Issue 34 | 2006 |
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NSDUH asks adults aged 18 or older questions to assess lifetime and past year major depressive episodes (MDEs). MDE is defined using diagnostic criteria from the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV),7 which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image.8 Suicide-related questions are administered to respondents who report having had a period of 2 weeks or longer during which they experienced either depressed mood or loss of interest or pleasure. These questions ask if (during their worst or most recent9 episode of depression) respondents thought it would be better if they were dead, thought about committing suicide, and, if they had thought about committing suicide, whether they made a suicide plan and whether they made a suicide attempt.
NSDUH also asks all respondents about their use of alcohol and illicit drugs during the 12 months prior to the interview. Binge alcohol use is defined as drinking five or more drinks on the same occasion (i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days. Any illicit drug refers to marijuana/hashish, cocaine (including crack), inhalants, hallucinogens, heroin, or prescription-type drugs used nonmedically.10
This section of the report examines the prevalence of suicidal thoughts among adults who experienced at least one MDE during the past year. Because mental illness and substance use commonly co-occur,11 the prevalence of past year MDE, suicidal thoughts, and suicide attempts is also examined by substance use status.
Prevalence of MDE. In 2004-2005, 14.5 percent of persons aged 18 or older (31.2 million adults) experienced at least one MDE in their lifetime, and 7.6 percent (16.4 million adults) experienced an MDE in the past year. Females were almost twice as likely as males to have experienced a past year MDE (9.8 vs. 5.4 percent). Rates of past year MDE varied by age group, with adults aged 55 or older being less likely to have had a past year MDE than adults in all other age groups (Figure 1).
Age | Percentage |
---|---|
18 to 20 | 10.2 |
21 to 24 | 9.9 |
25 to 34 | 8.7 |
35 to 54 | 9.1 |
55 or Older | 4.0 |
Source: SAMHSA, 2004 and 2005 NSDUHs. |
Suicidal Thoughts among Adults with MDE. Among adults aged 18 or older who experienced a past year MDE, 56.3 percent thought, during their worst or most recent MDE, that it would be better if they were dead, and 40.3 percent thought about committing suicide. There were some differences in suicidal thoughts by gender and age. Although males and females with past year MDE did not differ significantly in the percentage who thought that it would be better if they were dead, males were more likely than females to have thought about committing suicide (45.5 vs. 37.6 percent). Among adults with a past year MDE, those aged 55 or older were less likely than individuals in all other age groups to have thought that it would be better if they were dead and to have thought about committing suicide (Figure 2). There were no significant differences in the prevalence of suicidal thoughts by region or urbanicity.
Age | |||||
---|---|---|---|---|---|
18 to 20 | 21 to 24 | 25 to 34 | 35 to 54 | 55 or Older | |
Thought Better if Dead |
64.3 | 62.8 | 57.5 | 56.5 | 46.2 |
Thought about Committing Suicide |
52.6 | 46.8 | 41.9 | 40.6 | 27.1 |
Source: SAMHSA, 2004 and 2005 NSDUHs. |
Suicide Plans and Attempts among Adults with MDE. Among persons aged 18 or older with a past year MDE, 14.5 percent made a suicide plan during their worst or most recent MDE. Also, 10.4 percent (1.7 million adults) made a suicide attempt during such an episode. There were no significant differences between males and females in attempting suicide, but males were more likely than females to have made a suicide plan (17.9 percent vs. 12.7 percent). There were also a few differences by age. Adults aged 55 or older with past year MDE were less likely than their counterparts in other age groups to have made a suicide plan (Figure 3). Adults aged 18 to 20 were more likely than adults in all other age groups to have attempted suicide. Among adults aged 18 or older with past year MDE, there were no significant differences in suicide planning or attempts by region or urbanicity.
Age | |||||
---|---|---|---|---|---|
18 to 20 | 21 to 24 | 25 to 34 | 35 to 54 | 55 or Older | |
Made Suicide Plan | 22.3 | 18.0 | 17.4 | 13.5 | 7.3 |
Attempted Suicide | 19.5 | 14.7 | 10.9 | 9.8 | 3.9 |
Source: SAMHSA, 2004 and 2005 NSDUHs. |
Past Month Substance Use, MDE, and Suicidal Thoughts and Behaviors. Adults aged 18 or older who reported binge alcohol use were more likely to report past year MDE than their counterparts who had not engaged in binge drinking (8.7 vs. 7.3 percent). In addition, adults with past year MDE and past month binge alcohol use were more likely to report past year suicidal thoughts and past year suicide attempts than those with MDE who did not binge drink (Figure 4).
Past Month Binge Alcohol Use | No Past Month Binge Alcohol Use | |
---|---|---|
Past Year Suicidal Thoughts | 61.8 | 57.1 |
Past Year Suicide Attempt | 13.7 | 9.1 |
Source: SAMHSA, 2004 and 2005 NSDUHs. |
Similarly, adults aged 18 or older who reported having used illicit drugs during the past month were more likely to report past year MDE than adults who had not used illicit drugs during the past month (14.2 vs. 7.1 percent). Rates of past year suicidal thoughts and suicide attempts were also higher among adults with past year MDE who had used illicit drugs during the past month than adults with past year MDE who had not used illicit drugs (Figure 5).
Past Month Illicit Drug Use | No Past Month Illicit Drug Use | |
---|---|---|
Past Year Suicidal Thoughts | 67.0 | 56.9 |
Past Year Suicide Attempt | 19.0 | 8.9 |
Source: SAMHSA, 2004 and 2005 NSDUHs. |
DAWN is a public health surveillance system that monitors drug-related ED visits in the United States. Data are collected from a nationally representative sample of short-stay, general, non-Federal hospitals that operate 24-hour EDs.12 In DAWN, a drug-related ED visit is defined as any ED visit related to drug use. The drug must be implicated in the ED visit, either as the direct cause or as a contributing factor. For each drug-related ED visit, information is gathered from medical records about the number and types of drugs involved. These include illegal or illicit drugs, such as cocaine, heroin, and marijuana;13 prescription drugs; over-the-counter medications; dietary supplements; inhalants; and alcohol.14 DAWN differs from NSDUH in that it captures medical as well as nonmedical use of pharmaceuticals and includes pharmaceuticals sold over the counter as well as by prescription. DAWN also collects demographic information about the patients, their diagnoses, and their disposition (i.e., outcome) at the time of their discharge from the ED.
In this report, ED visits associated with drug-related suicide attempts15 among persons aged 18 or older are examined. Although DAWN includes only those suicide attempts that involve drugs, these attempts are not limited to overdoses. Also included are suicide attempts made by other means (e.g., by firearm) when drugs are involved. National estimates of the number of ED visits involving drug-related suicide attempts in 2004 are presented, along with percentages of visits and visit rates per 100,000 population. The patients, types of drugs, and other characteristics of drug-related suicide attempts treated in EDs are described.16
Characteristics of Patients Involved in ED Visits for Drug-Related Suicide Attempts. In 2004, an estimated 106,079 ED visits were the result of drug-related suicide attempts by persons aged 18 or older. Females had a higher rate of these drug-related suicide attempts (57 visits per 100,000 population) than males (39 visits per 100,000 population) (Table 1). Comparing age groups, adults aged 18 to 34 had the highest rates of drug-related suicide attempts treated in the ED (from 75 to 90 visits per 100,000 population), while adults aged 55 or older had the lowest rate (10 visits per 100,000 population). Comparisons based on race and ethnicity are not possible because the racial/ethnic categories used by the Census Bureau are incompatible with the categories used by DAWN. Therefore, population data are not available to calculate rates.
Demographic Characteristics | Population (in millions) |
Estimated ED Visits |
ED Visits per 100,000 Population |
---|---|---|---|
Gender+ | |||
Male | 144.5 | 41,430 | 39 |
Female | 149.1 | 64,632 | 57 |
Age in Years++ | |||
18-20 | 12.4 | 11,145 | 90 |
21-24 | 16.9 | 13,180 | 78 |
25-34 | 40.0 | 30,076 | 75 |
35-54 | 85.7 | 45,111 | 53 |
55 or Older | 65.4 | 6,568 | 10 |
Source: SAMHSA, 2004 DAWN (September 2005 update). |
A psychiatric condition was diagnosed in 41 percent (43,176) of the drug-related suicide attempts treated in the ED. The most frequent psychiatric diagnosis was depression, which was documented in 36 percent of the total visits (37,886 visits).
Substances Involved in Drug-Related Suicide Attempts Treated in EDs. In 2004, an average of 2.3 drugs were implicated in suicide attempts by adults aged 18 or older that were treated in the ED. Over 33 percent (35,560 visits) involved only one drug, 51.3 percent involved two or three drugs, and 15.2 percent involved four or more drugs.
About one third of the drug-related suicide attempts treated in the ED involved alcohol (Table 2). Alcohol is always reported to DAWN if the patient was younger than age 21. If the patient was aged 21 or older, alcohol is reported only if it was used with another drug. Although it is an illegal substance for persons under age 21, alcohol was involved in approximately 25 percent (2,504 visits) of the suicide-related DAWN ED visits by patients aged 18 to 20 and frequently was combined with another drug (2,504 visits). The suicide-related DAWN ED visits involving patients aged 55 or older had the lowest rate of alcohol involvement, although it should be noted that DAWN only captured these visits for adults if alcohol was used with another drug.
Selected Drug Category/Drug | Estimated ED Visits | Percentage of ED Visits |
---|---|---|
Alcohol | 35,242 | 33.2 |
Illicit Drugs | 30,109 | 28.4 |
Cocaine | 13,620 | 12.8 |
Marijuana | 8,490 | 8.0 |
Psychotherapeutic Medications | 62,502 | 58.9 |
Antidepressants | 23,359 | 22.0 |
Anxiolytics/sedatives/hypnotics | 41,188 | 38.8 |
Antipsychotics | 11,968 | 11.3 |
Pain Medications | 38,238 | 36.0 |
Opioids | 15,706 | 14.8 |
Nonsteroidal anti-inflammatory agents (NSAIDs) |
8,167 | 7.7 |
Acetaminophen/combinations | 14,410 | 13.6 |
Anticonvulsants | 7,961 | 7.5 |
Cardiovascular Medications | 5,859 | 5.5 |
Source: SAMHSA, 2004 DAWN (September 2005 update). |
Illicit drugs13 were involved in an estimated 28.4 percent (30,109 visits) of the drug-related suicide attempts treated in the ED (Table 2). The most frequently reported illicit drug was cocaine (13,620 visits), followed by marijuana (8,490 visits).
Almost 59 percent (62,502) of the drug-related suicide attempts treated in the ED involved a psychotherapeutic drug. Among these, drugs used to treat anxiety and sleeplessness (anxiolytics, sedatives, and hypnotics) were involved in 38.8 percent (41,188) of the drug-related suicide attempts; most of the drugs reported in these visits were benzodiazepines. Antidepressants were involved in 22.0 percent (23,359) of the visits. It should be noted that it is not possible in the DAWN system to distinguish the patients who had been prescribed antidepressants to treat preexisting depression and other mental health problems from those who obtained antidepressants by other means.
Pain medications (analgesics) were involved in 36.0 percent (38,238) of the drug-related suicide attempts treated in the ED. Analgesics containing opiates were involved in an estimated 15,706 suicide attempts. They were followed in frequency by drugs containing acetaminophen (14,410 visits) and nonsteroidal anti-inflammatory agents (NSAIDs) (8,167 visits).
Outcomes from Drug-Related Suicide Attempts. The disposition of an ED visit provides information about the patient's outcome, as well as clues to the suicide attempt's severity (Figure 6). Of the estimated 106,079 drug-related suicide attempts treated in EDs, less than 1 percent ended in death in the ED. However, this estimate is based solely on ED records, which do not include patients who died before coming to the ED or after leaving the ED (e.g., after admission to the hospital). Patients in about 81 percent (85,789) of the visits received further treatment, either as inpatients at the same hospital (60,020) or by transfer to another health care facility (25,769). In an estimated 16 percent (16,811) of visits, the patients were released after treatment in the ED.
Disposition | Percentage |
---|---|
Treated and Released | 15.8 |
Admitted to ICU/Critical Care in This Hospital | 25.4 |
Transferred to Another Health Facility | 24.3 |
All Other Admissions to This Hospital | 31.2 |
Died | 0.3 |
All Other | 3.0 |
Source: SAMHSA, 2004 DAWN (September 2005 update). |
The National Survey on Drug Use and Health (NSDUH) and the Drug Abuse Warning Network (DAWN) are two of the three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Office of Applied Studies (SAMHSA/OAS). For information on these surveys, go to http://www.oas.samhsa.gov. NSDUH is an annual survey sponsored by SAMHSA. Prior to 2002, this survey was called the National Household Survey on Drug Abuse (NHSDA). The 2004 data are based on information obtained from 45,453 persons aged 18 or older, of whom 22,825 were asked questions about experiences with depression. The 2005 data are based on information obtained from 45,774 persons aged 18 or older. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence. Information on NSDUH used in compiling data for this issue is available in the following publications: Office of Applied Studies. (in press). Results from the 2005 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 06-4194, NSDUH Series H-30). Rockville, MD: Substance Abuse and Mental Health Services Administration. Office of Applied Studies. (2005). Results from the 2004 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 05-4062, NSDUH Series H-28). Rockville, MD: Substance Abuse and Mental Health Services Administration. DAWN is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States. Any ED visit or death related to recent drug use is included in DAWN. All types of drugs-licit and illicit-are covered. Alcohol is included for adults when it occurs with another drug. Alcohol is always included for minors. DAWN's method of classifying drugs was derived from the Multum Lexicon, Copyright © 2005, Multum Information Services, Inc. The Multum Licensing Agreement can be found in DAWN annual publications and at http://www.multum.com/license.htm. The OAS Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.) |
The OAS Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://www.oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov. |
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