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1.  Meta-analysis of depression and substance use and impairment among intravenous drug users (IDUs) 
Addiction (Abingdon, England)  2008;103(4):524-534.
Aims
To evaluate, among intravenous drug users (IDUs), the hypothesized positive association of depression with substance-related behaviors including concurrent drug use and impairment, future drug use and impairment, alcohol use and impairment, needle sharing and substance use treatment participation, and to identify moderators of these associations.
Design
Meta-analysis of reports on IDUs published in English in peer-reviewed journals since 1986 that contained data on depression and substance use outcome(s) with no restrictions on range of depression scores to select the sample.
Setting
Fifty-five reports containing 55 samples met criteria, including 42 (76%) samples from clinical venues and 13 (24%) that were community-based.
Participants
Mean age was 34.3 (standard deviation = 4.5) years, comprising approximately 68% men and 43% white, non-Hispanic subjects.
Measurements
Depression was assessed with the Beck Depression Inventory, Center for Epidemiological Studies Depression Scale (CES-D) and other validated scales or diagnostic interviews. The Addiction Severity Index was the most frequently used measure of substance-related outcomes.
Findings
A priori hypotheses pertaining to depression and the substance-related variables were supported, with the exception of the predicted association of depression and future drug use and impairment. Effect sizes were small. Moderating effects of gender were identified, including greater associations of depression with substance use treatment participation and needle sharing among women and a greater association of depression with future drug use and impairment among men. Effect sizes of moderators were large.
Conclusions
Depression is associated with several substance-related behaviors, and select associations are stronger according to gender. Prospective associations of depression with future drug use and impairment are not immediately evident, but could be examined in subsequent research.
doi:10.1111/j.1360-0443.2007.02118.x
PMCID: PMC4864591  PMID: 18261192
Depression; intravenous drug use; meta-analysis; substance-related disorders
2.  Mood-, Anxiety-, and Substance Use Disorders and Suicide Risk in a Military Population Cohort 
There are meager prospective data from nonclinical samples on the link between anxiety disorders and suicide or the extent to which the association varies over time. We examined these issues in a cohort of 309,861 United States Air Force service members, with 227 suicides over follow-up. Mental disorder diagnoses including anxiety, mood, and substance use disorders (SUD) were based on treatment encounters. Risk for suicide associated with anxiety disorders were lower compared to mood disorders and similar to SUD. Moreover, the associations between mood and anxiety disorders with suicide were greatest within a year of treatment presentation.
doi:10.1111/j.1943-278X.2012.00125.x
PMCID: PMC4863230  PMID: 23094649
suicide; mental disorder; risk factor; military; cohort
3.  A test of the reactive aggression – suicidal behavior hypothesis: Is there a case for proactive aggression? 
Journal of abnormal psychology  2009;118(1):235-240.
A large body of literature suggests that aggressive behavior can be classified into two subtypes, reactive aggression (RA) and proactive aggression (PA), which differ on dimensions of emotional arousal, control, and impulsivity. A longstanding hypothesis posits that RA underlies the association between aggression and suicidal behavior, with the implicit assumption that PA is unrelated to suicidal behavior. However, no empirical study to date has specifically investigated this question. We examined associations of RA and PA with suicide attempts and suicidal ideation among 878 male and female patients in substance dependence treatment programs. We also examined the moderating effects of sex. Contrary to hypotheses, PA was associated with both suicide attempts and suicidal ideation. RA was also associated with both outcomes in unadjusted analyses, but became non-significant for suicide attempts in multivariate analyses. Moreover, sex served as a moderator, with PA showing an association with suicide attempt among men, but not women. Results indicate the need for additional studies of PA and suicidal behavior.
doi:10.1037/a0014659
PMCID: PMC4861304  PMID: 19222330
4.  A Test of Core Psychopathic Traits as a Moderator of the Efficacy of a Brief Motivational Intervention for Substance Using Offenders 
Objective
In a randomized controlled trial we studied a Brief Motivational Intervention (BMI) for substance use, examining core psychopathic traits as a moderator of treatment efficacy.
Method
Participants were 105 males and females who were 18 years of age and older and in a pretrial jail diversion program. The sample was approximately 52% black and other minorities and 48% white. Outcome variables at a six-month follow-up were frequency of substance use (assessed with the Timeline Follow-back Interview and objective toxicology screens), substance use consequences (Short Inventory of Problems-Alcohol and Drug Version), and self-reported participation in non-study mental health and/or substance use treatment. Psychopathy was assessed using the Psychopathy Checklist-Revised (PCL-R).
Results
BMI interacted with core psychopathic traits to account for 7% of the variance in substance use at follow-up. Treatment was associated with greater use among individuals with high levels of core psychopathic traits. Toxicology screening results were consistent with self-report data. The treatment and standard care groups did not differ on substance use consequences or non-study treatment participation at follow-up and no moderation was found with these outcomes. An exploratory analysis indicated that low levels of affective traits of psychopathy were associated with benefit from the BMI in terms of decreased substance use.
Discussion
Findings suggest that caution is warranted when applying BMIs among offenders; individuals with high levels of core psychopathic traits may not benefit and may be hindered in recovery. Conversely, they indicate that a low-psychopathy subgroup of offenders benefits from these brief and efficient treatments for substance use.
Public Health Significance
This study of an intervention that is widely used in criminal justice systems provides information regarding for whom the treatment works and for whom it may be unhelpful.
doi:10.1037/ccp0000065
PMCID: PMC4760863  PMID: 26727409
5.  IMPROVING COORDINATED RESPONSES FOR VICTIMS OF INTIMATE PARTNER VIOLENCE: LAW ENFORCEMENT COMPLIANCE WITH STATE MANDATED INTIMATE PARTNER VIOLENCE DOCUMENTATION 
Violence against women  2015;21(7):897-907.
New York State law mandates specific IPV documentation under all circumstances meeting the enumerated relationship and crime criteria at the scene of a domestic dispute. Law enforcement compliance with this mandate is unknown. We reviewed law enforcement completion rates of Domestic Violence Incident Reports (DVIRs) and assessed correlations with individual or legal factors. Law enforcement officers filed DVIRs in 54% of the cases (n=191), more often when injury occurred (p<.01) and the defendant had prior court contact (p<.05). The discussion explores policy implications and potential means to rectify the gap between mandated processes and implementation.
doi:10.1177/1077801215584072
PMCID: PMC4629466  PMID: 25926052
Intimate Partner Violence; Abuse; Domestic Violence; Law Enforcement
6.  Reactive and proactive aggression and suicide attempts among criminal offenders 
Criminal justice and behavior  2013;41(3):337-344.
Outwardly-directed aggression is associated with suicide attempts, but aggression is a heterogeneous construct. Increased specificity in our understanding of the link between aggression and suicide attempts can be attained by examining subtypes of aggression. We studied the relationships of reactive and proactive aggression to history of a suicide attempt among 96 criminal offenders in a pretrial supervision program. Consistent with prior findings in non-offender samples, reactive aggression was associated with a history of suicide attempt after controlling for gender and depression. Proactive aggression was unrelated to suicide attempts. Results indicate that suicide risk assessments in forensic settings may be informed by the measurement of reactive aggression.
doi:10.1177/0093854813508764
PMCID: PMC4472462  PMID: 26097269
7.  Warning signs for suicide within a week of healthcare contact in Veteran decedents 
Psychiatry research  2012;200(2-3):395-399.
Objectives
This study examined warning signs for suicide observed in the final day(s) of life in Veteran decedents who received healthcare from Veterans Health Administration (VHA) (N=381), using data obtained from detailed chart reviews.
Methods
Veterans who died within a week (7 days) of healthcare contact (18%) were compared to those who died later (82%). Multivariate logistic regression was used to examine differences in suicidal thoughts, psychiatric symptoms, and somatic symptoms as documented at the last visit, after controlling for demographic variables. A second multivariate regression examined whether the identified warning signs were also risk factors for suicide within a month (30 days) of contact.
Results
Documented suicidal ideation, OR (95% CI) = 3.46 (1.15-10.38), and psychotic symptoms, OR (95% CI) = 2.67 (1.11-6.42), at the last visit increased the likelihood of suicide within a week of healthcare contact. Both variables also increased the odds of suicide within a month of contact.
Conclusions
The assessment of suicidal ideation is critical to identifying Veterans at immediate risk. However, recognition of psychotic symptoms may also improve identification. In addition to indicating immediate risk, some warning signs may also suggest on-going risk.
doi:10.1016/j.psychres.2012.06.036
PMCID: PMC5064427  PMID: 22796102
risk factors; death; military personnel
8.  Influences on call outcomes among Veteran callers to the National Veterans Crisis Line 
This evaluation examined the association of caller and call characteristics with proximal outcomes of Veterans Crisis Line calls. From October 1-7, 2010, 665 Veterans with recent suicidal ideation or a history of attempted suicide called the Veterans Crisis Line, 646 had complete data and were included in the analyses. A multivariable multinomial logistic regression was conducted to identify correlates of a favorable outcome, either a resolution or a referral, when compared to an unfavorable outcome, no resolution or referral. A multivariable logistic regression was used to identify correlates of responder-rated caller risk in a subset of calls. Approximately 84% of calls ended with a favorable outcome, 25% with a resolution and 59% with a referral to a local health care provider. Calls from high-risk callers had greater odds of ending with a referral than without a resolution or referral, as did weekday calls (6:00 am to 5:59 pm EST, Monday through Friday). Responders used caller intent to die and the absence of future plans to determine caller risk. Findings suggest that the Veterans Crisis Line is a useful mechanism for generating referrals for high-risk Veteran callers. Responders appeared to use known risk and protective factors to determine caller risk.
doi:10.1111/sltb.12033
PMCID: PMC5064431  PMID: 23611446
9.  An Open Trial of Motivational Interviewing to Address Suicidal Ideation with Hospitalized Veterans 
Journal of clinical psychology  2012;68(9):961-971.
Objective
The purpose of this open trial was to test the acceptability of Motivational Interviewing to Address Suicidal Ideation (MI-SI) for psychiatrically hospitalized veterans with suicidal ideation, estimate its pre-post effect size on the severity of suicidal ideation, and examine the rate of treatment engagement after discharge.
Methods
Participants received a screening assessment, baseline assessment, one or two MI-SI sessions, post-treatment assessment, and 60-day follow-up assessment. Thirteen veterans were enrolled, nine (70%) completed both MI-SI sessions and the post-treatment assessment, and eleven (85%) completed the follow-up assessment.
Results
Participants found MI-SI to be acceptable. They experienced large reductions in the severity of suicidal ideation at post-treatment and follow-up. In the two months following discharge, 73% of participants completed two or more mental health or substance abuse treatment sessions each month.
Conclusions
These preliminary findings suggest that MI-SI has potential to reduce risk for suicide in psychiatrically hospitalized veterans and that a more rigorous trial is needed.
doi:10.1002/jclp.21885
PMCID: PMC5064432  PMID: 22753109
Veterans; suicidal ideation; motivational interviewing; inpatients; treatment engagement
10.  Suicide Attempts within 12 Months of Treatment for Substance Use Disorders 
There are limited prospective data on suicide attempts (SA) during the months following treatment for substance use disorders (SUD), a period of high risk. In an analysis of the Drug Abuse Treatment Outcomes Study (DATOS), a longitudinal naturalistic multisite study of treated SUDs, variables associated with SA in the 12 months following SUD treatment were examined. Participants included 2,966 patients with one or more SUDs. By 12 months, 77 (2.6%) subjects had attempted suicide. Multivariate logistic regression analyses were used to identify variables associated with SA. Variables collected at baseline that were associated with SA included lifetime histories of SA, suicidal ideation (SI), and depression, cocaine as primary substance of use, outpatient methadone treatment, and short-term inpatient treatment. Male sex, older age, and minority race/ethnicity were associated with lower likelihood of SA. After controlling for baseline predictors, variables assessed at 12 months associated with SA included SI during follow-up and daily or more use of cocaine. The data contribute to a small but growing literature of prospective studies of SA among treated SUDs, and suggest that SUDs with cocaine use disorders in particular should be a focus of prevention efforts.
doi:10.1521/suli.2010.40.1.14
PMCID: PMC5064437  PMID: 20170258
11.  Parent and Child Psychopathology and Suicide Attempts among Children of Parents with Alcohol Use Disorder 
Parents with psychopathology such as alcohol use disorder (AUD) that confers risk for suicide attempt (SA) may have children who are more likely to develop such psychopathology and to attempt suicide, suggesting that risk may be “transmitted” from parents to children. We examined this phenomenon during the transition from childhood to adolescence, when risk for SA increases dramatically. A cohort of 418 children were examined at average age 9.4 (range 7–14) years at enrollment (Time 1, childhood) and approximately five years later, prior to reaching age 18 (Time 2, adolescence). One or both biological parents, oversampled for AUD, were also interviewed. Structural equation models (SEM) examined father-child, mother-child, and either/both parent-child associations. The primary outcome was SA over follow-up among offspring, assessed at Time 2. As hypothesized, parental antisocial personality disorder predicted conduct disorder symptoms in offspring both during childhood and adolescence (parent-child model, father-child model) and maternal AUD predicted conduct disorder symptoms during childhood (mother-child model). However, we did not find evidence to support transmission of depression from parents to offspring either during childhood or adolescence, and parent psychopathology did not show statistically significant associations with SA during adolescence. In conclusion, we conducted a rare study of parent-to-child “transmission” of risk for SA that used a prospective research design, included diagnostic interviews with both parents and offspring, and examined the transition from childhood to adolescence, and the first such study in children of parents with AUD. Results provided mixed support for hypothesized parent-child associations.
doi:10.1080/13811118.2013.826154
PMCID: PMC4059391  PMID: 24716789
adolescent; parent; suicide attempt; alcohol use disorder; risk factor
12.  Interpersonal Violence Victimization and Suicidal Ideation 
Crisis  2011;32(5):240-245.
Background
Offenders are at elevated risk for interpersonal violence victimization (IVV), which is a risk factor for suicide-related outcomes in some populations, suggesting the importance of examining risk associated with IVV in offenders.
Aims
The present study examined the association between IVV and suicidal ideation (SI) among criminal offenders in a pretrial jail diversion program in the United States.
Methods
266 offenders were screened for ten common Axis I psychiatric disorders along with current SI and past-year IVV.
Results
Past-year IVV was significantly associated with current SI, and the association remained significant after adjusting for symptoms of ten Axis I psychiatric disorders, respectively and simultaneously. Gender did not moderate the IVV-SI association.
Conclusions
The findings support a connection between IVV and SI in criminal offenders.
doi:10.1027/0227-5910/a000080
PMCID: PMC4150083  PMID: 21940254
suicide; suicidal ideation; violence; victimization; offenders
13.  Impulsive versus Premeditated Aggression in the Prediction of Violent Criminal Recidivism 
Aggressive behavior  2014;41(4):346-352.
Past aggression is a potent predictor of future aggression and informs the prediction of violent criminal recidivism. However, aggression is a heterogeneous construct and different types of aggression may confer different levels of risk for future violence. In this prospective study of 91 adults in a pretrial diversion program, we examined a) premeditated versus impulsive aggression in the prediction of violent recidivism during a one-year follow-up period, and b) whether either type of aggression would have incremental validity in the prediction of violent recidivism after taking into account frequency of past general aggression. Findings indicate that premeditated, but not impulsive, aggression predicts violent recidivism. Moreover, premeditated aggression remained a predictor of recidivism even with general aggression frequency in the model. Results provide preliminary evidence that the assessment of premeditated aggression provides relevant information for the management of violent offenders.
doi:10.1002/ab.21549
PMCID: PMC4449320  PMID: 25043811
14.  Evaluation of a suicide prevention training curriculum for substance abuse treatment providers based on Treatment Improvement Protocol Number 50 (TIP 50) 
Substance use disorders (SUD) confer risk for suicide yet there are no empirically supported suicide prevention training curricula tailored to SUD treatment providers. We assessed the efficacy of a 2-hour training that featured a suicide prevention training video produced by the Department of Veterans Affairs (VA). The video was based on Treatment Improvement Protocol Number 50, TIP 50, a practical manual to manage suicide risk produced by the Substance Abuse and Mental Health Services Administration (SAMHSA). The training was provided in small groups to 273 SUD treatment providers in 18 states. Results were evaluated using self-report assessments obtained at pre-test, post-test, and 2-month follow-up. Statistically significant changes (p<.001) within subjects were obtained on self-efficacy, knowledge, and frequency of suicide prevention practice behaviors. The positive results together with the brevity of the training and its ease of implementation indicate high potential for widespread adoption and the importance of further study.
doi:10.1016/j.jsat.2012.01.008
PMCID: PMC3640862  PMID: 22417671
suicide; Veteran; substance abuse; training; evaluation
15.  A procedure that differentiates unintentional from intentional overdose in opioid abusers 
Addictive behaviors  2011;37(1):127-130.
Objective
The purpose of this study is to develop a procedure for assessing unintentional overdose (OD) in opiate abusers that differentiates it from intentional OD, and provides reliable information about the incident.
Methods
A sample of 121 patients in a methadone maintenance program at an urban university hospital completed a baseline assessment. A total of 70 participants completed an identical assessment at least 14 days later. The ability of an OD item to differentiate unintentional OD from intentional OD was tested, as was the test-retest reliability of questions assessing symptoms and treatment of OD.
Results
The procedure differentiated unintentional OD from intentional OD, and is reliable. Questions assessing symptoms of OD were endorsed in almost every unintentional OD incident, although reliability was affected by loss of consciousness. The reliability of questions assessing emergency treatment and Narcan administration was outstanding.
Conclusions
Our procedure for assessing OD differentiates unintentional OD from intentional OD. The use of follow-up questions assessing acute treatment for OD is recommended. Items concerning symptoms of OD are not needed to confirm the presence of an OD, but may be used to clarify whether an event was an OD.
doi:10.1016/j.addbeh.2011.08.006
PMCID: PMC4864590  PMID: 21955872
Opioid-Related Disorders; Analgesics; Methadone; Heroin Dependence; Overdose; Attempted Suicide; Reliability; Questionnaire
16.  Meta-analysis of depression and substance use among individuals with alcohol use disorders 
The relationships of depression with alcohol and drug use and impairment were examined. Additional analyses were conducted to examine moderators of these associations. Empirical reports on adults with alcohol abuse or dependence published in English in peer-reviewed journals since 1986 that contained data on depression and substance use variable(s) were obtained using a systematic search. The search yielded 74 studies including 58 reports from clinical venues, 10 that were community-based, and 6 with subjects from both settings. As hypothesized, the analyses showed that depression is associated with concurrent alcohol use and impairment and drug use and impairment. Effect sizes were small. Depression was also related to future alcohol use and impairment, an earlier age of onset of an AUD, and higher treatment participation. Age moderated the association between depression and alcohol use and impairment such that the association was stronger in older samples.
doi:10.1016/j.jsat.2008.11.007
PMCID: PMC4864601  PMID: 19150207
depression; alcohol abuse; alcohol dependence; meta-analysis
17.  Stressful life events and suicidal behavior in adults with alcohol use disorders: Role of event severity, timing, and type 
Drug and alcohol dependence  2011;120(1-3):155-161.
Background
Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events.
Method
Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed.
Results
Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI) = 5.50 (1.73, 17.53), p=.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI) = 6.05 (1.31, 28.02), p=.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned.
Conclusions
Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.
doi:10.1016/j.drugalcdep.2011.07.013
PMCID: PMC3235540  PMID: 21835560
alcohol use disorder; suicide attempt; suicide; stressful life event
18.  Acute alcohol use among suicide decedents in 14 U.S. States: Impacts of off-premise and on-premise alcohol outlet density 
Addiction (Abingdon, England)  2014;110(2):300-307.
Background and Aims
This study estimates the association between per capita alcohol retail outlet density and blood alcohol concentration (BAC) from 51,547 suicide decedents. It also analyzes the relationship between alcohol outlet density and socio-demographic characteristics among alcohol positive suicide decedents in the United States by racial/ethnic groups and method of suicide.
Design
Analysis of U.S. data, 2003–11, National Violent Death Reporting System
Setting
Suicide decedents from 14 U.S. States
Cases
A total of 51,547 suicide decedents tested for blood alcohol content.
Measurements
Blood alcohol content and levels were derived from coroner/medical examiner reports. Densities of county level on-premise and off-premise alcohol retail outlets were calculated using the 2010 Census.
Findings
Multilevel logistic regression models suggested that higher off-premise alcohol outlet densities were associated with greater proportions of alcohol-related suicides among men -- for suicides with alcohol present (BAC>0; adjusted odds ratio [AOR]= 1.08, 95% confidence interval [CI]= 1.03–1.13). Interactions between outlet density and decedents’ characteristics were also tested. There was an interaction between off-premise alcohol availability and American Indian/Alaska Native race (AOR=1.36; 95% CI=1.10–1,69) such that this sub-group had highest BAC positivity. On-premise density was also associated with BAC > 0 (AOR=1.05; 95% CI=1.03–1.11) and BAC≥ 0.08 (AOR=1.05; 95% CI=1.02–1.09) among male decedents.
Conclusions
County-level on- and off-premise density are associated with alcohol-related suicide, especially among American Indians/Alaska Natives.
doi:10.1111/add.12762
PMCID: PMC4427246  PMID: 25310999
suicide; acute alcohol use; alcohol outlet density; U.S. States
19.  Social Connections and Suicidal Thoughts and Behavior 
Disrupted social connectedness is associated with suicidal thoughts and behaviors among individuals with substance use disorders (SUDs). The current study sought to further characterize this relationship by examining several indices of social connectedness—1) living alone, 2) perceived social support, 3) interpersonal conflict, 4) belongingness. Participants (n = 814) were recruited from four residential substance-use treatment programs and completed self-report measures of social connectedness as well as whether they had ever thought about or attempted suicide. Multivariate results indicated that interpersonal conflict and belongingness were significant predictors of a history of suicidal ideation, and belongingness, perceived social support, and living alone were significant predictors of suicide attempt. These results indicate the most consistent support for the relationship between suicidality and thwarted belongingness, and also support the clinical utility of assessing whether individuals live alone.
doi:10.1037/a0020936
PMCID: PMC3066301  PMID: 21142333
suicide attempts; suicidal ideation; loneliness; thwarted belongingness; social support
20.  Test of a Clinical Model of Drinking and Suicidal Risk 
Background
There are few data on the role of drinking patterns in suicidal thoughts or behavior among alcohol dependent individuals (ADIs), and meager data on variables that may influence the role of drinking in suicidal thoughts and behavior. This study tested a heuristic model that predicts that drinking promotes suicidal thoughts and behavior, the association is mediated (accounted for) by depressive symptoms, and that anger moderates (increases) the risk associated with intense drinking.
Methods
Data from Project MATCH, a multi-site alcohol use disorders treatment trial, were analyzed using structural equation modeling. There were 1,726 participants including 24% women and a mean age of 40.2 ± 11.0 years. Subjects were assessed at baseline and at 3-, 9-, and 15-month follow-up. Two categorical measures (presence/absence) of suicidal ideation (SI) were used that were analyzed in separate models. Predictors of interest were continuous assessments of average drinking intensity (i.e., drinks per drinking day or DDD), drinking frequency (i.e., percent days abstinent or PDA), depression, and anger.
Results
Both DDD and PDA were associated with SI at a statistically significant level, with PDA showing an inverse association. Depression scores served as a partial mediator or a full mediator of the drinking – SI relationship depending on the measure of SI used in the analysis. The models testing anger scores as a moderator fit the data poorly and did not support that anger serves as a moderator of the drinking – SI association.
Conclusions
Greater drinking intensity and drinking frequency predict SI among ADIs and depression serves as a mediator of these associations but anger does not appear to serve as a moderator. Further research is required to clarify if depression serves as a partial- or full mediator and to see if the results herein extend to suicidal behavior (i.e., suicide attempt, suicide).
doi:10.1111/j.1530-0277.2010.01322.x
PMCID: PMC3005075  PMID: 20958331
suicide; alcohol dependence; drinking; depression
21.  Meta-analysis of depression and substance use and impairment among cocaine users* 
Drug and alcohol dependence  2008;98(1-2):13-23.
Background
The study evaluated, among cocaine users, the hypothesized positive association of depression and concurrent cocaine use and impairment, alcohol use and impairment, and general drug use and impairment. The hypothesis that gender would moderate these associations, with women showing a stronger correlation between depression and measures of substance use and impairment, was also tested. Also examined was the association of depression with future cocaine use and impairment and substance use treatment participation.
Methods
Empirical reports on adult cocaine users published in English in peer-reviewed journals since 1986 that contained data on depression and substance use outcome(s) were obtained using a systematic search. Studies that placed restrictions on range of depression scores to select the sample, experiments that administered cocaine to subjects, and trials of antidepressant medications were excluded. The search yielded 60 studies for the analysis including 53 reports that collected data from clinical venues and 7 that were community-based.
Results
As hypothesized, the analyses showed that depression is associated with concurrent cocaine-, alcohol-, and general drug use and impairment. Effect sizes were small. Hypothesized moderating effects of gender were not supported. Depression was not associated, at a statistically significant level, with treatment participation or future cocaine use and impairment.
Conclusions
Depression is consistently but modestly associated with measures of cocaine-, alcohol-, and general drug use and impairment among cocaine users. Associations of depression with treatment participation and with future cocaine use and impairment are not immediately evident, although limitations of data warrant cautious interpretation.
doi:10.1016/j.drugalcdep.2008.05.005
PMCID: PMC2570759  PMID: 18585871
depression; cocaine; alcohol abuse; drug abuse
22.  Use of Alcohol Before Suicide in the United States 
Annals of epidemiology  2014;24(8):588-592.e2.
Purpose
Few studies have compared acute use of alcohol in suicide decedents with that in a nonsuicide group. This study provides the first national analysis of acute use of alcohol prior to suicide compared with an estimate of acute use of alcohol in a living sample.
Methods
Pooled 2003-2011 National Violent Death Reporting System data were used to estimate the prevalence of postmortem blood alcohol content positivity (BAC >0.0 g/dl) and intoxication (BAC ≥ 0.08 g/dl). Population estimates of comparable use of alcohol (within the past 48 hours) were based on the National Epidemiologic Survey on Alcohol and Related Conditions.
Results
Compared to the living sample, male and female suicide decedents showed, respectively, a 1.83- (95% confidence interval [CI], 1.73-1.93) and 2.40-fold (95% CI, 2.24-2.57) increased risk of alcohol ingestion prior to their death after age, race/ethnicity, and chronic alcohol problems were controlled. Furthermore, male and female decedents exhibited, respectively, a 6.18- (95% CI, 5.57-6.86) and a 10.04-fold (95% CI, 8.67-11.64) increased risk of being intoxicated prior to their death after confounders were considered.
Conclusions
The findings underscore the crucial need to include among the essential components of suicide prevention policies programs that minimize use of alcohol, particularly drinking to intoxication.
doi:10.1016/j.annepidem.2014.05.008
PMCID: PMC4119510  PMID: 24953567
Suicide; Toxicology; Alcohol Drinking; and Epidemiology
23.  The relationship of outwardly-directed aggression to suicidal ideation and suicide attempts across two high-risk samples 
Psychology of violence  2014;4(2):184-195.
Objective
While research has established some relationships between risk factors and specific suicide-related outcomes, in large part the extent to which suicidal ideation and attempts have different risk profiles is unclear. Using two theories of suicidal behavior to guide our hypotheses, we studied the relationship of outwardly-directed aggression to suicidal ideation and attempts in two high-risk samples.
Method
Participants in study one were 271 criminal offenders in a pretrial diversion program. Participants in study two were 892 psychiatric inpatients who participated in the MacArthur Violence Risk Assessment Study.
Results
In both studies, after controlling for relevant covariates, outwardly-directed aggression was associated with suicide attempts, but not ideation. Among psychiatric patients, further analyses revealed that outwardly-directed aggression was associated with planned, but not unplanned, suicide attempts.
Conclusions
That aggression is related to suicide attempts and not ideation is consistent with hypotheses based on both Joiner's (2005) interpersonal theory of suicidal behavior and theories based on a diathesis toward behavioral dysregulation (e.g., Mann, 2009). That aggression was associated with planned suicide attempts is consistent with Joiner's theory. Competing explanations for the results include a potential role of proactive aggression in suicide attempts, particularly planned attempts.
doi:10.1037/a0033212
PMCID: PMC4500128  PMID: 26180654
aggression; suicide; suicide attempts; suicidal ideation; interpersonal theory
24.  Acute Use of Alcohol and Methods of Suicide in a US National Sample 
American journal of public health  2013;104(1):10.2105/AJPH.2013.301352.
Objectives
We explored age, gender, and racial/ethnic differences with alcohol use and firearms, hanging or asphyxiation, and poisoning methods of suicide.
Methods
We analyzed data for 37 993 suicide decedents aged 18 years and older from the 2005–2010 National Violent Death Reporting System database. Multinomial logistic regressions examined associations of method with alcohol use defined by blood alcohol content. Two-way interactions tested the effects of age, gender, and race/ethnicity on the associations between alcohol use and method of suicide.
Results
Alcohol was present among decedents who used the 3 leading methods of suicide: firearm (35.0%), hanging (36.8%), and poisoning (32.7%). Two-way interaction tests suggested that in young and middle adulthood, individuals were more likely to drink alcohol when they used a firearm or hanging (compared with poisoning), but in older adulthood, the reverse was true, with alcohol use more likely with poisoning. Interaction tests also suggested that Asians and Pacific Islanders were most likely to use alcohol in poisonings and that Blacks were least likely to use alcohol in hangings.
Conclusions
The results suggested that alcohol use before suicide was influenced by several factors, including age, race/ethnicity, and suicide method.
doi:10.2105/AJPH.2013.301352
PMCID: PMC3865232  PMID: 23678938
25.  A Pilot Study of Interpersonal Psychotherapy (IPT) for Alcohol Dependent Women with Co-occurring Major Depression 
Co-occurring major depression is prevalent among alcohol dependent women and is a risk factor for poor treatment outcomes. This uncontrolled pilot study tested the feasibility, acceptability, and initial effects of Interpersonal Psychotherapy (IPT) for women with co-occurring alcohol dependence and major depression (AD-MD) in an outpatient community addiction treatment program. Fourteen female patients with concurrent diagnoses of alcohol dependence and major depression participated. Assessments were conducted at baseline, mid-treatment (8- and 16-weeks), post-treatment (24-weeks), and follow-up (32-weeks). Participants attended a mode of 8 out of 8 possible sessions of IPT in addition to their routine addiction care, and reported high treatment satisfaction on the Client Satisfaction Questionnaire-8. Women’s drinking behavior, depressive symptoms, and interpersonal functioning improved significantly over the treatment period and were sustained at follow-up. These preliminary findings suggest that IPT is a feasible, highly acceptable adjunctive behavioral intervention for AD-MD women.
doi:10.1080/08897077.2012.746950
PMCID: PMC3711642  PMID: 23844953
Treatment; Alcohol; Depression; Co-occurring Disorders; Women

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