Suicidal Ideation and Attempts Among Women Seeking Treatment for Substance Use and Trauma

Background & Purpose:Co-occurring Substance Use Disorder (SUD) and Posttraumatic Stress Disorder (PTSD) are common, particularly among women. Research has shown that those with both disorders have a more severe clinical profile and may be at high risk for suicidal thoughts and behaviors (Harned and Najavits, 2006). Building on earlier efforts to understand suicidal thought and behaviors among women with trauma and substance use histories (e.g. Harned & Najavits, 2006; Najavits, Weiss & Shaw, 1999), we examine rates and correlates of suicidal ideation and attempts among a community-based sample of women seeking treatment for substance use and trauma.

Methods: Data were from the screening sample of the NIDA Clinical Trial Network’s Women and Trauma Study (Hien et al., 2009). Participants (n=541) were women seeking treatment for substance use and trauma at one of seven outpatient substance abuse programs. The sample included women between the ages of 18-65 (mean=39.2 sd=9.3) and was 44% White; 33% African American; 8% Latina and 15% other races/ethnicities (e.g. Asian American). We used logistic regression models to examine factors associated with a lifetime history of serious suicidal ideation and a serious suicide attempt.

Results:  Women in the screening sample had extensive trauma histories and the majority had experienced physical assault (90%), sexual assault (85%), or other unwanted sexual experiences (80%). Over a third of the women (37%) reported they were held captive by an abuser. Eight percent of women reported serious suicidal ideation in the past 6 months, while 21% of women reported recurrent suicidal ideation in their lifetime. Although most women screened for the study did not report a suicide attempt in the past six months (98%), a quarter of the women (25%) had attempted suicide in their lifetime. Some of these attempts were impulsive and did not have accompanying serious suicidal ideation. Results of the logistic regression analyses indicate the age PTSD symptoms began (OR = 0.97) an alcohol use disorder (OR = 1.9), taking medications for psychological/emotional problems (OR = 2.6), and not meeting study eligibility criteria* (OR  = 2.2) were associated with serious suicidal ideation. Older Age (OR = 0.97), current PTSD (OR = 2.6), taking medications for psychological/emotional problems (OR = 1.8), experiencing more types of traumas (OR = 1.1) and not meeting eligibility criteria (OR  = 2.2) were significantly associated with a past suicide attempt. Other variables (e.g. race/ethnicity, cocaine use disorder, opiod use disorder) were not significantly associated with suicidal ideation or attempts.

Conclusions & Implications:  Findings highlight the need for social workers to attend to elevated risk levels for suicidal thoughts and behaviors when working with women with histories of substance use and trauma. Future research would benefit from examining other potential correlates of such behavior (eg., coping style), as well as mechanisms (eg., emotion dysregulation) that may explain the relationship among these co-occurring problems.

*Women were eligible for the study if they met DSM-IV-TR criteria for PTSD. Exclusion criteria included active psychosis, cognitive impairment, a history of schizophrenia, current suicidal/homicidal thoughts/behavior, or PTSD-related litigation involvement.