Prediction of attempted suicide in men and women with crack-cocaine use disorder in Brazil

• Published in: PloS one Vol. 15; no. 5; p. e0232242
• Main Authors: Roglio, Vinícius Serafini, Borges, Eduardo Nunes, Rabelo-da-Ponte, Francisco Diego, Ornell, Felipe, Scherer, Juliana Nichterwitz, Schuch, Jaqueline Bohrer, Passos, Ives Cavalcante, Sanvicente-Vieira, Breno, Grassi-Oliveira, Rodrigo, von Diemen, Lisia, Pechansky, Flavio, Kessler, Felix Henrique Paim
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 04-05-2020; Public Library of Science (PLoS)
• Subjects: Addictions; Addictive behaviors; Alcohol; Algorithms; Behavior; Behavioral sciences; Biology and Life Sciences; Childhood; Childhood mental disorders; Children; Cocaine; Computer and Information Sciences; Diagnostic systems; Drug abuse; Drug use; Gender differences; Hallucinations; Handbooks; Health; Health aspects; Hospital patients; Hospitals; Laboratories; Machine learning; Medical research; Medicine and Health Sciences; Mental depression; Mental disorders; Mental health; Methods; Narcotics; Neurosciences; Physical Sciences; Power (Philosophy); Prediction models; Predictions; Psychiatry; Public health; Regression analysis; Research and Analysis Methods; Social Sciences; Statistical analysis; Statistics; Studies; Substance abuse treatment; Suicidal behavior; Suicide; Suicides & suicide attempts; Trauma; Womens health; Brazil; Rio Grande do Sul Brazil
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0232242

Suicide is a severe health problem, with high rates in individuals with addiction. Considering the lack of studies exploring suicide predictors in this population, we aimed to investigate factors associated with attempted suicide in inpatients diagnosed with cocaine use disorder using two analytical approaches.
This is a cross-sectional study using a secondary database with 247 men and 442 women hospitalized for cocaine use disorder. Clinical assessment included the Addiction Severity Index, the Childhood Trauma Questionnaire, and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, totalling 58 variables. Descriptive Poisson regression and predictive Random Forest algorithm were used complementarily to estimate prevalence ratios and to build prediction models, respectively. All analyses were stratified by gender.
The prevalence of attempted suicide was 34% for men and 50% for women. In both genders, depression (PRM = 1.56, PRW = 1.27) and hallucinations (PRM = 1.80, PRW = 1.39) were factors associated with attempted suicide. Other specific factors were found for men and women, such as childhood trauma, aggression, and drug use severity. The men's predictive model had prediction statistics of AUC = 0.68, Acc. = 0.66, Sens. = 0.82, Spec. = 0.50, PPV = 0.47 and NPV = 0.84. This model identified several variables as important predictors, mainly related to drug use severity. The women's model had higher predictive power (AUC = 0.73 and all other statistics were equal to 0.71) and was parsimonious.
Our findings indicate that attempted suicide is associated with depression, hallucinations and childhood trauma in both genders. Also, it suggests that severity of drug use may be a moderator between predictors and suicide among men, while psychiatric issues shown to be more important for women.