Ahuja Manik, Jain Monika, Mamudu Hadii, Al Ksir Kawther, Sathiyaseelan Thiveya, Zare Shahin, Went Nils, Fernandopulle Praveen, Schuver Trisha, Pons Amanda, Dooley McKenzie, Nwanecki Chisom, Dahal Kajol
College of Public Health, East Tennessee State University, Johnson City, TN, USA.
Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA.
Chronic Stress (Thousand Oaks). 2024 Aug 6;8:24705470241268483. doi: 10.1177/24705470241268483. eCollection 2024 Jan-Dec.
Rural areas in the United States have been disproportionately burdened with high rates of substance use, mental health challenges, chronic stress, and suicide behaviors. Factors such as a lack of mental health services, decreased accessibility to public health resources, and social isolation contribute to these disparities. The current study explores risk factors to suicidal ideation, using emergency room discharge data from Maryland.
The current study used data from the Healthcare Cost and Utilization Project (HCUP) State Emergency Department Databases (SEDD) from the State of Maryland. Logistic regression was used to assess the association between ICD-10 coded opioid use disorder, alcohol use disorder, cannabis use disorder, major depressive disorder, and the outcome variable of suicidal ideation discharge. We controlled for income, race, age, and gender.
Lifetime major depressive disorder diagnosis (odds ration [OR] = 79.30; 95% confidence interval [CI] 51.91-121.15), alcohol use disorder (OR = 6.87; 95% CI 4.97-9.51), opioid use disorder (OR = 5.39; 95% CI 3.63-7.99), and cannabis use disorder (OR = 2.67; 95% CI 1.37-5.18) were all positively associated with suicidal ideation.
The study highlights the strong link between prior substance use disorder, depression, and suicidal ideation visit to the emergency room, indicating the need for prevention and intervention, particularly among those in rural areas where the burden of suicidal ideation and chronic stress are high. As health disparities between rural and urban areas further widened during the COVID-19 pandemic, there is an urgent need to address these issues.
美国农村地区承受着不成比例的重负，面临着药物使用、心理健康挑战、慢性压力和自杀行为的高发生率。诸如心理健康服务缺乏、公共卫生资源可及性降低以及社会孤立等因素导致了这些差异。本研究利用马里兰州的急诊室出院数据，探讨自杀意念的风险因素。
本研究使用了来自马里兰州医疗保健成本与利用项目（HCUP）的州急诊科数据库（SEDD）的数据。采用逻辑回归分析来评估国际疾病分类第十版（ICD - 10）编码的阿片类物质使用障碍、酒精使用障碍、大麻使用障碍、重度抑郁症与自杀意念出院这一结果变量之间的关联。我们对收入、种族、年龄和性别进行了控制。
终生重度抑郁症诊断（优势比[OR] = 79.30；95%置信区间[CI] 51.91 - 121.15）、酒精使用障碍（OR = 6.87；95% CI 4.97 - 9.51）、阿片类物质使用障碍（OR = 5.39；95% CI 3.63 - 7.99）和大麻使用障碍（OR = 2.67；95% CI 1.37 - 5.18）均与自杀意念呈正相关。
该研究突出了既往物质使用障碍、抑郁症与急诊室自杀意念就诊之间的紧密联系，表明需要进行预防和干预，尤其是在自杀意念和慢性压力负担较重的农村地区人群中。由于在2019冠状病毒病大流行期间城乡之间的健康差异进一步扩大，迫切需要解决这些问题。
