Conference Agenda

Introduction

With a suicide rate of 18 per 100 000 and 10 litres of pure alcohol consumption per capita (age 15+) both indicators in Slovenia are well above the EU average. Alcohol is an important risk factor for suicidality, albeit majority of the studies have a focus on clinical population. Hence, the aim of our study was to investigate the association between different levels of alcohol use and suicidality in general population.

Methods

Data were obtained from the 2023 National survey on the use of tobacco, alcohol and other drugs, conducted on a nationally representative probability sample of 16,000 residents of Slovenia aged 15–74 years, with a 61% response rate (final sample: n = 8,937). We categorised past-12-month alcohol use into abstinent, light, moderate, hazardous and harmful drinking, and examined lifetime suicidal ideation (active/passive) and suicide attempt. Associations were estimated using weighted logistic regression adjusted for gender and age group; affective condition (professionally diagnosed anxiety or depression in the past 12 months) was examined in an additional interaction model.

Results

Alcohol showed positive dose–response associations with suicidal ideation. For active ideation (adjusted for gender and age group), compared with abstainers odds were higher for light (OR=1.48, 95%CI 1.20–1.82), moderate (3.15, 2.24–4.43), hazardous (4.08, 2.53–6.56) and harmful drinking (4.59, 2.29–9.20; all p<.001). Passive ideation showed similar dose–response patterns. Suicide attempts were associated only with hazardous/harmful drinking, with wide confidence intervals due to few events. In the interaction model, an affective condition (anxiety or depression) was strongly associated with active suicidal ideation; the light-drinking (vs abstinence) association with active suicidal ideation was weaker among participants with an affective condition than among those without.

Conclusions

Preliminary findings suggest graded increases in suicidal ideation across alcohol-use levels, while attempts occur mainly at higher-risk drinking; recent affective conditions may warrant particular attention.

Background:

During the COVID-19 pandemic, opioid-related mortality increased sharply in Canada while suicide rates initially declined. One proposed explanation is that suicide deaths may have been misclassified as opioid overdose deaths. Quantitative studies suggest overlap between opioid overdose and suicidality, yet little qualitative research has examined how people who survive overdoses understand the relationship between overdose, suicide, and motivation for drug use.

Methods:

We conducted an in-depth qualitative study with people who survived a non-fatal opioid overdose during the COVID-19 pandemic in Ottawa, Canada. Fourteen participants (10 men, 4 women) were recruited through community-based organizations serving people who use drugs. Semi-structured interviews explored substance use histories, overdose experiences, motivations for overdose, suicidality, and the impacts of COVID-19. Interviews incorporated photo elicitation techniques and were analyzed using thematic analysis informed by a consensual qualitative research approach.

Results:

Participants described complex overdose experiences shaped by a highly toxic drug supply, polysubstance use, housing precarity, and repeated exposure to trauma and loss. Contrary to the misclassification hypothesis, most participants did not report an active intention to die at the time of overdose. Accounts instead reflected a spectrum ranging from no perceived link between overdose and suicide, to ambivalence toward living and dying, to retrospective reflections on “testing fate.” Motivations for overdose extended beyond suicidality and included boredom, grief, emotional numbing, interpersonal conflict, sleep, and social connection. COVID-19-related service disruptions, isolation, and boredom were described as exacerbating overdose risk. Participants emphasized harm reduction, stigma reduction, and safer supply as central to prevention.

Conclusions:

Findings challenge simplistic categorizations of overdose as accidental or suicidal and highlight ambivalence as a key experiential state. Conventional approaches to assessing suicidal intent may inadequately capture lived realities. Overdose prevention should be understood as a core component of suicide prevention, requiring nuanced, trauma-informed, person-centred responses.

Introduction

The increased suicide risk associated with substance use disorders is well known. Evidence has suggested that elements of quality care can reduce the suicide rates in people in contact with mental health services. Whether this is the case for patients with substance use disorders is still unknown. The first step in establishing evidence for service recommendations is to develop recommendations that are adapted to the characteristics of the group.

Method

We identified prevalent characteristics from three studies describing characteristics of suicide in people with substance use disorders. Prevalent characteristics were presented to a group comprising individuals with lived experience, interest organizations, and clinicians. Preliminary service recommendations were then co-developed with this group.

Results

Three key areas were identified. First, increase treatment engagement and retention through psychoeducation about acute services, routines for contacting next of kin if the patients drop out, and offering crisis or safety plans. Second, follow up after discharge through 72-hour follow-up, establishing agreements with services that can facilitate follow-up, and offering self-referral admissions. Third, offer integrated treatment of substance use, mental disorders, and suicidal behavior through implementing guidelines for comorbid mental disorders, written routines for cooperation between mental health and substance use services, training the staff in integrated treatment, having written procedures and training for assessing and managing self-harm in line with the national guideline.

Conclusions

We co-developed preliminary service recommendations. They need further development before they can be implemented and subsequently evaluated. This could advance the evidence base for suicide prevention strategies in people with substance use disorders.

Background

Self-harm and alcohol misuse pose significant public health challenges, yet important knowledge gaps remain. A tendency to act impulsively in response to negative emotions while drinking (alcohol-related negative urgency), along with subjective beliefs about the outcomes of drinking (alcohol expectancies), may represent important alcohol‑related pathways toward self-harm. This study examined alcohol-related factors associated with non-suicidal self-harm (NSSH) at baseline and again 22 months later.

Method

Adults recruited from community settings completed baseline measures of socio-demographics, mood and alcohol-related factors including alcohol consumption and harm, alcohol-related negative urgency and different domains of alcohol expectancies. NSSH was assessed at baseline and 22-month follow-up. Logistic regression examined baseline cross-sectional associations of alcohol-related factors with lifetime NSSH and as predictors of recent NSSH at 22 months.

Results

A total of 896 adults (626 female; Mean = 36y; 94% White) are included in the study. In cross-sectional models adjusted for alcohol consumption and harm, demographic factors (age, gender) and mood, baseline alcohol-related negative urgency and specific domains of alcohol expectancy were associated with lifetime NSSH (Negative Urgency-A: OR = 1.66, 95% CI = 1.28–2.15, p < 0.001; ‘Self Perception’ expectancies: OR = 1.62, CI = 1.21–2.17, p < 0.001; ‘Self-Harm’ expectancies: OR = 2.42, 95% CI = 1.65–3.57, p < 0.001). Other alcohol expectancy domains (‘Liquid Courage’, ‘Cognitive and Behavioural Impairment’, ‘Risk-taking and Aggression’, ‘Sociability’, ‘Tension Reduction’) were not associated with lifetime NSSH. In longitudinal models stronger alcohol expectancies for self-harm predicted recent NSSH at 22 months in models adjusted for baseline NSSH, alcohol use and harm, demographics and mood (OR = 2.03, 95% CI 1.12–3.66, p = 0.002).

Conclusions

Expectancies that drinking can lead to self-harm significantly predicted NSSH almost two years later. Cognitive schema which frame anticipated future drinking outcomes may be suitable therapeutic targets to prevent future NSSH risk.

Gambling has expanded rapidly globally and has been linked to suicide. Yet systems to monitor gambling harms are underdeveloped. Operators have been shown to use predatory practices in pursuit of profits and maximise ‘revenue per available customer’ (revpac). The capacity of operators to exploit customers is further increased by digital technologies that track customer activity and push marketing that encourages gambling. This study was designed to consider ways to improve the identification of gambling suicides to inform prevention efforts.

We conducted 32 in-depth interviews in Australia. Participants were people who had survived a gambling-related suicide attempt, professionals working in death investigation, data custodians, researchers and lived experience advocates. Transcripts were analysed using reflexive thematic analysis and informed by our experiences reviewing Australian mortality datasets.

Identifying a gambling-related suicide relies on manual review of evidence that might spontaneously emerge during the death investigation process. Unlike drugs, alcohol or relationship difficulties, very few systems prompt death investigators or coders to capture whether gambling was a factor in a suicide. Social and cultural norms may discourage death investigators, clinicians and witnesses from considering gambling as a relevant factor in a suicide death. Sources of financial distress rarely required to be identified, compounding the underestimation of gambling harms. In cases where gambling is noted, relevant detail that could inform prevention efforts - such as the gambling product that was the main source of harm - is not consistently recorded.

Urgent efforts are needed to improve monitoring and surveillance of gambling suicides. Gambling operators hold transaction data that should be centrally accessible to regulators and death investigators to enable them to review account data in a centralized ‘data vault’. Account based gambling provides people who gamble the ability to set loss limits. Yet vested interests often obstruct efforts by policy makers to introduce these measures.