Elsevier

Psychiatry Research

Volume 225, Issue 3, 28 February 2015, Pages 706-709
Psychiatry Research

Suicidal ideation and lifetime attempts in substance and gambling disorders

https://doi.org/10.1016/j.psychres.2014.11.011Get rights and content

Abstract

Suicidality is more commonly reported among individuals with addictions relative to the general population, though data from Asian countries remain scarce. The medical records of 2187 Singaporean patients with drug (n=879), alcohol (n=754) or gambling (n=554) disorders entering an outpatient treatment service were examined to explore differences in suicidal ideation and lifetime attempts between substance and gambling addictions. The relationship between suicidality, co-morbidity and addiction severity were also examined. 25.0% reported thoughts of suicide in the past month, 11.8% had a suicide plan and 12.2% reported lifetime attempts. Rates of suicidal ideation (thoughts, and plan) but not lifetime attempts were significantly higher among gambling than substance use patients. Co-morbid (DSM-IV axis-1) disorders were found among 32.5%, 38% and 40% of those reporting thoughts, plan and lifetime attempts respectively. Addiction severity was higher and quality of life lower among those reporting suicidal behaviors. Logistic regression revealed co-morbidity, debt, gender (being female) and being a gambling patient as significant predictors of suicidal behaviors. The findings highlight the importance of screening for suicidality, even in the absence of co-morbidity, particularly among gambling disorder patients with debts. Suicide risk should be assessed periodically and referral to suicidal prevention interventions routinely offered to this vulnerable population.

Introduction

In 2010, suicide was identified as the tenth leading cause of death for all ages in the US (CDCP, 2010) and substance use disorders (SUDs) are among the most commonly associated mental health conditions (Wilcox et al., 2004). Suicide rates in Asia account for approximately 60% of the world׳s suicide rates (Chen et al., 2012; Beautrais, 2006). International research indicates that suicide attempts occur more frequently (up to 13.5 times) among individuals with SUDs relative to the general population (Wilcox et al., 2004). Among treated populations, rates of suicide attempts among heroin-dependent patients are 18% in Taiwan (Chen et al., 2010), 31% in Australia (Darke et al., 2007) and 49.5% among drug rehabilitation attendees in Japan (Okasaka et al., 2006). Among alcohol patients, rates of suicide attempts have been reported around 40% in the US (Roy, 2003) and Europe (Driessen et al., 1998). In contrast to substance users or abusers, comparatively little is known about suicide in individuals with behavioral addictions such as pathological gambling. However, according to Maccallum and Blaszczynski (2003) rates of suicidal ideation among pathological gamblers in Austria, Germany and the United States are 17–80%, and suicide attempts 4–23%. In the US, 32% of pathological gamblers in treatment reported suicidal ideation and 17% had made an attempt (Petry and Kiluk, 2002), with similar rates reported in a recent Singaporean study (Lee et al., 2011)

Discrepancies in the prevalence of suicidal behaviors among individuals with addiction problems can be attributed to differences in definitions, assessment methods and cultural differences. In Singapore, where the current study was conducted, attempting suicide is illegal, punishable with a one-year prison sentence or a fine, though rarely enforced. Although it has one of the lowest rates among Asian countries, occurring in 9.8 to 13 per 100,000 over the past five decades, which is equivalent to 350–400 each year (Chia et al., 2010), little is known about suicide among addicted individuals in this region. To address some of the knowledge gaps, we examined rates of suicide behaviors (ideation, plans and attempts) among substance use disorder (SUD) and gambling disorder (GD) patients seeking outpatient treatment in Singapore, as well as the relationship between suicidality, co-morbidity and addiction severity.

Section snippets

Method

The study uses baseline data from a prospective treatment outcome monitoring program in operation between July 2009 and December 2011 when the program underwent further revisions. During this 2.5 year interval, 2616 outpatients presented to the National Addictions Management Service for substance or behavioral addiction problems. Of these, 2193 (83.8%) entered the Treatment Outcome Monitoring (TOM) program. The 423 excluded individuals were those who: declined participation (n=29), had

Clinical and demographic characteristics

The sample (n=2187) was predominantly male (86.8%), averaged 42.1 (±11.7) years old, and comprised 61.3% Chinese, 19.7% Indian, 15.6% Malay and 3.4% of other races. Just under half (47.0%) were married, 56.6% were employed and 68.7% educated to secondary level or above. Following psychiatric assessment, 22.8% was diagnosed with a co-morbid psychiatric disorder (DSM-IV diagnosis) (23.1% of SUD and 21.9% of GD patients). Among those with co-morbidities, the most common axis-1 disorders were

Discussion

In support of international literature, high rates of suicidality were found among individuals with addiction disorders. Among patients with SUD, rates of lifetime attempts (around 13%) were comparably lower than reported among Western treatment-seeking population where they tend to be around 30–40% (Darke et al., 2007, Roy, 2003; Driessen et al., 1998). Nonetheless, one in five expressed suicidal ideation in the past month. Among GD patients however, rates of suicidality (both ideation and

Acknowledgments

The authors would like to thank staff and clinicians at the National Addictions Management Service for their support in treatment outcome monitoring. The Treatment Outcome Monitoring Programme, from which this paper has derived its findings, is funded by the Ministry of Health, Singapore. The authors declare that they have no conflict of interest.

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