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.

中文翻译：

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物质相关疾病患者使用急诊室进行自杀行为的预测因素

摘要

客观的

本研究旨在确定在魁北克（加拿大）的 14,158 名患有物质相关疾病 (SRD) 的患者中，与其他原因相比，急诊科 (ED) 使用自杀意念或自杀未遂的预测因素。

方法

从魁北克行政数据库中提取了 2012-13 年使用成瘾治疗中心的患者的临床、社会人口统计学和服务使用变量的纵向数据。产生了多项逻辑回归，将自杀意念或企图的预测因素与 2015-16 年使用 ED 的其他原因进行了比较。

结果

因自杀意念和自杀企图而使用 ED 的患者更有可能患有躁郁症或人格障碍、与社会环境相关的问题、之前每年与他们通常的精神科医生进行 4 次以上的门诊咨询、大量使用 ED 以及从成瘾治疗的 SRD 计划中退出与因其他原因使用 ED 的中心相比，过去 7 年的中心。生活在物质最匮乏地区、城市地区和大学医疗保健区的患有除大麻以外的酒精或药物相关疾病的患者比因其他原因使用 ED 的患者有更多的自杀企图。患有常见精神障碍的患者，之前每年与他们通常的精神科医生进行 1-3 次门诊咨询，之前在成瘾治疗中心接受过一次治疗，

结论

临床变量最能预测自杀行为，而完成 SRD 计划可能有助于减少自杀行为。应加强 SRD 服务和外展策略，特别是对于生活在更有利的城市地区的具有复杂问题的患者。

• 强调

• 超过 10% 的急诊就诊是针对 SRD 患者的自杀行为。

• ED 用于自杀行为主要与临床变量有关。

• 成瘾治疗中心可能有助于减少 ED 对自杀行为的使用。