The association of acute alcohol use and dynamic suicide risk with variation in onward care after psychiatric crisis

TY - JOUR

T1 - The association of acute alcohol use and dynamic suicide risk with variation in onward care after psychiatric crisis

AU - Robins, John

AU - Kalk, Nicola

AU - Curtis, Vivienne

AU - Pritchard, Megan

AU - Ross, Kezia

AU - Morley, Katherine

N1 - Funding Information: The authors wish to thank all service users and staff from the SLaM centralised Place of Safety who provided the data for this study. This work was supported by a grant from the Wellcome Trust (KIM, grant number 109823/Z/15/Z); NJK was supported by a NIHR Clinical Lectureship; and JER was supported by a Society for the Study of Addiction student bursary. This manuscript represents independent research part funded by the National Institute for Health Research Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research or the Department of Health and Social Care. Publisher Copyright: © 2021 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/3/5

Y1 - 2021/3/5

N2 - Introduction: Despite the association of alcohol use with recurrent suicidal acts, individuals attempting suicide after drinking alcohol face barriers accessing crisis care following emergency assessment, demonstrated by higher odds of inpatient admission for those whose suicide attempt did not feature alcohol. This disparity may be due to suicidality dissipating more rapidly after a suicide attempt involving alcohol. We investigated the effect of acute alcohol use and ongoing suicidality on onward care decisions after emergency assessment. Methods: We analysed electronic health records of 650 suicidal adults detained under Section 136 of the Mental Health Act (1983, amended 2007) for up to 36 h at a London psychiatric emergency care centre. We used logistic regression to estimate the association of acute alcohol use and ongoing suicidality (including their interaction) with admission to psychiatric hospital. Results: Fifteen percent of previously intoxicated detainees expressed suicidal intent at detention end, compared to 24% of detainees who had not used alcohol prior to detention. Compared to those who were not previously intoxicated and not suicidal at detention end, acute alcohol use was associated with reduced odds of admission amongst those no longer suicidal (AOR 0.4, 95% CI 0.2, 0.6). Where suicidality persisted, odds of admission rose; however, the magnitude of increase when in combination with prior alcohol use (AOR 3.6, 95% CI 1.9, 7.1) was under half that of when alcohol was not involved (AOR 8.2, 95% CI 3.5, 19.1). Discussion and Conclusions: Acute alcohol use is associated with transient suicidality, but this only partially accounts for disparities in care following suicide attempts.

AB - Introduction: Despite the association of alcohol use with recurrent suicidal acts, individuals attempting suicide after drinking alcohol face barriers accessing crisis care following emergency assessment, demonstrated by higher odds of inpatient admission for those whose suicide attempt did not feature alcohol. This disparity may be due to suicidality dissipating more rapidly after a suicide attempt involving alcohol. We investigated the effect of acute alcohol use and ongoing suicidality on onward care decisions after emergency assessment. Methods: We analysed electronic health records of 650 suicidal adults detained under Section 136 of the Mental Health Act (1983, amended 2007) for up to 36 h at a London psychiatric emergency care centre. We used logistic regression to estimate the association of acute alcohol use and ongoing suicidality (including their interaction) with admission to psychiatric hospital. Results: Fifteen percent of previously intoxicated detainees expressed suicidal intent at detention end, compared to 24% of detainees who had not used alcohol prior to detention. Compared to those who were not previously intoxicated and not suicidal at detention end, acute alcohol use was associated with reduced odds of admission amongst those no longer suicidal (AOR 0.4, 95% CI 0.2, 0.6). Where suicidality persisted, odds of admission rose; however, the magnitude of increase when in combination with prior alcohol use (AOR 3.6, 95% CI 1.9, 7.1) was under half that of when alcohol was not involved (AOR 8.2, 95% CI 3.5, 19.1). Discussion and Conclusions: Acute alcohol use is associated with transient suicidality, but this only partially accounts for disparities in care following suicide attempts.

KW - PSYCHIATRIC EMERGENCY SERVICE

KW - SUICIDAL-BEHAVIOR

KW - Electronic Health Records (EHR)

KW - ALCOHOL-USE

KW - Patient-discharge

UR - http://www.scopus.com/inward/record.url?scp=85100943400&partnerID=8YFLogxK

U2 - 10.1111/dar.13231

DO - 10.1111/dar.13231

M3 - Article

SN - 1465-3362

VL - 40

SP - 499

EP - 508

JO - Drug and Alcohol Review

JF - Drug and Alcohol Review

IS - 3

M1 - DOI: 10.1111/dar.13231

ER -