The impact of detoxification on suicidal behaviour among heroin users: longitudinal data from South Africa
Suicide is a leading cause of mortality among heroin users, yet there is limited data assessing the impact of treatment on suicidal ideation and behaviour (SIB) in heroin users. The objectives of the study were to longitudinally assess the outcomes and correlates SIB among heroin users who attended inpatient detoxification and psychosocial rehabilitation.
The suicidality scale from the Mini International Neuropsychiatric Interview V7.02 for DSM 5 was used to assess SIB in 300 heroin users upon entry into inpatient detoxification (baseline) as well as at 3-months (t1) (n=252; 84%) and 9-months (t2) (n=225; 75%) post treatment. Multivariable logistic regression was used to determine the demographic, clinical and treatment related risk factors that increased the risk for a high SIB score.
From baseline to t1 there was a significant decrease in the proportion of those who endorsed SIB (68.7% vs 38.9%, p<0.0001). There was an increase in the proportion of those who endorsed SIB from t1 to t2 (38,9% vs 47.1%, p=0.047). There was a significant increase in the proportion of those reporting suicide likely in the near future from baseline to t1 (8.7% vs 16.3%: p<0.0049) and from t1 to t2 (22.7%) (t1 vs t2: p=0.031). Poorer general health (RR 1.02; 95% CL 1.01-1.04) (p=0.001) and a comorbid mental illness (MI) at baseline (RR 1.63; 95% CL 1.30-2.03) (p<0.0001) was associated with a high SIB score at baseline. A comorbid MI at t1(RR 2.73; 95% CL 1.78-4.19) (p<0.0001) and poorer social functioning at baseline (RR 1.07; 95% CL 1.04-1.11) (p<0.0001) were associated with a high SIB score at t2.
The results suggest that the current treatment exposure did not adequately mitigate suicide risk and that there is an urgent need for review of the treatment as well as targeted screening and management of SIB in heroin users attending treatment services