Screening for Suicidal Thoughts and Behaviors in Trauma-Exposed People with SUDs

Addiction Science Made Easy
July 2021
CTN Dissemination Library

The co-occurrence of substance use disorders (SUD) and exposure to trauma is a risk factor for suicidal thoughts and behaviors (STB), with about 35% of individuals who have made a suicide attempt having an SUD and about 72% of individuals with SUDs also having trauma histories. Given these strong associations, it’s essential that providers be able to accurately estimate STB in trauma-exposed people with SUD and identify which clinical factors are associated with it.

Pensive Woman on Bench Resting Head on her elbow

One challenge with this is that traditional methods of measuring suicidal thoughts and behaviors are limited by an overreliance on dichotomous (e.g., yes or no) and summed scale score measurements, where all items in the survey are given the same weight, even when they may not be equal (for example, passive thoughts about death and an actual suicide plan are often weighted the same in determining suicide risk). Despite this, these scales are what most clinicians and researchers use to determine who may be at high or low “suicide risk.”

Additionally, for trauma-exposed people with SUD, it remains unclear which specific demographic factors, types of SUDs, and trauma-related issues (e.g. PTSD symptoms) may be associated with increased STB.

This study used item response theory (IRT) to a) generate more accurate STB scores by weighting individual scale items differently based on their severity, and b) examine which demographic factors, SUD diagnoses, and DSM-IV PTSD symptom clusters are associated with suicidality in a trauma-exposed group of people with SUD. 

Women with trauma histories and SUDs were recruited from community substance use treatment facilities affiliated with the NIDA Clinical Trials Network (CTN). Clinicians administered interview-type measures to assess each participant for STB, SUD, and PTSD symptoms.

Results found that the item response theory model used to estimate STB severity scores worked well and provided more accurate measurements of STB. It also revealed several reliable predictors of elevated suicidal thoughts and behaviors, including younger age, being opioid dependent, and having higher trauma reexperiencing symptoms.

Conclusions: Despite the critical importance of understanding, assessing, and identifying STB in trauma-exposed individuals with SUDs, research methods that measure these variables are limited. This study used an innovative statistical analysis method to look at STB in a way that mirrors the weighting of various factors in suicide risk assessment. The findings highlight that trauma-exposed women with substance dependence who are younger, have opioid dependence, and/or have higher trauma reexperiencing symptoms may be at higher risk for suicide. Clinicians should screen for and target these factors when addressing suicidal thoughts and behaviors in trauma-exposed individuals with SUDs.

Find it in the CTN Dissemination Library

Skye S, et al. Graded response item response theory in scaling suicidal thoughts and behaviors among trauma-exposed women with substance use disorders. Psychology of Addictive Behaviors 2021 (in press).