Epidemiology of substance use among service users admitted to hospital following a medically serious act of deliberate self-harm: a feasibility study

Stanbridge, Jessica A

Epidemiology of substance use among service users admitted to hospital following a medically serious act of deliberate self-harm: a feasibility study

Master Thesis

2019

Abstract

Background: Suicidal behaviour is increasing internationally and in South Africa and is considered a national public health problem (1). Literature has shown that substance use is a potentially modifiable risk factor for both fatal and non-fatal suicidal behavior (2- 6). In South Africa, 43 percent of patients who present to emergency departments with intentional or unintentional injuries meet the criteria for a substance use disorder (SUD) (7). The association between substance use and suicidal behavior has been well established, however, the exact nature of this relationship awaits further investigation and clarification. Aims: The proposed study’s aims are; (i)to determine the patterns of substance abuse and the prevalence of SUDs (past and current) among patients admitted following an act of DSH, (ii) to compare patterns of substance use and the prevalence of SUDs (past and current) among those admitted following an episode of DSH, those admitted to the emergency psychiatric unit for reasons other than DSH and medical patients admitted for reasons other than DSH, (iii) to determine if patterns of substance use or the diagnosis of substance use or the diagnosis of SUDs predicts hospital admission for DSH. It concurrently analyzed preliminary data in order to determine if outcomes of the larger study would be meaningful and significant. Methods: Seventy-six patients were recruited over a period of 19 weeks. Twenty-seven consecutive patients with a medically serious act of DSH were recruited and were matched with a control group based on age range and gender. Demographic data and substance use history were collected using; (i) a self reported questionnaire, (ii) Alcohol Use Disorders Identification Tests (AUDIT), (iii) Drug Use Disorders Identification Test (DUDIT) and (iv) SUD module of the structured clinical interview of the DSM. Results: Findings of the feasibility study indicated low recruitment numbers and data collection challenges. Causes of low recruitment number were multifactorial, including low base rates for self-harm, length of recruitment time, consenting capacity, tight control criteria, exclusion of manic and psychotic patients and declining of patients to participate. Data collection faced challenges including difficult navigation of hospital premises, long data collection times, limited understanding of questions, language barriers and lack of privacy. Formal suicide risk assessment was a challenge for some data collectors. Preliminary data confirmed that substance use is a significant risk factor for DSH. Conclusions: This feasibility study demonstrated the existing protocol can be used to generate meaningful data and identified specific steps to be altered in a scaled-up study. These steps included; expansion of study sites to more institutions to increase recruitment numbers, a wider range in matching criteria for control groups and improved orientation and training of data collectors regarding use of the data collection tool, navigation of the hospital premises, maintaining confidentiality and formal suicide risk assessments. Formal translation of the research tool into other languages was recommended. Despite low recruitment numbers, data collected from this study was meaningful.

Keywords

Psychiatry

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