Suicide Risk after Hospital Discharge for Drug Dependence

People receiving treatment for drug abuse are at increased risk for drug-related deaths (including suicide) as well as suicides involving other means after being released from hospitalization, according to a study of nearly 70,000 Scottish drug users. The post-discharge rate of both drug-related deaths and suicides by other means were highest within 28 days of discharge. The year after discharge accounted for 40 percent of drug-related deaths and 38 percent of suicides by other means. The rates of both drug-related deaths and suicides by other means were highest during hospitalization. The majority of these deaths were associated with the reasons people were hospitalized (e.g. a drug overdose or self-inflicted injury). Death rates were calculated based on person-years of follow-up. The rate of drug-related deaths after discharge was 21/1,000 person-years within 28 days of discharge; 12/1,000 person-year within 29-90 days of discharge; and 8.5/1,000 person-years within 91-365 days after discharge. The rate of drug-related deaths for persons in drug treatment who had never been hospitalized was 1.9/1,000 person-years. The rate of suicide by means other than drugs for this group was .35/1,000 person years. This study was based on data from the Scottish Drug Misuse Database, which was used to identify individuals with drug abuse problems and includes information on people treated for problems related to drug abuse by general medical services or specialized drug abuse services. Drug-related deaths included suicides, as well as deaths due to “mental and behavioral disorders due to psychoactive substance misuse,” unintentional or intentional poisonings involving drugs, and drug-poisoning in which the intent was not determined.

SPRC Commentary

This study reinforces the need for follow-up and support services for people on release from inpatient psychiatric units or from hospitals and emergency departments if their visit was related to self-injury, including drug overdoses (whether intentional or unintentional). The critical components for reducing suicide risk in this population include setting appropriate criteria for discharge. These might include whether the patient has responded to treatment, a thorough suicide assessment, involving the patient and his or her family in safety planning, and steps to maintain continuity of care (such as follow-up appointments, emergency contacts, and community linkages).

Merrall, E. L., Bird, S. M., & Hutchinson, S. J. (2012). A record linkage study of drug-related death and suicide after hospital discharge among drug-treatment clients in Scotland, 1996-2006. Addiction Research and Theory, 21(1):52-61.