Evaluating the risk of suicidal intent in individuals who survive overdoses via routine screening for depression and alcohol abuse
Suicide is a major public health concern that claims the lives of more than 800,000 people every year worldwide [1]. Among the various methods of suicide, intentional drug overdose (IDO) is one of the most common, accounting for about 20% of all suicide deaths [2]. However, not all IDO attempts are fatal, and many individuals who survive an overdose may still be at high risk of subsequent suicide or self-harm. Therefore, it is crucial to identify and intervene with these individuals as early as possible, before they make another potentially lethal attempt.
One way to assess the risk of suicidal intent in IDO survivors is to screen them for depression and alcohol abuse, two of the most prevalent and modifiable risk factors for suicide [3]. Depression is a mood disorder characterized by persistent sadness, hopelessness, and loss of interest in life. Alcohol abuse is a pattern of excessive drinking that causes physical, psychological dissertation writers, and social problems. Both depression and alcohol abuse can impair one’s judgment, lower one’s inhibitions, and increase one’s impulsivity, making one more likely to engage in suicidal behavior [4].
Several screening tools have been developed and validated to detect depression and alcohol abuse in various settings, such as primary care, emergency departments, and mental health services. For example, the Patient Health Questionnaire-9 (PHQ-9) is a nine-item questionnaire that measures the severity of depressive symptoms in the past two weeks [5]. The Alcohol Use Disorders Identification Test (AUDIT) is a 10-item questionnaire that assesses the frequency, quantity, and consequences of alcohol consumption in the past year [6]. These tools are brief, easy to administer, and have good psychometric properties. They can help clinicians to identify IDO survivors who may benefit from further assessment and treatment for depression and alcohol abuse.
By screening IDO survivors for depression and alcohol abuse, clinicians can not only evaluate their risk of suicidal intent, but also provide them with appropriate interventions that may reduce their distress and enhance their coping skills. For instance, cognitive-behavioral therapy (CBT) is an evidence-based psychotherapy that aims to modify negative thoughts and behaviors that contribute to depression and alcohol abuse [7]. Pharmacotherapy, such as antidepressants and anti-craving medications, can also help to alleviate depressive symptoms and reduce alcohol cravings [8]. Moreover, referral to specialized services, such as addiction treatment programs or suicide prevention centers, can offer additional support and resources for IDO survivors who have complex or severe needs [9].
In conclusion, routine screening for depression and alcohol abuse is a feasible and effective way to evaluate the risk of suicidal intent in individuals who survive overdoses. By using validated screening tools, such as the PHQ-9 and the AUDIT, clinicians can identify IDO survivors who may be suffering from these common and treatable mental health problems. Furthermore, by providing them with appropriate interventions, such as CBT, pharmacotherapy, or referral to specialized services, clinicians can help IDO survivors to recover from their overdose experience and prevent future suicide attempts.
References:
[1] World Health Organization. (2021). Suicide worldwide in 2019. https://www.who.int/publications/i/item/suicide-worldwide-in-2019
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[4] Sher L. (2006). Alcohol consumption and suicide. QJM: An International Journal of Medicine 99(1):57-61. https://doi.org/10.1093/qjmed/hci146
[5] Kroenke K., Spitzer R.L., Williams J.B.W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine 16(9):606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
[6] Saunders J.B., Aasland O.G., Babor T.F., de la Fuente J.R., Grant M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption-II. Addiction 88(6):791-804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x
[7] Hofmann S.G., Asnaani A., Vonk I.J.J., Sawyer A.T., Fang A. (2012). The efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive Therapy and Research 36(5):427-440. https://doi.org/10.1007/s10608-012-9476-1
[8] Oslin D.W., Lynch K.G., Maisto S.A., Lantinga L.J., McKay J.R., Possemato K., et al. (2014). A randomized clinical trial of alcohol care management delivered in Department of Veterans Affairs primary care clinics versus specialty addiction treatment. Journal of General Internal Medicine 29(1):162-168. https://doi.org/10.1007/s11606-013-2645-x
[9] Zalsman G., Hawton K., Wasserman D., van Heeringen K., Arensman E., Sarchiapone M., et al. (2016). Suicide prevention strategies revisited: 10-year systematic review. The Lancet Psychiatry 3(7):646-659. https://doi.org/10.1016/S2215-0366(16)30030-X
