Health Care Processes Contributing to Suicide Risk in Veterans During and After Residential Substance Abuse Treatment

Abstract

Objective: Substance use disorders are an important risk factor for suicide. While residential drug treatment programs improve clinical outcomes for substance use disorders, less is known about the role of related health care processes in contributing to suicide risk. These data may help to inform strategies to prevent suicide during and after residential treatment.

Methods: A retrospective analysis was conducted on root-cause analysis (RCA) reports of suicide in veterans occurring within 3 months of discharge from a residential drug treatment program that were reported to a Veterans Affairs facility between 2001 and 2017. Demographic information such as age, gender, and psychiatric comorbidity were abstracted from each report. In addition, an established codebook was used to code root causes from each report. Root causes were grouped into categories in order to characterize the key system and organizational-level processes that may have contributed to the suicide.

Results: A total of 39 RCA reports of suicide occurring within 3 months after discharge from a residential drug treatment program were identified. The majority of decedents were men and the average age was 42.9 years (SD = 11.2). The most common method of suicide was overdose (33%) followed by hanging (28%). Most suicides occurred in close proximity to discharge, with 56% (n = 22) occurring within seven days of discharge and 36% (n = 14) occurring within 48 hours of discharge. The most common substances used by decedents prior to admission were alcohol or opiates. RCA teams identified a total of 140 root causes and the majority were due to problems with suicide risk assessment (n = 32, 22.9%). Non-engagement with treatment during (n = 20, 14.3%) and after the residential stay (n = 18, 12.9%) was also highlighted as an important concern. Finally, several reports raised concerns that a discharge prior to treatment completion or a precipitous discharge due to program violation negatively impacted treatment outcomes.

Conclusions: Efforts to prevent suicide in the period following discharge from a residential drug treatment program should focus on addressing suicide risk factors during admission and helping patients engage more fully in substance use disorder treatment.

Keywords:

• Suicide
• residential treatment
• substance abuse
• discharge

Acknowledgments

Outside of the authors, there were no additional individuals who contributed in a meaningful way to the development of the manuscript. The work described in this paper was presented as a poster at the Vermont Genetics Network Annual Career Day Event, Burlington, VT, April 3, 2019.

Disclosures

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was funded by the VA New England Early Career Development Award Program [V1CDA2017-06], VA New England Healthcare System, Bedford, MA (Dr. Riblet); the Patient Safety Center of Inquiry Program, National Center for Patient Safety, Ann Arbor, MI (PSCI-WRJ- Shiner) (Dr. Shiner); and the VA Health Services Research and Development Career Development Award Program [CDA11-263], Veterans Health Administration, Washington, DC (Dr. Shiner). Research reported in this publication was also supported by an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number [P20GM103449] (Ms. Kenneally). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of National Institute of General Medical Sciences (NIGMS) or National Institutes of Health (NIH). Funders had no role in the design, analysis, interpretation, or publication of this study.