Ilgen Mark A, Jain Anuja, Lucas Emma, Moos Rudolf H
Center for Health Care Evaluation, Department of Veterans Affairs Palo Alto Health Care System, 795 Willow Road (MPD 152), Menlo Park, California 94025, USA.
J Stud Alcohol Drugs. 2007 Jul;68(4):503-9. doi: 10.15288/jsad.2007.68.503.
Suicide attempts are common in patients being treated for substance-use disorders (SUDs). However, little is known about the frequency of suicidal behavior during and after SUD treatment or about aspects of treatment that predict subsequent suicidal behavior. The present study examines whether treatment setting, length of treatment, and availability/use of psychiatric services are associated with a reduced likelihood of a suicide attempt during and 1 year after treatment.
A national sample of 3,733 patients was assessed at the start of an episode of SUD treatment and again at discharge and/or 1 year after treatment. Mixed-model logistic regression analyses examined treatment-related predictors of in-treatment and posttreatment suicide attempts.
The rate of suicide attempts was significantly lower in the year following treatment (4%) than in the year before treatment (9%). Additionally, a total of 2% of patients reported a suicide attempt during treatment. Suicide attempts made during treatment were less likely in patients treated in residential as compared with outpatient settings. A longer course of treatment was associated with a lower likelihood of a posttreatment suicide attempt.
A sizable minority of patients report a suicide attempt either during or within 1 year after completion of SUD treatment. Even after controlling for baseline suicidality, aspects of the SUD treatment episode are associated with a lower risk of a future suicide attempt. Treatment providers should consider placing patients in residential settings to reduce suicide attempts made during treatment and providing a longer course of treatment to reduce the likelihood of suicide following treatment.
自杀未遂在接受物质使用障碍（SUDs）治疗的患者中很常见。然而，对于SUD治疗期间及之后自杀行为的频率，以及预测后续自杀行为的治疗方面，我们知之甚少。本研究探讨治疗环境、治疗时长以及精神科服务的可获得性/使用情况是否与治疗期间及治疗后1年内自杀未遂可能性的降低相关。
对3733名患者的全国样本在SUD治疗开始时进行评估，并在出院时和/或治疗后1年再次评估。混合模型逻辑回归分析检验了与治疗相关的治疗期间及治疗后自杀未遂的预测因素。
治疗后一年的自杀未遂率（4%）显著低于治疗前一年（9%）。此外，共有2%的患者报告在治疗期间有自杀未遂行为。与门诊治疗相比，住院治疗的患者在治疗期间自杀未遂的可能性较小。治疗疗程较长与治疗后自杀未遂的可能性较低相关。
相当一部分患者报告在SUD治疗期间或完成治疗后的1年内有自杀未遂行为。即使在控制了基线自杀倾向之后，SUD治疗过程中的一些方面仍与未来自杀未遂风险较低相关。治疗提供者应考虑将患者安置在住院环境中，以减少治疗期间的自杀未遂行为，并提供较长疗程的治疗，以降低治疗后自杀的可能性。
