Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

TY - JOUR

T1 - Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

AU - Robins, John

AU - Morley, Katherine

AU - Hayes, Richard

AU - Pritchard, Megan

AU - Curtis, Vivienne

AU - Ross, Kezia R.

AU - Kalk, Nicola

N1 - Funding Information: MP and RDH receive salary support from the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. Funding Information: RDH has received research funding from Roche, Pfizer, Janssen and Lundbeck. Funding Information: KIM has received grants from the Wellcome Trust during the conduct of the study, and grants from Alcohol Research UK outside the submitted work. KIM has done paid consulting work for London Joint Working Group on Hepatitis C outside the submitted work. Funding Information: This work was supported by the Clinical Record Interactive Search (CRIS) platform funded and developed by the National Institute for Health Research (NIHR)Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, and a joint infrastructure grant from Guy's and St Thomas? Charity and the Maudsley Charity (grant number BRC-2011-10035). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Funding Information: NJK was supported by a NIHR Clinical Lectureship when part of this work was done and is a psychiatrist employed in the NHS. NJK has received PhD funding, research materials funding, and educational funds from GSK during her PhD (2010–2013). Funding Information: This work was supported by the Clinical Record Interactive Search (CRIS) platform funded and developed by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London , and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity (grant number BRC-2011-10035 ). The views expressed are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. Publisher Copyright: © 2021 Elsevier B.V. Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/7/1

Y1 - 2021/7/1

N2 - Background: Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take ‘one-size-fits-all’ approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. Methods: We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. Results: Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62–3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53−0.81, p < 0.001). Conclusions: The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.

AB - Background: Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take ‘one-size-fits-all’ approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks. Methods: We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis. Results: Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62–3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53−0.81, p < 0.001). Conclusions: The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.

KW - ALCOHOL-USE

KW - SUICIDE

KW - Mental Health Act

KW - Emergency Psychiatric Care

KW - Latent class analysis

KW - Section 136

UR - http://www.scopus.com/inward/record.url?scp=85104950650&partnerID=8YFLogxK

U2 - 10.1016/j.drugalcdep.2021.108725

DO - 10.1016/j.drugalcdep.2021.108725

M3 - Article

SN - 0376-8716

VL - 224

JO - Drug and alcohol dependence

JF - Drug and alcohol dependence

M1 - 108725

ER -