        Unemployed152 (81.3)390 (73.3)1.64.0146 (83.6)541 (74.9)1.70.16
        Receiving welfare136 (72.7)373 (70.0)1.22.2938 (69.1)513 (70.9)0.87.64
        Waiting legal charges9 (4.8)29 (5.5)0.91.795 (9.3)40 (5.5)1.83.21
        Jail in the past 90 days11 (5.9)25 (4.7)1.37.405 (9.1)40 (5.5)1.66.30
        Homeless in the past 90 days53 (28.5)148 (27.8)1.08.6618 (32.7)212 (29.3)1.18.57
    Psychiatric symptoms
        Depression155 (82.9)300 (56.2)3.56<.00147 (85.5)449 (61.9)3.17.002
        Anxiety156 (83.4)306 (57.3)3.55<.00146 (83.6)459 (63.3)2.70.01
        Hallucinations29 (15.6)34 (6.4)2.53<.00111 (20.0)61 (8.4)2.66.01
        Concentration128 (68.4)220 (41.2)3.06<.00138 (69.1)340 (46.9)2.45.003
        Violent behavior47 (25.1)58 (10.9)2.59<.00123 (41.8)96 (13.2)4.43<.001
    Suicidality
        Suicidal ideation in the past 30 days (at baseline)70 (37.4)25 (4.7)12.28<.00124 (43.6)71 (9.8)6.78<.001
        Suicide attempt during lifetime (at baseline)126 (67.4)171 (32.1)4.36<.00144 (80.0)266 (36.7)6.39<.001
    Substance use in the past 30 days
        Any alcohol120 (64.2)384 (71.9)0.69.0334 (61.8)510 (70.3)0.69.20
        Daily alcohol12 (6.4)43 (8.1)0.73.354 (7.3)56 (7.7)0.90.84
        Any opiate58 (31.0)139 (26.0)1.36.1018 (32.7)193 (26.6)1.39.27
        Daily opiate3 (1.6)7 (1.3)1.62.460 (0.0)10 (1.4)0.00.99
        Any sedative/hypnotic/tranquilizer23 (12.3)40 (7.5)1.63.074 (7.3)64 (8.8)0.84.74
        Daily sedative/hypnotic/tranquilizer13 (7.1)20 (3.8)1.97.053 (5.8)31 (4.4)1.26.70
        Any stimulant77 (41.2)218 (40.8)1.05.7629 (52.7)297 (41.0)1.66.07
        Daily stimulant11 (5.9)11 (2.1)3.57.0036 (10.9)17 (2.3)5.26<.001
        Any marijuana134 (71.7)414 (77.5)0.74.1239 (70.9)549 (75.7)0.82.51
        Daily marijuana26 (13.9)93 (17.4)0.78.2812 (21.8)116 (16.0)1.52.21
        Any nicotine138 (73.8)375 (70.5)1.24.2646 (83.6)511 (70.7)2.02.07
        Daily nicotine102 (54.5)270 (50.8)1.25.2136 (65.5)369 (51.0)1.78.05
        Any injection drug use8 (4.3)23 (4.3)1.17.701 (1.8)31 (4.3)0.73.72
        ASI, mean (SD)
            Alcohol score0.16 (0.21)0.14 (0.19)1.08.330.15 (0.22)0.15 (0.20)1.01.97
            Drug score0.15 (0.12)0.12 (0.10)1.29.0020.17 (0.14)0.13 (0.11)1.50.002
        Days using alcohol or drugs (of past 30), mean (SD)16.0 (11.3)15.4 (11.4)1.08.3618.8 (11.3)15.1 (11.4)1.43.01
    Medical, psychiatric, and substance use treatment in the past 90 days
        Substance use treatment14 (7.6)32 (6.0)1.19.584 (7.3)50 (7.0)1.01.98
        12-Step participation38 (20.3)84 (15.7)1.40.129 (16.4)125 (17.2)0.94.87
        Emergency department86 (46.2)228 (42.7)1.20.3134 (63.0)311 (42.9)2.25.01
        Medical visit147 (79.5)439 (82.5)0.83.3742 (77.8)586 (81.2)0.80.51
        Psychiatric outpatient80 (43.0)113 (21.2)2.70<.00121 (38.2)182 (25.2)1.75.05
    EuroQol health-related quality of life
        Mobility impairment126 (67.7)280 (52.4)1.89<.00142 (76.4)402 (55.5)2.33.01
        Self-care impairment33 (17.7)84 (15.7)1.16.5011 (20.0)115 (15.9)1.28.48
        Usual activity impairment117 (62.9)229 (42.9)2.11<.00138 (69.1)333 (46.0)2.31.004
        Pain153 (82.3)423 (79.2)1.31.2143 (78.2)575 (79.4)0.95.87
        Anxiety or depression139 (74.7)242 (45.4)3.45<.00142 (76.4)374 (51.7)2.70.002
        Visual-Analogue Health Scale, mean (SD)55 (24.0)63 (22.3)0.73<.00150 (24.6)62 (22.6)0.63<.001
    • Data are n (%) unless otherwise indicated. Counts include participants with available baseline measures and suicide ideation (SI) and suicide attempt (SA) data at follow-up. Variables with significant univariate associations are presented in boldface.

    • ASI, Addiction Severity Index Lite; OR, odds ratio; SD, standard deviation.

    • View popup
    Table 4.

    Multiple Regression Predictors of Suicidal Ideation and Suicide Attempt

    Baseline Variable12-Month SI12-Month SA
    OR95% CIP ValueOR95% CIP Value
    Age1.020.82–1.26.850.770.54–1.11.16
    Female sex0.820.54–1.24.341.500.76–2.96.25
    African American0.850.54–1.33.471.830.91–3.70.09
    High school graduate0.850.50–1.44.550.520.26–1.04.07
    Unemployed1.040.62–1.73.881.200.48–3.02.70
    Depression1.050.58–1.90.871.010.39–2.61.98
    Anxiety1.600.89–2.88.110.660.24–1.84.43
    Hallucinations1.250.62–2.52.541.120.45–2.79.80
    Concentration1.400.86–2.26.171.030.47–2.28.94
    Violent behavior1.240.74–2.09.412.211.10–4.42.03
    SI in the past 30 days (at baseline)6.053.40–10.76<.0013.691.72–7.93<.001
    SA during lifetime (at baseline)2.661.76–4.02<.0013.521.60–7.78.002
    Daily stimulant use in the past 30 days2.370.79–7.14.121.860.46–7.43.38
    Daily nicotine in the past 30 days0.960.62–1.48.861.320.66–2.66.43
    ASI drug score1.070.82–1.41.611.040.68–1.58.86
    Days using alcohol or drugs (of past 30)0.970.74–1.28.851.170.78–1.74.44
    Emergency department in the past 90 days0.750.49–1.16.201.660.82–3.37.16
    Psychiatric outpatient in the past 90 days1.410.90–2.21.131.380.68–2.81.37
    EuroQol
        Mobility impairment1.320.84–2.09.231.150.55–2.40.70
        Usual activity impairment1.160.71–1.91.551.140.52–2.50.73
        Depression or anxiety1.781.07–2.96.031.100.48–2.54.81
        Visual-Analogue Health Scale1.060.86–1.31.570.850.61–1.19.35
    • Variables with significant associations are presented in boldface.

    • ASI, Addiction Severity Index Lite; CI, confidence interval; OR, odds ratio; SA, suicide attempt; SI, suicide ideation.

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The Journal of the American Board of Family     Medicine: 30 (2)
The Journal of the American Board of Family Medicine
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Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care
Kevin A. Hallgren, Richard K. Ries, David C. Atkins, Kristin Bumgardner, Peter Roy-Byrne
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 150-160; DOI: 10.3122/jabfm.2017.02.160264

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Prediction of Suicide Ideation and Attempt Among Substance-Using Patients in Primary Care
Kevin A. Hallgren, Richard K. Ries, David C. Atkins, Kristin Bumgardner, Peter Roy-Byrne
The Journal of the American Board of Family Medicine Mar 2017, 30 (2) 150-160; DOI: 10.3122/jabfm.2017.02.160264
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