Drug Abuse, Psychological Variables and Suicide Attempts

描述（由申请人提供）：本研究的目的是使用现有数据库前瞻性地检查药物滥用、临床和心理变量与重复自杀企图之间的关系。本研究的数据库包括151名患者，其中91人（60%）是药物滥用者，他们在最近自杀未遂后在一家大型城市医院的急诊科接受评估，随后在特定的时间间隔接受评估，至少一年。具体而言，我们计划（a）测试在3年随访期间，患有药物使用障碍（DUD）的患者的重复自杀企图的风险率是否显著高于没有药物使用障碍的患者的风险率;以及（B）探索抑郁、绝望、自杀意念和DUD诊断或当前非法药物使用预测随后的自杀企图。生存分析，使用参数和非参数模型，将是主要的分析策略，以检查药物滥用和临床和心理变量之间的关系，随时间变化的协变量，自杀企图。除了这些分析外，还将系统分析约300例自杀企图的详细临床叙述，以建立一个描述自杀企图发生前典型模式的心理模型。然后将这种模式分析与生存分析结合使用，以开发混合模型，从而更清楚地了解药物使用、相关心理变量和重复自杀企图之间的复杂关系。

DESCRIPTION (provided by applicant): The purpose of the present study is to use an existing database to examine prospectively the relationship among drug abuse, clinical and psychological variables, and repeated suicide attempts. The database for this study includes 151 patients, 91 (60%) of whom were drug abusers, who were evaluated at the emergency department of a large urban hospital following a recent suicide attempt and who were evaluated subsequently at specific intervals for at least a one-year period. Specifically, we plan (a) to test whether the hazard rate for a repeat suicide attempt during a 3 year follow-up period will be significantly higher for patients with a Drug Use Disorder (DUD) than the hazard rate for patients without a Drug Use Disorder; and (b) to explore whether there is an additive or interactive relationship between depression,hopelessness, and suicidal ideation and a DUD diagnosis or current illicit drug use in predicting subsequent suicide attempts. Survival analysis, using both parametric and nonparametric models, will be the primary analytic strategy to examine the relationship among drug abuse and clinical and psychological variables, as time-varying covariates, and suicide attempts. In addition to these analyses, detailed clinical narratives of approximately 300 suicide attempts will be systematically analyzed to develop a psychological model that describes the patterns that typically precede a suicide attempt. This pattern analysis will then be used in conjunction with the survival analyses to develop mixed models that provide a clearer picture of the complex relationships among drug use, relevant psychological variables and repeat suicide attempts.