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.

中文翻译：

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导致退伍军人在住院药物滥用治疗期间和之后自杀风险的医疗保健过程


摘要 目的：药物滥用障碍是自杀的重要危险因素。虽然住院药物治疗计划改善了物质使用障碍的临床结果，但人们对相关医疗保健过程在导致自杀风险中的作用知之甚少。这些数据可能有助于制定住院治疗期间和治疗后预防自杀的策略。方法：对 2001 年至 2017 年间向退伍军人事务机构报告的退伍军人从住院戒毒治疗计划出院后 3 个月内发生的自杀根本原因分析 (RCA) 报告进行回顾性分析。年龄等人口统计信息从每份报告中提取了性别和精神合并症。此外，还使用既定的密码簿对每份报告中的根本原因进行编码。根本原因被分为几类，以便描述可能导致自杀的关键系统和组织层面的过程。结果：总共确定了 39 份 RCA 报告，表明从住院戒毒治疗计划出院后 3 个月内发生自杀。大多数死者是男性，平均年龄为 42.9 岁（SD = 11.2）。最常见的自杀方法是服药过量（33%），其次是上吊（28%）。大多数自杀发生在出院前不久，其中 56% (n = 22) 发生在出院后 7 天内，36% (n = 14) 发生在出院后 48 小时内。死者入院前最常使用的物质是酒精或阿片类药物。 RCA 团队总共确定了 140 个根本原因，其中大多数是由于自杀风险评估问题造成的（n = 32，22.9%）。住院期间（n = 20, 14.3%）和住院后（n = 18, 12.9%）也被强调为一个重要问题。最后，一些报告提出了这样的担忧：在治疗完成之前出院或因违反计划而突然出院会对治疗结果产生负面影响。结论：在住院戒毒治疗计划出院后的一段时间内预防自杀的努力应侧重于解决入院期间的自杀危险因素，并帮助患者更充分地参与药物滥用障碍治疗。