Hazardous, harmful and dependent alcohol use in Crisis Resolution Team patients: relationship with death or service recontact after a suicidal crisis.
Research suggests that following suicidal crisis, patients who use alcohol are more likely to re-attempt or die by suicide than non-drinkers. However, there is little research measuring the characteristics and prognosis of alcohol-using patients under the care of services providing the most intensive community-based intervention for suicidal individuals: Crisis Resolution Teams (CRTs). We investigated a cohort of suicidal patients under the care of four London-based CRTs and estimated the association of alcohol use at hazardous, harmful or dependent levels with death or recontact with psychiatric crisis care.
We analysed electronic health records from 1615 suicidal CRT patients over 38 months. Using logistic regression we estimated the association of hazardous, harmful or dependent alcohol use (indicated by risk assessment, AUDIT or ICD-10 diagnosis) with death-or-recontact at (i) 30 days and (ii) 1 year after first contact, adjusted for age, sex, ethnicity, psychiatric diagnosis and HoNOS score.
Alcohol use at a hazardous level or above was identified in 270 cases (16.7%) with 73 (4.5%) alcohol dependent. By 1 year, 622 patients (38.5%) had recontacted crisis care or died. In adjusted analyses, hazardous, harmful or dependent alcohol use was not associated with increased odds of death-or-recontact at 30 days (AOR 1.17, 95%CI 0.73-1.88) or 1 year (AOR 1.17, 95%CI 0.85-1.60). Poor prognosis was related to psychiatric diagnosis, specifically psychotic and personality disorders.
Patients with hazardous, harmful and dependent alcohol use account for a small proportion of patients cared for by CRTs despite the association between alcohol use and suicidal acts, and higher proportions in other crisis care settings. However, patients with hazardous, harmful or dependent use by the CRT do not appear to be associated with mortality or service recontact within 30 days or the year following treatment, although this may be due to heavier drinkers being excluded from CRT caseloads.