Factors Associated With Suicide Attempts Among Injection Drug Users

Abstract

Injection drug users (IDUs) entering an urban low-threshold opiate detoxification unit in Munich, Germany, between 1991 and 1997 were asked for lifetime suicide attempts and administered a questionnaire, including sociodemographic, IDU-related, and drug user treatment related variables. Among 1,049 participants, 20% had ever tried to commit suicide. In the logistic regression, female gender, older age, drug user treatment experience, lack of drug user counseling, and emergency treatment were associated with attempted suicide. Regular screening for suicidal behavior in IDUs should be undertaken with a special focus to mention risk factors. The study's limitations are noted. This study was partially sponsored by the German Ministry of Health.

RÉSUMÉ

Des utilisateurs de drogues injectables, qui étaient en contact avec une unité urbaine de désintoxication des opiacés à bas-seuil à Munich en Allemagne entre 1991 et 1997, ont été interrogés par rapport aux tentatives de suicide au courant de leur vie, et un questionnaire leur fur présenté comprenant des variables sociodémographiques ainsi que des variables concernant l'injection de drogues et le traitement. Parmi les 1049 participants, 20% avaient déjà essayé de se suicider. Dans la régression logistique, le sexe féminin, l’âge avancé, l'expérience de traitement de toxicomanie, l'absence de conseils par rapport aux drogues et le traitement d'urgence étaient associés à la tentative de suicide. Il faudrait effectuer un dépistage régulier pour le comportement suicidaire chez les utilisateurs de drogues injectables en considérant surtout les facteurs de risque mentionnés. Les limites de l’étude ont été indiquées. Cette étude a été parrainée en partie par le ministère allemand de la santé.

RESUMEN

Se preguntó a usuarios de drogas intravenosas (UDIs) que comenzaron tratamiento en una unidad de desintoxicación de bajo umbral en Múnich (Alemania) entre 1991 y 1997 sobre intentos de suicidio a lo largo de su vida y se les administró un cuestionario que incluía datos sociodemográficos y aspectos relevantes sobre el tratamiento de UDI y drogas. Entre los 1049 participantes, el 20% habían intentado alguna vez suicidarse. En una regresión logística se encontró relación entre las variables género femenino, mayor edad, experiencia en el tratamiento de drogas, falta de consejo sobre drogas y tratamiento de emergencia con intentos de suicidio. La detección precoz de conductas suicidas en UDIs debe emprenderse con especial enfoque a los factores de riesgo mencionados. Las limitaciones del estudio están comentadas. Este estudio ha sido parcialmente patrocinado por el Ministerio de Salud Alemán.

Keywords :

• opiate dependence
• attempted suicide
• risk factor
• screening
• burden of disease
• social bereavement
• treatment access

THE AUTHORS

Dr. Markus Backmund (MD, PhD) has been conducting clinical research with injection drug users (IDUs) and HCV infection and other medical consequences of drug abuse since 1991. His expertise is in the area of treatment of IDUs and HCV, especially treatment of IDUs. He has published many papers and chapters in the field and is the editor of Suchtmedizin in Forschung und Praxis. He is head of the department of addiction medicine at the Städtisches Klinikum München GmbH and he also is deputy chair of the German Society of Addiction Medicine (Deutsche Gesellschaft für Suchtmedizin). In 2007, together with scientists from Germany, Austria, and Canada, he founded the Institute of Addiction Medicine and Obesity.

Kirsten Meyer works in the Städtische Klinikum München GmbH, Klinikum Schwabing, department of addiction medicine since 1992. She functions as deputy head. Her expertise is in the area of treatment of IDUs (injection drug users) and HCV, especially in diagnosis and treatment of co-morbidity. She is specialized in internal medicine and psychotherapeutic aspects of addicted persons, especially withdrawal also in pregnancy or newborns. She is co-author of many papers in national and international journals. Moreover, she is member of the German Society of Addiction Medicine (Deutsche Gesellschaft für Suchtmedizin).

Christian G. Schütz, MD, MPH, Institute of Mental Health, University of British Columbia, Canada, The main areas of research interests are addictive disorders and co-occurring mental disorders, with a focus on treatment and neurobiological and psychosocial factors influencing treatment outcome. I am a psychiatrist (Ludwigs Maximilians University, Munich, Germany) and epidemiologist (Johns Hopkins University, Baltimore, MD) by training. A Fogerty Fellowship at the Intramural Research Center of the National Institute of Drug Abuse/National Institute of Health extended my training to include preclinical and clinical behavioral pharmacology. Recent studies focused on predicting treatment outcome and relapse, combining neuroimaging, neurocognition and genetic approaches with clinical and psychosocial measures.

Jens Reimer, M.D., has been working with marginalized patients groups (HIV-positive, injection drug users) for more than a decade. His expertise is in treatment of somatic and mental co-morbidity in integrated settings. Dr. Reimer is a senior psychiatrist at the University Medical Centre Hamburg-Eppendorf, Hamburg, Germany and acts as managing director of the Centre for Interdisciplinary Addiction Research of the University of Hamburg. He is Editor-in-Chief of the journals Mental Illness and Suchttherapie, as well editorial assistant of European Addiction Research, and vice president of the German Society of Addiction Medicine.