National Addiction Centre, King's College London Institute of Psychiatry, Psychology and Neuroscience, London, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Drug Alcohol Rev. 2021 Mar;40(3):499-508. doi: 10.1111/dar.13231. Epub 2021 Feb 10.
Despite the association of alcohol use with recurrent suicidal acts, individuals attempting suicide after drinking alcohol face barriers accessing crisis care following emergency assessment, demonstrated by higher odds of inpatient admission for those whose suicide attempt did not feature alcohol. This disparity may be due to suicidality dissipating more rapidly after a suicide attempt involving alcohol. We investigated the effect of acute alcohol use and ongoing suicidality on onward care decisions after emergency assessment.
We analysed electronic health records of 650 suicidal adults detained under Section 136 of the Mental Health Act (1983, amended 2007) for up to 36 h at a London psychiatric emergency care centre. We used logistic regression to estimate the association of acute alcohol use and ongoing suicidality (including their interaction) with admission to psychiatric hospital.
Fifteen percent of previously intoxicated detainees expressed suicidal intent at detention end, compared to 24% of detainees who had not used alcohol prior to detention. Compared to those who were not previously intoxicated and not suicidal at detention end, acute alcohol use was associated with reduced odds of admission amongst those no longer suicidal (AOR 0.4, 95% CI 0.2, 0.6). Where suicidality persisted, odds of admission rose; however, the magnitude of increase when in combination with prior alcohol use (AOR 3.6, 95% CI 1.9, 7.1) was under half that of when alcohol was not involved (AOR 8.2, 95% CI 3.5, 19.1).
Acute alcohol use is associated with transient suicidality, but this only partially accounts for disparities in care following suicide attempts.
尽管饮酒与复发性自杀行为有关，但在急诊评估后，那些尝试自杀时并未饮酒的个体在寻求危机护理时面临障碍，这表现为住院的可能性更高。这种差异可能是由于自杀未遂后，酒精导致的自杀意念更快地消散。我们调查了急性酒精使用和持续的自杀意念对急诊评估后继续治疗决策的影响。
我们分析了 650 名因自杀而被伦敦精神病急诊中心根据 1983 年（经 2007 年修订）《精神卫生法》第 136 条拘留的成年自杀者的电子健康记录，最长可达 36 小时。我们使用逻辑回归来估计急性酒精使用和持续自杀意念（包括它们的相互作用）与精神病院入院之间的关联。
与没有在拘留前饮酒的被拘留者相比，15%的先前醉酒被拘留者在拘留结束时表达了自杀意图，而 24%的被拘留者没有在拘留前饮酒。与那些在拘留结束时没有醉酒且没有自杀的人相比，急性酒精使用与那些不再有自杀念头的人入院的可能性降低有关（比值比 0.4，95%置信区间 0.2，0.6）。如果自杀意念持续存在，入院的可能性会增加；然而，当与先前的酒精使用结合时，增加的幅度（比值比 3.6，95%置信区间 1.9，7.1）不到不涉及酒精时的一半（比值比 8.2，95%置信区间 3.5，19.1）。
急性酒精使用与短暂的自杀意念有关，但这仅部分解释了自杀未遂后护理方面的差异。
