Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders

TLDR: Systematic screening of suicidal risk in patients seeking treatment in addiction centres with histories of abuse is recommended and the relationship between previous traumatic experiences and suicidal behaviours is highlighted.

Abstract: Background: Several studies indicate that lifetime abuse is a relevant risk factor for suicidal ideation and/or attempts. However, little is known about this phenomenon in patients seeking treatmen...

Figures

Table 2 Comparisons between patients who did and patients who did not experience lifetime suicidal ideation

Table 1 Rate of suicidal ideation and suicide attempts

Table 4 Logistic regression analyses*

Table 3 Comparisons between patients who did and patients who did not attempt suicide

Full text

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ADDICTION RESEARCH & THEORY
2019, VOL. 27, NO. 3, 204–209
https://doi.org/10.1080/16066359.2018.1485891
Suicidal ideation and attempts among patients with lifetime physical and/or sexual
abuse in treatment for substance use disorders
Running head: Drug addiction, lifetime abuse and suicide
Javier Fernández-Montalvo
1
, José J. López-Goñi
1
, Alfonso Arteaga
1
, and Begoña Haro
1
1
Departamento de Psicología y Pedagogía. Universidad Pública de Navarra. 31006
Pamplona. Spain
Corresponding author: Javier Fernández-Montalvo, Departamento de Psicología y
Pedagogía, Universidad Pública de Navarra, 31006 Pamplona (Spain). Phone: 0034
948169830. Email: fernandez.montalvo@unavarra.es
Acknowledgements: The authors thank the “Proyecto Hombre de Navarra” programme
staff for their help with assessing the clinical sample. This study was supported by a
grant (code PSI2016--76511-R) from the Agencia Estatal de Investigación (AEI) of the
Spanish Government and Fondo Europeo de Desarrollo Regional of the European
Union (FEDER, EU).
This is an Accepted Manuscript of an article published by Taylor &
Francis in Addiction Research & Theory on 2019-24-07, available
online: https://doi.org/10.1080/16066359.2018.1485891

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ADDICTION RESEARCH & THEORY
2019, VOL. 27, NO. 3, 204–209
https://doi.org/10.1080/16066359.2018.1485891
TITLE: Suicidal ideation and attempts among patients with lifetime physical and/or
sexual abuse in treatment for substance use disorders
ABSTRACT
Background: Several studies indicate that lifetime abuse is a relevant risk factor for
suicidal ideation and/or attempts. However, little is known about this phenomenon in
patients seeking treatment for substance use disorder. The prevalence rate of suicidal
ideation and/or suicide attempts was explored among lifetime physically and/or sexually
abused patients receiving treatment for drug addiction. The differential characteristics
between these patients and those without suicidal behaviours were studied. Method:
Three hundred and seventy-five patients were assessed. Socio-demographic
characteristics, addiction severity, lifetime abuse, suicidal ideation and attempts, and
psychopathological symptoms were explored. Results: Eighty-two patients (21.9%)
presented with a history of lifetime abuse and were included in the study (37 men and
45 women). Sixty-two per cent of them presented with lifetime suicidal ideation (12.2%
in the last month), and 30.5% with suicide attempts (1.2% in the last month). Patients
with suicidal ideation or attempts showed a more severe addiction profile (assessed by
the EuropASI) and more psychopathological symptoms (assessed by the SCL-90-R).
Conclusion: This study highlights the relationship between previous traumatic
experiences and suicidal behaviours. According to these results, systematic screening of
suicidal risk in patients seeking treatment in addiction centres with histories of abuse is
recommended.
Keywords: Addiction; physical abuse; sexual abuse; suicidal ideation; suicide attempts;
assessment.

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ADDICTION RESEARCH & THEORY
2019, VOL. 27, NO. 3, 204–209
https://doi.org/10.1080/16066359.2018.1485891

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ADDICTION RESEARCH & THEORY
2019, VOL. 27, NO. 3, 204–209
https://doi.org/10.1080/16066359.2018.1485891
INTRODUCTION
In recent years, several studies have shown high prevalence rates of suicidal
ideation and attempts in patients with addiction problems (Dinwiddie, 2017; Simoneau,
Menard, & Blanchette-Martin, 2017; Yuodelis‐Flores & Ries, 2015). For suicidal
ideation, the prevalence rates range from 17% to 50% (Darvishi, Farhadi, Haghtalab, &
Poorolajal, 2015; Garlow, Purselle, & D'Orio, 2003; Moghaddam, Yoon, Dickerson,
Kim, & Westermeyer, 2015; Petry & Kiluk, 2002; Vaszari, Bradford, O'Leary, Ben
Abdallah, & Cottler, 2011). For suicide attempts, the rates vary between 16% and 44%
(Darke et al., 2015; Garlow et al., 2003; Hung, Caine, Fan, Huang, & Chen, 2013;
Moghaddam et al., 2015; Petry & Kiluk, 2002; Pirkola, Suominen, & Isometsa, 2004;
Roy, 2001, 2002, 2009, 2010; Roy & Janal, 2007).
Among patients with drug addiction problems, those presenting with suicidal-
related behaviours appear to have suffered more from lifetime abuse. Similarly, patients
who sought treatment for substance use disorder with a history of lifetime abuse show
higher rates of suicidal ideation and/or suicide attempts (Fernández-Montalvo, López-
Goñi, & Arteaga, 2015; Hung et al., 2013; Roy, 2010; Roy & Janal, 2007; Trout,
Hernandez, Kleiman, & Liu, 2017; Vaszari et al., 2011). For example, in a study by
Fernández-Montalvo et al. (2015), the rate of suicidal ideation in a sample of 115
patients in treatment for addictions problems with histories of any type of lifetime abuse
(psychological, physical and/or sexual) reached 48.8%, and the rate of suicide attempts
was 21.3%.
From the risk-factor perspective, several studies have found that childhood
adverse experiences, together with other variables (e.g., gender, comorbidity and
personality disorders), are a relevant risk factor for suicidal ideation and/or suicide
attempts in patients with substance use disorders (Pereira-Morales, Adan, Camargo, &

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ADDICTION RESEARCH & THEORY
2019, VOL. 27, NO. 3, 204–209
https://doi.org/10.1080/16066359.2018.1485891
Forero, 2017; Roy, 2003b; Trout et al., 2017; Vaszari et al., 2011; Yuodelis‐Flores &
Ries, 2015).
Despite the relationship found between lifetime abuse and suicidal behaviours in
patients in addiction treatment, there are no studies examining the specific
characteristics of abused patients with suicidal ideation and/or suicide attempts in
centres for addiction treatment. However, greater understanding of this profile is crucial
to develop effective strategies for the early detection of, prevention of and intervention
for suicide. Therefore, this is the first study providing specific information on suicidal
ideation and/or suicide attempts in a sample of patients with lifetime abuse who sought
treatment for substance use disorder. This study had two goals: a) to determine the
prevalence rate of both suicidal ideation and attempts among patients receiving
treatment for addiction with a history of physical and/or sexual lifetime abuse, and b) to
analyse the differential characteristics between abused patients with and without
suicidal ideation and with and without suicide attempts.
METHODS
The protocol for this study was approved by the ethics committees of the
Universidad Pública de Navarra (PI-006/16) and of the Fundación Proyecto Hombre de
Navarra (PHN2016-01). Informed consent was provided by all participants.
Participants
The initial sample consisted of 375 consecutive patients who sought treatment
for addiction in one of the two programmes (outpatient and inpatient) of the Proyecto
Hombre Navarra Foundation (Spain). These programmes have a cognitive behavioural
basis and are geared towards abstinence. They are public and attend to patients who are
representative of Spanish patients with addiction problems. Both outpatient and
inpatient modalities have been effective in the treatment of addiction (Fernández-

Frequently asked questions

Q1. What contributions have the authors mentioned in the paper "Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders running head: drug addiction, lifetime abuse and suicide" ?

The differential characteristics between these patients and those without suicidal behaviours were studied. Results: Eighty-two patients ( 21. 9 % ) presented with a history of lifetime abuse and were included in the study ( 37 men and 45 women ). This study highlights the relationship between previous traumatic experiences and suicidal behaviours. 

Q2. What have the authors stated for future works in "Suicidal ideation and attempts among patients with lifetime physical and/or sexual abuse in treatment for substance use disorders running head: drug addiction, lifetime abuse and suicide" ?

Future longitudinal studies should be developed to provide accurate information on the causal link between the variables studied. Future studies should include larger samples to corroborate these results. 

Q3. What are the primary symptoms of the SCL-90-R?

The SCL-90-R measures nine areas of primary symptoms: somatisation, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism. 

Q4. What was the important factor for determining the prevalence of suicidal thoughts and attempts?

In the bivariate analysisbetween patients with and patients without a history of suicidal ideation and attempts, χ2 or Student’s t test for independent samples was used, depending on the nature of the variables analysed. 

Q5. how many people with suicidal ideation have attempted suicide?

The rate of patients with lifetime abuse who presented with suicidal ideation was62.2% (n = 51), with 12.2% of patients presenting with suicidal ideation in the past 30 days (n = 10). 

Q6. What is the prevalence of suicidal ideation among patients with addiction problems?

Among patients with drug addiction problems, those presenting with suicidal-related behaviours appear to have suffered more from lifetime abuse. 

Q7. What is the main contribution of this study?

another strength of this study is that it explores both the behavioural aspect of suicide (suicide attempts) and the cognitive perspective (suicidal ideation). 

Q8. How many subjects did they not complete the two assessment sessions?

Two hundred and ninety-three (78.1%) of the 375 initial subjects did not meetthe above criteria, mainly the third criterion related to lifetime physical and/or sexual abuse (n = 252), followed by 32 patients who did not complete the two assessment sessions, and 9 who did not sign the informed consent. 

Q9. How many patients were included in the study?

The initial sample consisted of 375 consecutive patients who sought treatmentfor addiction in one of the two programmes (outpatient and inpatient) of the Proyecto Hombre Navarra Foundation (Spain). 

Q10. How many people with substance use problems have attempted suicide?

For suicidal ideation, the prevalence rates range from 17% to 50% (Darvishi, Farhadi, Haghtalab, & Poorolajal, 2015; Garlow, Purselle, & D'Orio, 2003; Moghaddam, Yoon, Dickerson, Kim, & Westermeyer, 2015; Petry & Kiluk, 2002; Vaszari, Bradford, O'Leary, Ben Abdallah, & Cottler, 2011). 

Q11. How many subjects were included in the study?

the final sample was composed of 82 subjects [physical abuse: n = 48 (58.5%), sexual abuse: n = 8 (9.8%), and both physical and sexual abuse: n = 26 (31.7%)]. 

Q12. What was the effect size of the two analyses?

Effect sizes (Cohen’s d) for all of the analyses were provided, taking into account Cohen’s recommendation (Cohen, 1988): d = 0.20 (small effect size), d = 0.50 (medium effect size), and d = 0.80 (large effect size).