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Social Psychiatry and Psychiatric Epidemiology

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01.01.2016 | Original Paper

A longitudinal study of suicidal ideation among homeless, mentally ill individuals

verfasst von: François Noël, Akm Moniruzzaman, Julian Somers, Jim Frankish, Verena Strehlau, Christian Schütz, Michael Krausz

Erschienen in: Social Psychiatry and Psychiatric Epidemiology | Ausgabe 1/2016

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Abstract

Purpose

Previous cross-sectional studies have indicated that homeless individuals may present with high rates of suicidal ideation, which are strongly associated with completed suicide. We conducted the first known longitudinal study of suicidal ideation in the homeless.

Methods

We used data collected over 24 months in the Vancouver At Home project (N = 497), comprised two randomized-controlled trials of housing interventions for homeless individuals with mental disorders. Presence of suicidal ideation was determined using the Colorado symptom index.

Results

Suicidal ideation significantly decreased over time [odds ratio (OR) = 0.31 at 24 months, 95 % confidence interval (CI) 0.21–0.46]. Baseline diagnoses of mood (OR = 2.18, 95 % CI 1.48–3.21) and anxiety disorders (OR = 2.05, 95 % CI 1.42–2.97), as well as depressive mood (OR = 2.52, 95 % CI 1.90–3.33), use of any substance (OR = 1.59, 95 % CI 1.09–2.32), and polysubstance use (OR = 1.90, 95 % CI 1.40–2.60) were significantly associated with suicidal ideation in the multivariate model. Baseline diagnosis of a psychotic disorder (protective effect), daily substance use, intravenous drug use, recent arrest, multiple physical illnesses and history of traumatic brain injury were significantly associated with suicidal ideation in the unadjusted model only.

Conclusions

Interventions targeting depressive symptoms and substance use could help decrease suicide risk in homeless individuals. Mental health services need to be tailored to address the complex needs of socially marginalized individuals.

Trial registration

Current controlled trials: ISRCTN57595077 (Vancouver At Home study: Housing First plus Assertive Community Treatment versus congregate housing plus supports versus treatment as usual) and ISRCTN66721740 (Vancouver At Home study: Housing first plus intensive case management versus treatment as usual). Assigned 9 Oct. 2012.

Babidge NC, Buhrich N, Butler T (2001) Mortality among homeless people with schizophrenia in Sydney, Australia: a 10-year follow-up. Acta Psychiatr Scand 103:105–110CrossRefPubMed

Hwang SW, Wilkins R, Tjepkema M, O’Campo PJ, Dunn JR (2009) Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ 339:b4036PubMedCentralCrossRefPubMed

Nielsen SF, Hjorthøj CR, Erlangsen A, Nordentoft M (2011) Psychiatric disorders and mortality among people in homeless shelters in Denmark: a nationwide register-based cohort study. Lancet 377:2205–2214CrossRefPubMed

Nordentoft M (2011) Crucial elements in suicide prevention strategies. Prog Neuropsychopharmacol Biol Psychiatry 35:848–853CrossRefPubMed

Bickley H, Kapur N, Hunt IM, Robinson J, Meehan J, Parsons R, McCann K, Flynn S, Burns J, Amos T, Shaw J, Appleby L (2006) Suicide in the homeless within 12 months of contact with mental health services: a national clinical survey in the UK. Soc Psychiatry Psychiatr Epidemiol 41:686–691CrossRefPubMed

Haw C, Hawton K, Casey D (2006) Deliberate self-harm patients of no fixed abode: a study of characteristics and subsequent deaths in patients presenting to a general hospital. Soc Psychiatry Psychiatr Epidemiol 41:918–925CrossRefPubMed

Desai RA, Liu-Mares W, Dausey DJ, Rosenheck RA (2003) Suicidal ideation and suicide attempts in a sample of homeless people with mental illness. J Nerv Ment Dis 191:365–371PubMed

Dietz TL (2010) Substance misuse, suicidal ideation, and suicide attempts among a national sample of homeless. J Soc Serv Res 37:1–18CrossRef

Eynan R, Langley J, Tolomiczenko G, Rhodes AE, Links P, Wasylenki D, Goering P (2002) The association between homelessness and suicidal ideation and behaviors: results of a cross-sectional survey. Suicide Life Threat Behav 32:418–427CrossRefPubMed

10.

Fitzpatrick KM, Irwin J, Lagory M, Ritchey F (2007) Just thinking about it: social capital and suicide ideation among homeless persons. J Health Psychol 12:750–760CrossRefPubMed

11.

Hawton K, van Heeringen K (2009) Suicide. Lancet 373:1372–1381CrossRefPubMed

12.

Cavanagh JTO, Carson AJ, Sharpe M, Lawrie SM (2003) Psychological autopsy studies of suicide: a systematic review. Psychol Med 33:395–405CrossRefPubMed

13.

Weissman MM, Bland RC, Canino GJ, Greenwald S, Hwu HG, Joyce PR, Karam EG, Lee CK, Lellouch J, Lepine JP, Newman SC, Rubio-Stipec M, Wells JE, Wickramaratne PJ, Wittchen HU, Yeh EK (1999) Prevalence of suicide ideation and suicide attempts in nine countries. Psychol Med 29:9–17CrossRefPubMed

14.

Somers JM, Patterson ML, Moniruzzaman A, Currie L, Rezansoff SN, Palepu A, Fryer K (2013) Vancouver At Home: pragmatic randomized trials investigating Housing First for homeless and mentally ill adults. Trials 14:365PubMedCentralCrossRefPubMed

15.

Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J, Hwang SW, Komaroff J, Latimer E, Somers J, Zabkiewicz DM (2011) The At Home/Chez Soi trial protocol: a pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open 1:e000323PubMedCentralCrossRefPubMed

16.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The mini-international neuropsychiatric interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33PubMed

17.

Barker S, Barron N, McFarland BH, Bigelow DA (1994) A community ability scale for chronically mentally ill consumers: Part I. Reliability and validity. Community Ment Health J 30:363–383CrossRefPubMed

18.

Conrad KJ, Yagelka JR, Matters MD, Rich AR, Williams V, Buchanan M (2001) Reliability and validity of a modified Colorado symptom index in a national homeless sample. Ment Health Serv Res 3:141–153CrossRefPubMed

19.

Walker J, Hansen CH, Hodges L, Thekkumpurath P, O’Connor M, Sharma N, Kleiboer A, Murray G, Kroenke K, Sharpe M (2010) Screening for suicidality in cancer patients using Item 9 of the nine-item patient health questionnaire; does the item score predict who requires further assessment? Gen Hosp Psychiatry 32:218–220CrossRefPubMed

20.

Simon GE, Rutter CM, Peterson D, Oliver M, Whiteside U, Operskalski B, Ludman EJ (2013) Does response on the PHQ-9 depression questionnaire predict subsequent suicide attempt or suicide death? Psychiatr Serv 64:1195–1202PubMedCentralCrossRefPubMed

21.

Marsden J, Gossop M, Stewart D, Best D, Farrell M, Lehmann P, Edwards C, Strang J (1998) The Maudsley addiction profile (MAP): a brief instrument for assessing treatment outcome. Addiction 93:1857–1867CrossRefPubMed

22.

Zeger SL, Liang KY (1986) Longitudinal data analysis for discrete and continuous outcomes. Biometrics 42:121–130CrossRefPubMed

23.

Hubbard AE, Ahern J, Fleischer NL, Van der Laan M, Lippman SA, Jewell N, Bruckner T, Satariano WA (2010) To GEE or not to GEE: comparing population average and mixed models for estimating the associations between neighborhood risk factors and health. Epidemiology 21:467–474CrossRefPubMed

24.

Hanley JA, Negassa A, Edwardes MD, Forrester JE (2003) Statistical analysis of correlated data using generalized estimating equations: an orientation. Am J Epidemiol 157:364–375CrossRefPubMed

25.

Kessler RC, Berglund P, Borges G, Nock M, Wang PS (2005) Trends in suicide ideation, plans, gestures, and attempts in the United States, 1990–1992 to 2001–2003. JAMA 293:2487–2495CrossRefPubMed

26.

Bryan CJ, Clemans TA (2013) Repetitive traumatic brain injury, psychological symptoms, and suicide risk in a clinical sample of deployed military personnel. JAMA Psychiatry 70:686–691CrossRefPubMed

27.

Qin P, Webb R, Kapur N, Sørensen HT (2013) Hospitalization for physical illness and risk of subsequent suicide: a population study. J Intern Med 273:48–58CrossRefPubMed

28.

Goldstein G, Luther JF, Haas GL (2012) Medical, psychiatric and demographic factors associated with suicidal behavior in homeless veterans. Psychiatry Res 199:37–43CrossRefPubMed

29.

Howland RH, Rush AJ, Wisniewski SR, Trivedi MH, Warden D, Fava M, Davis LL, Balasubramani GK, McGrath PJ, Berman SR (2009) Concurrent anxiety and substance use disorders among outpatients with major depression: clinical features and effect on treatment outcome. Drug Alcohol Depend 99:248–260CrossRefPubMed

30.

Cipriani A, Pretty H, Hawton K, Geddes JR (2005) Lithium in the prevention of suicidal behavior and all-cause mortality in patients with mood disorders: a systematic review of randomized trials. Am J Psychiatry 162:1805–1819CrossRefPubMed

31.

Gusmão R, Quintão S, McDaid D, Arensman E, Van Audenhove C, Coffey C, Värnik A, Värnik P, Coyne J, Hegerl U (2013) Antidepressant utilization and suicide in Europe: an ecological multi-national study. PLoS One 8:e66455–e66455PubMedCentralCrossRefPubMed

32.

Weitz E, Hollon SD, Kerkhof A, Cuijpers P (2014) Do depression treatments reduce suicidal ideation? The effects of CBT, IPT, pharmacotherapy, and placebo on suicidality. J Affect Disord 167:98–103CrossRefPubMed

33.

Sareen J, Houlahan T, Cox BJ, Asmundson GJG (2005) Anxiety disorders associated with suicidal ideation and suicide attempts in the national comorbidity survey. J Nerv Ment Dis 193:450–454CrossRefPubMed

34.

Borges G, Walters EE, Kessler RC (2000) Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol 151:781–789CrossRefPubMed

35.

Mathias CW, Michael Furr R, Sheftall AH, Hill-Kapturczak N, Crum P, Dougherty DM (2012) What’s the harm in asking about suicidal ideation? Suicide Life Threat Behav 42:341–351PubMedCentralCrossRefPubMed

36.

Cukrowicz K, Smith P, Poindexter E (2010) The effect of participating in suicide research: does participating in a research protocol on suicide and psychiatric symptoms increase suicide ideation and attempts? Suicide Life Threat Behav 40:535–543CrossRefPubMed

37.

Owens D, Horrocks J, House A (2002) Fatal and non-fatal repetition of self-harm. systematic review. Br J Psychiatry J Ment Sci 181:193–199CrossRef

38.

Foster RP (2007) Treating depression in vulnerable urban women: a feasibility study of clinical outcomes in community service settings. Am J Orthopsychiatry 77:443–453CrossRefPubMed

39.

Austin J, McKellar JD, Moos R (2011) The influence of co-occurring axis I disorders on treatment utilization and outcome in homeless patients with substance use disorders. Addict Behav 36:941–944CrossRefPubMed

40.

Hunt GE, Siegfried N, Morley K, Sitharthan T, Cleary M (2013) Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database Syst Rev 10:CD001088PubMed

41.

Krausz RM, Clarkson AF, Strehlau V, Torchalla I, Li K, Schuetz CG (2013) Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Soc Psychiatry Psychiatr Epidemiol 48:1235–1243CrossRefPubMed

Titel: A longitudinal study of suicidal ideation among homeless, mentally ill individuals
verfasst von: François Noël
Akm Moniruzzaman
Julian Somers
Jim Frankish
Verena Strehlau
Christian Schütz
Michael Krausz
Publikationsdatum: 01.01.2016
Verlag: Springer Berlin Heidelberg
Erschienen in: Social Psychiatry and Psychiatric Epidemiology / Ausgabe 1/2016
Print ISSN: 0933-7954
Elektronische ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-015-1142-y

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A longitudinal study of suicidal ideation among homeless, mentally ill individuals

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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Live-Webinar: Aktuelle Leitlinien bei Herz-Kreislauf-Erkrankungen

Springer Medizin

Abstract

Purpose

Methods

Results

Conclusions

Trial registration

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