Background

Substance use is a strong risk factor for suicidal behavior. To date, however, no known study has evaluated optimal cut-off scores on substance use severity measures to identify individuals who may be at elevated risk for suicide.

Methods

Data were analyzed from the 2019–2020 National Health and Resilience in Veterans Study, which surveyed a nationally representative sample of 4069 U.S. veterans. Receiver operating characteristic curve analyses were conducted to identify cut-off scores on the Alcohol Use Disorders Identification Test (AUDIT) and Screen of Drug Use (SDU) that optimally differentiated veterans with and without past-year suicidal ideation (SI) in the full sample, as well a high-risk subsample with histories of major depressive disorder (MDD) and/or posttraumatic stress disorder (PTSD).

Results

The prevalence of past-year SI was 11.7% (n = 387); A total of 10.5% (n = 360) of the sample screened positive for past-year alcohol use disorder, 9.1% (n = 314) for past-year drug use disorder, and 22.4% (n = 833) for lifetime MDD/PTSD. The optimal AUDIT cut-off score that differentiated suicide ideators and non-ideators was ≥14 in the full sample, and ≥18 in the high-risk subsample; these scores are indicative of moderate-to-severe alcohol use disorder. The optimal SDU cut-off score was ≥1 for both the full sample and high-risk subsample, which is lower than the recommend cut-off score for probable drug use disorder (≥7).

Conclusions

Results identify high-specificity thresholds on the AUDIT and SDU that may have clinical utility in suicide risk assessment in veterans. Veterans with moderate-to-severe alcohol use disorder or who use non-prescription drugs may warrant further suicide risk assessment.

中文翻译：

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作为美国退伍军人自杀风险指标的物质使用严重程度

背景

物质使用是自杀行为的重要危险因素。然而，迄今为止，还没有任何已知的研究评估了物质使用严重程度测量的最佳截止分数，以识别可能有自杀风险的个体。

方法

数据来自 2019-2020 年退伍军人国家健康和复原力研究，该研究调查了 4069 名美国退伍军人的全国代表性样本。接受者操作特征曲线分析用于确定酒精使用障碍识别测试 (AUDIT) 和药物使用筛选 (SDU) 的截止分数，它们可以最佳地区分完整样本中是否有过去一年自杀意念 (SI) 的退伍军人，以及具有重度抑郁症 (MDD) 和/或创伤后应激障碍 (PTSD) 病史的高风险子样本。

结果

过去一年 SI 的患病率为 11.7% (n = 387)；总共有 10.5% (n = 360) 的样本筛选出上一年酒精使用障碍呈阳性，9.1% (n = 314) 筛选出上一年吸毒障碍，以及 22.4% (n = 833) 终生 MDD/创伤后应激障碍。区分自杀意念者和非意念者的最佳审计截止分数在全样本中≥14，在高风险子样本中≥18；这些分数表明中度至重度酒精使用障碍。全样本和高风险子样本的最佳 SDU 临界值均≥1，低于可能的药物使用障碍的推荐临界值（≥7）。

结论

结果确定了 AUDIT 和 SDU 的高特异性阈值，这些阈值可能在退伍军人自杀风险评估中具有临床效用。患有中度至重度酒精使用障碍或使用非处方药的退伍军人可能需要进一步评估自杀风险。