Preventing suicidal ideation and intentional self-inflicted injuries among people with substance abuse disorders -- Roles of local health departments in Maryland
Suicide is the leading cause of death among people with substance use disorders (SUDs). From 2006 to 2013, the rate of emergency department (ED) adult visits involving SUDs increased by 34% and the rate of ED visits related to suicidal ideation more than doubled from 173 to 376 visits per 100,000 population. Together, 42% of ED suicidal ideation-related visits were associated with SUDs in 2013. Though, numerous studies indicate ED-initiated interventions have been successful in reducing adult suicidal ideation and intentional self-inflicted injury, none are wide-spread; and while other studies recommend interventions outside the ED, none examine the role of local health departments (LHDs) in relation to suicide prevention.
The objective of this study is to examine whether LHDs’ active roles of health promotion are associated with reductions in the rates of suicidal ideation and intentional self-inflicted injury in the ED settings.
Using data sets linked from multiple sources, including 2012-2013 State ED Databases for the State of Maryland, the National Association of County and City Health Officials Profiles Survey, the Area Health Resource File, and U.S. Census data, we employed multi-level/hierarchical logistic models to examine whether LHDs’ active provisions of preventive care and primary care services and health policy advocacy (such as affordable housing, mental health, education, etc.) were associated with the reduction of having suicidal ideation and intentional self-inflicted injuries. Analyses were conducted among individuals with substance use disorders (SUDs) aged 18 and above.
People with SUDs who committed suicidal ideation and intentional self-inflicted injuries were more likely to be White, had more chronic conditions, and were more likely to live in rural areas. The rate of suicidal ideation and intentional self-inflicted injury was 0.78% overall, but the rate increased to 7.26% of among patients with SUDs. Levels of LHDs’ activities vary by services. Approximately 7.23% of patients with SUDs resided in counties with LHDs’ active advocacy for affordable housing, and 92.07% patients with SUDs resided in counties with LHDS’ active education on tobacco, alcohol, or other drugs. After adjusting for individual-, hospital-, LHD-, and county-level characteristics, multilevel logistic regressions showed that LHDs’ health promotions on affordable housing (OR=0.65 , p<0.05) and education on tobacco, alcohol, or other drugs (OR=0.63, p<0.001) were significantly associated with the reduction of suicidal ideation and intentional self-inflicted injury in the ED settings for people with SUDs. Associations of LHDs’ provision of behavioral health preventive care and health services were not significant.
Suicide is the product of multiple causes, its prevention requires broad, interdisciplinary approaches. Though results demonstrate a benefit of health education related to affordable housing, tobacco, alcohol, and other drugs, there is a need to further examine the impact of LHD activity on mental health and the health system. Future studies should drill down into the SUDs variable to determine if these results vary by alcohol or drug use; and should explore the policy differences of jurisdictional tobacco control and housing policies on suicidal ideation and intentional self-inflicted injury.