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Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention

OBJECTIVES: The objective of the study was to longitudinally assess the outcomes and correlates of suicidal ideation and behavior (SIB) among heroin users who attended inpatient detoxification and psychosocial rehabilitation. SIB was assessed in 300 heroin users upon entry into inpatient detoxificat...

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Autores principales: Morgan, Nirvana, Denton, Ellen-ge, Subramaney, Ugasvaree, Daniels, William, Steinert, Tilman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9193372/
https://www.ncbi.nlm.nih.gov/pubmed/35711608
http://dx.doi.org/10.3389/fpsyt.2022.883878
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author Morgan, Nirvana
Denton, Ellen-ge
Subramaney, Ugasvaree
Daniels, William
Steinert, Tilman
author_facet Morgan, Nirvana
Denton, Ellen-ge
Subramaney, Ugasvaree
Daniels, William
Steinert, Tilman
author_sort Morgan, Nirvana
collection PubMed
description OBJECTIVES: The objective of the study was to longitudinally assess the outcomes and correlates of suicidal ideation and behavior (SIB) among heroin users who attended inpatient detoxification and psychosocial rehabilitation. SIB was assessed in 300 heroin users upon entry into inpatient detoxification (baseline) as well as 3-months (t1) (n = 252; 84%) and 9-months (t2) (n = 225; 75%) post treatment. Multivariable logistic regression was used to determine the demographic, clinical and treatment related factors that increased the risk for a high SIB score. RESULTS: From baseline to t1 there was a significant decrease in the proportion of those who endorsed SIB (68.7 vs. 38.9%, p < 0.0001). There was an increase in the proportion of those who endorsed SIB from t1 to t2 (38,9 vs. 47.1%, p = 0.047). There was a significant increase in the proportion of those reporting suicide likely in the near future from baseline to t1 (8.7 vs. 16.3%: p < 0.0049) and this was repeated from t1 to t2 (22.7%) (t1 vs. t2: p = 0.031). After controlling for all other variables, a comorbid mental illness (MI) at baseline was a significant independent risk factor for a high SIB score at t1(RR 1.63; 95% CL 1.30–2.03) (p < 0.0001) and a comorbid MI at t1 increased the risk for a high SIB score at t2 (RR 2.73; 95% CL 1.78–4.19) (p < 0.0001). A poorer general health score and poorer social functioning score at baseline were associated with a high SIB score at baseline (RR 1.02; 95% CL 1.01–1.04) (p = 0.001) and t2, respectively (RR 1.07; 95% CL 1.04–1.11) (p < 0.0001). CONCLUSIONS: Among heroin users, a comorbid mental illness, poorer physical health and poorer social functioning are important factors to consider in suicide risk assessment. Although there were decreases in overall SIB 3 months after detoxification, this trend was not sustained at 9-month follow-up. After detoxification there were significant increases in the proportion of those reporting a likelihood of suicide in the following 3 months. The results suggests that the treatment exposure did not adequately mitigate suicide risk. There is a need for review of the treatment as well as targeted screening and management of SIB in heroin users attending treatment services.
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spelling pubmed-91933722022-06-15 Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention Morgan, Nirvana Denton, Ellen-ge Subramaney, Ugasvaree Daniels, William Steinert, Tilman Front Psychiatry Psychiatry OBJECTIVES: The objective of the study was to longitudinally assess the outcomes and correlates of suicidal ideation and behavior (SIB) among heroin users who attended inpatient detoxification and psychosocial rehabilitation. SIB was assessed in 300 heroin users upon entry into inpatient detoxification (baseline) as well as 3-months (t1) (n = 252; 84%) and 9-months (t2) (n = 225; 75%) post treatment. Multivariable logistic regression was used to determine the demographic, clinical and treatment related factors that increased the risk for a high SIB score. RESULTS: From baseline to t1 there was a significant decrease in the proportion of those who endorsed SIB (68.7 vs. 38.9%, p < 0.0001). There was an increase in the proportion of those who endorsed SIB from t1 to t2 (38,9 vs. 47.1%, p = 0.047). There was a significant increase in the proportion of those reporting suicide likely in the near future from baseline to t1 (8.7 vs. 16.3%: p < 0.0049) and this was repeated from t1 to t2 (22.7%) (t1 vs. t2: p = 0.031). After controlling for all other variables, a comorbid mental illness (MI) at baseline was a significant independent risk factor for a high SIB score at t1(RR 1.63; 95% CL 1.30–2.03) (p < 0.0001) and a comorbid MI at t1 increased the risk for a high SIB score at t2 (RR 2.73; 95% CL 1.78–4.19) (p < 0.0001). A poorer general health score and poorer social functioning score at baseline were associated with a high SIB score at baseline (RR 1.02; 95% CL 1.01–1.04) (p = 0.001) and t2, respectively (RR 1.07; 95% CL 1.04–1.11) (p < 0.0001). CONCLUSIONS: Among heroin users, a comorbid mental illness, poorer physical health and poorer social functioning are important factors to consider in suicide risk assessment. Although there were decreases in overall SIB 3 months after detoxification, this trend was not sustained at 9-month follow-up. After detoxification there were significant increases in the proportion of those reporting a likelihood of suicide in the following 3 months. The results suggests that the treatment exposure did not adequately mitigate suicide risk. There is a need for review of the treatment as well as targeted screening and management of SIB in heroin users attending treatment services. Frontiers Media S.A. 2022-05-31 /pmc/articles/PMC9193372/ /pubmed/35711608 http://dx.doi.org/10.3389/fpsyt.2022.883878 Text en Copyright © 2022 Morgan, Denton, Subramaney, Daniels and Steinert. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Psychiatry
Morgan, Nirvana
Denton, Ellen-ge
Subramaney, Ugasvaree
Daniels, William
Steinert, Tilman
Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title_full Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title_fullStr Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title_full_unstemmed Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title_short Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention
title_sort longitudinal patterns of suicidality among heroin users in johannesburg, south africa: a need for suicide screening and intervention
topic Psychiatry
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9193372/
https://www.ncbi.nlm.nih.gov/pubmed/35711608
http://dx.doi.org/10.3389/fpsyt.2022.883878
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