Predictors of Emergency Department Use for Suicidal Behaviors among Patients with Substance-Related Disorders

Abstract

Objective

This study aimed to identify predictors of emergency department (ED) use for suicide ideation or suicide attempt compared with other reasons among 14,158 patients with substance-related disorders (SRD) in Quebec (Canada).

Methods

Longitudinal data on clinical, sociodemographic, and service use variables for patients who used addiction treatment centers in 2012–13 were extracted from Quebec administrative databases. A multinomial logistic regression was produced, comparing predictors of suicide ideation or attempts to other reasons for ED use in 2015–16.

Results

Patients using ED for both suicide ideation and attempt were more likely to have bipolar or personality disorders, problems related to the social environment, 4+ previous yearly outpatient consultations with their usual psychiatrist, high prior ED use, and dropout from SRD programs in addiction treatment centers in the previous 7 years, compared with those using ED for other reasons. Patients with alcohol- or drug-related disorders other than cannabis and living in the least materially deprived areas, urban territories, and university healthcare regions made more suicide attempts than those using ED for other reasons. Patients with common mental disorders, 1–3 previous yearly outpatient consultations with their usual psychiatrist, one previous treatment episode in addiction treatment centers, and those using at least one SRD program experienced more suicide ideation than patients using ED for other reasons.

Conclusion

Clinical variables most strongly predicted suicidal behaviors, whereas completion of SRD programs may help to reduce them. SRD services and outreach strategies should be reinforced, particularly for patients with complex issues living in more advantaged urban areas.

HIGHLIGHTS

• Over 10% of ED visits were for suicidal behaviors among patients with SRD.

• ED use for suicidal behaviors was mainly associated with clinical variables.

• Addiction treatment centers may help reduce ED use for suicidal behaviors.

Keywords:

• Addiction treatment centers
• emergency department use
• predictors
• substance-related disorders
• suicidal behaviors

ACKNOWLEDGMENTS

We gratefully acknowledge the support of the Substance Use and Addiction Program of Health Canada, the Québec Ministère de la santé et des services sociaux (Ministry of Health and Social Services: MSSS), the Institut universitaire sur les dépendances (IUD—University Institute on Addictions) and the Quebec Network on Suicide, Mood Disorders, and Associated Disorders. We are also grateful to Judith Sabetti for her editorial assistance.

DISCLOSURE STATEMENT

The authors declared no competing interests.

AUTHOR CONTRIBUTIONS

MJF and CH designed the overall research project and were responsible for data collection. MJF and CH designed the analytical plan for the article. ZC produced the quantitative analyses and tables. DC helped with the literature review and prepared some preliminary drafts of the article introduction and results sections. MJF, GG, and ZC wrote the article, and CH revised the final version.

AUTHOR NOTES

Marie-Josée Fleury, Department of Psychiatry, McGill University, Montreal, Canada and Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada. Guy Grenier and Zhirong Cao, Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Canada. Christophe Huỳnh, Institut Universitaire sur les Dépendances, Centre Intégré Universitaire de Santé et des Services Sociaux du Centre, Montreal, Canada. Dietta Chihade, Department of Psychiatry, McGill University, Montreal, Canada.

DATA AVAILABILITY STATEMENT

In accordance with the relevant ethics regulations for the province of Quebec, the principal investigator is responsible for preserving the confidentiality of the data.

Additional information

Funding

This study was funded by the Substance Use and Addiction Program of Health Canada, and the Ministère de la Santé et des Services Sociaux (Ministry of Health and Social Services: MSSS, Addiction and Homelessness Division). The sponsors had no role in the study design, data analysis, and interpretation, dating of the manuscript, or the decision to submit this article for publication.