阿片类药物过量和抑郁作为自杀念头预测因素的数量。
Number of opioid overdoses and depression as a predictor of suicidal thoughts.
机构信息
University of Pennsylvania, Department of Psychiatry, 3535 Market Street, Philadelphia, PA, 19104, USA.
Children's Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA; University of Pennsylvania, Department of Pediatrics, 3401 Civic Center Blvd., Philadelphia, PA, 19104, USA.
出版信息
Drug Alcohol Depend. 2021 Jul 1;224:108728. doi: 10.1016/j.drugalcdep.2021.108728. Epub 2021 Apr 24.
BACKGROUND
Opioid use disorders are associated with increased risk of suicide thoughts, attempts, and death. We explored key variables from two theories of the development of suicidal thoughts and attempts (the interpersonal and three-step theories of suicide) to understand possible mechanisms underlying the association between opioid use and suicide risk. We hypothesized that interpersonal connections, variables reflecting psychological and physical pain, and variables that reduce fear of death (prior overdoses and risk-taking behaviors) would be associated with increased risk of thoughts of suicide.
METHODS
Participants (N = 141) were opioid users recruited from an epicenter of the opioid crisis in Philadelphia using a mobile research center and completed an interview to assess substance use, depression, medical comorbidities, and suicidal thoughts among other variables.
RESULTS
Univariate analyses showed that prior history of overdose, diagnosis of depression, older age, homelessness, and interpersonal connection were each associated with increased likelihood of endorsing thoughts of death/suicide. Multivariable analyses revealed prior history of overdose and depression were the variables most strongly associated with risk for thoughts of suicide.
CONCLUSIONS
Consistent with two theories of the development of suicidal thoughts and attempts, exposure to variables that reduce fear of death (e.g., overdoses) were associated with suicidal thoughts. In contrast, other risk-taking behaviors, medical comorbidities, and substance use were not key predictors of suicidal thoughts in this sample. Implications for targeted risk assessment among clinicians are discussed.
背景
阿片类药物使用障碍与自杀念头、自杀企图和死亡的风险增加有关。我们探讨了自杀想法和企图发展的两个理论（人际和三步自杀理论）中的关键变量，以了解阿片类药物使用与自杀风险之间关联的可能机制。我们假设人际联系、反映心理和身体疼痛的变量以及减少对死亡恐惧的变量（以前的过量用药和冒险行为）与自杀念头的风险增加有关。
方法
使用移动研究中心从费城阿片类药物危机的震中招募了 141 名阿片类药物使用者，参与者完成了一次访谈，以评估物质使用、抑郁、合并症和自杀念头等其他变量。
结果
单变量分析表明，以前的过量用药史、抑郁诊断、年龄较大、无家可归和人际联系与更有可能认可死亡/自杀念头有关。多变量分析显示，以前的过量用药史和抑郁是与自杀念头风险最相关的两个变量。
结论
与自杀想法发展的两个理论一致，接触减少对死亡恐惧的变量（例如，过量用药）与自杀念头有关。相比之下，在这个样本中，其他冒险行为、合并症和物质使用并不是自杀念头的关键预测因素。讨论了针对临床医生进行有针对性的风险评估的意义。
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