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SUICIDAL BEHAVIOR IN ALCOHOLICS HOMELESS MEN TREATED IN ASSOCIACIO RAUXA Barcelona - Spain 9th ANNUAL INTERNATIONAL STREET MEDICINE SYMPOSIUM BOSTON, MASSACHUSETTS OCTOBER 24-26 2013. ASSOCIACIÓ RAUXA. NGO founded in 1989 in Barcelona (Spain) with - PowerPoint PPT Presentation
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SUICIDAL BEHAVIOR IN ALCOHOLICS HOMELESS
MEN TREATED INASSOCIACIO RAUXABarcelona - Spain
9th ANNUAL INTERNATIONAL STREET MEDICINE SYMPOSIUM
BOSTON, MASSACHUSETTS OCTOBER 24-26 2013
ASSOCIACIÓ RAUXA
NGO founded in 1989 in Barcelona (Spain) with
the aim of alleviating the extreme situation of the
homeless population, offering a more than two
years integral treatment of alcohol dependence
and other drugs
Integral treatment of alcohol dependence for alcoholic homeless
Phases
1. RAUXA VAN: Street outreach resource. Detection and motivation
2. URBAN THERAPEUTIC COMMUNITY: Detox, Reduction of addictive habits & Rehabilitation
3. RAUXA FLATS: Social rehabilitation
4. LABOUR INTEGRATION: Rauxa Cooperative & “La Terrasseta” restaurant
5. DISCHARGE
INTRODUCCION
World Health Organization (WHO) estimates that
about 1 million people commit suicide every
year. And about 5 million are directly affected by
it. Attempted suicides are 10-20 times higher.
In Spain (2010) the rate of completed suicide
increased up to 12,6 for men and 3,9 for women /
100.000 inhabitants of general population.
The report of Drug Abuse Warning Network
(DAWN, 2006) demonstrate that 30 % of suicide
attempts implied a combination of alcohol and
other drugs. The risk of suicide in lifetime of
alcoholics is as high as 18 % (Roy, 1986); and
individuals with alcoholism have 60-120 times
greater suicide risk than non-psychiatrically ill
population.
High rates of completed suicide in alcoholics
(5,6% Freixa and Bach, 1981) as well of
attempted suicide (18% Rodriguez Martos, 1971;
19,4% Freixa and Bach, 1981 in Spain, or up to
24% Weissman, 1980 in USA) have been
reported.
Since one of the worse complication of alcohol
dependence is completed suicide and attempted
suicide we decided to report data on alcoholic
homeless men (N=495) treated at Associacio
Rauxa, with the aim of showing the severity of
this fact especially in this homeless population.
Material and methodology: Sample: alcoholic homeless men treated at
the Associació Rauxa, with or without other drugs dependence (tobacco,
cocaine, cannabis, BZD, heroine…), criteria DSMIV-TR. All of them go
through medical and addictive history, physical exam, blood and urine
analysis, thorax Xray. It is examined the prevalence of completed and
attempted suicide (before admission in Ass. Rauxa) of this sample, as well
as the number of suicide attempts by each man, and its correlation with the
following subgroups of substances consumers (1- only alcohol and alcohol
+ tobacco; 2- alcohol + tobacco + cocaine; 3- alcohol + tobacco + other
drugs). Previous diagnosis to admission in Associacio Rauxa are study in
relation to the presence of mental illness, personality disorders and
depressive disorder and are correlated with suicide attempts and substance
consumers subgroups.
It is evaluated and SD; differences considered significant at X2 p<0,05, in
statiscal analyses to correlate different parameters with suicide attempts.
SAMPLE N= 495
WITHOUT ATTEMPTS N=319 WITH ATTEMPTS N=176
• Age at the admission in treatment 47,79 44,11
• Status marital - Married 12 3 - Divorced 30 24 - Separated 156 80 - Single 107 68 - Widower 7 1
• Time on the street 758,60 days 771,79 days
• Where are from - Catalunya 127 86 - España 165 66 - Extranjeros 27 24
• Income - With income 121 70 - Without income 198 106
X
X
Parameters and results:
* Alcoholic homeless men 495/495 (100%)
* Age at the admission in treatment in Associacio Rauxa SD46,49 8,76
* Attempted suicides 176 /495 (35,55%) Nº of suicide attempts per person 1 time N=94 (53,41%)
>1-5 times N=64 (36,36%) > 5 times N=18 (10,23%)
* Subgroups of drug consumer (N=495) With attempted suicide 176 / 495 - 1 Alcohol only (46) Alcohol + tobacco (240) N= 286 / 495 (58%) 77 / 286 (27%) - 2 Alcohol + tobacco + cocaine N=120 / 495 (24%) 68 / 120 (57%) - 3 Alcohol + tobacco + other drugs N= 89 / 495 (18%) 31 / 89 (35%)
__________________ ________________
* Mental Pathology 195/495 (39%) Global With attempted suicide 101/176 (57%) Mental illness disorders 39 / 495 (7,88%) 18 / 39 (46%) Personality disorders 47 / 495 (9,49%) 29 / 47 (62%) Depressive disorders 109 / 495 (22,02%) 54 / 109 (50%)
* Completed suicide 2/495 (0,40%)
X
N=319 (64%)
N=176 (36%)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
(N=495)
NO ATTEMPTED SUICIDE (N=319) ATTEMPTED SUICIDE (N=176)
N=209 (73%)
N=77 (27%)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
SUBGROUP 1- ONLY OH (46)OH+TOBACCO (240)
(N=286)
NO SUICIDE ATTEMPT (N=209) SUICIDE ATTEMPT (N=77)
N=52 (43%)
N=68 (57%)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
SUBGROUP 2- ALCOHOL+TOBACCO+COCAINE (N=120)
NO SUICIDE ATTEMPT (N=52) SUICIDE ATTEMPT (N=68)
N=58 (65%)
N=31 (35%)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
SUBGROUP 3- ALCOHOL+TOBACCO+OTHER DRUGS
(N=89)
NO SUICIDE ATTEMPT (N=58) SUICIDE ATTEMPT (N=31)
N=319 (64%)
N=176 (36%)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
(N=495)
NO ATTEMPTED SUICIDE (N=319) ATTEMPTED SUICIDE (N=176)
N=52 (43%)N=68 (57%)
SUBGROUP 2- ALCOHOL+TOBACCO+COCAINE
(N=120)
NO SUICIDE ATTEMPT (N=52)SUICIDE ATTEMPT (N=68)
N=209 (73%)
N=77 (27%)
SUBGROUP 1-
ONLY OH (46)OH+TOBACCO (240) (N=286)
NO SUICIDE ATTEMPT (N=209)SUICIDE ATTEMPT (N=77)
N=58 (65%)
N=31 (35%)
SUBGROUP 3-
ALCOHOL+TOBACCO+OTHER DRUGS (N=89)
NO SUICIDE ATTEMPT (N=58)SUICIDE ATTEMPT (N=31)
ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA(N=495)
ONLY OH (46)OH+TOBACCO (240) (N=286)
OH+TOBACCO+COCAINE (N=120) OH+TOBACCO+OTHER DRUGS (N=89)
NO SUICIDE ATTEMPTS (N=319)
209 52 58
SUICIDE ATTEMPS (N=176) 77 68 31
25
75
125
175
225
275
325
209
52 58
77
6831
ATTEMPED SUICIDES IN ALCOHOLICOS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA
(N=495)
X2= 32,57253561 X2= 9,772467749 P=
<0,00000001 P= <0,001771445
COMMENTS 1
• In this sample of homeless alcoholic men
there is a high number of suicide attempts
up to 36%; as well as a high comorbidity of
other mental disorders, around 39%.
.
COMMENTS 2
• The Subgroup of alcohol + tobacco +
cocaine shows a high rate of suicide
attempts up to 59%, statistically significant;
with a lower comorbidity of other
psychiatric illness.
COMMENTS 3
• Most of psychiatric symptoms of these
patients disappear after an abstinence
period of 6 to 12 months. Some psychiatric
diagnosis may be considered as erroneous,
so many patients are overmedicated and
some develop even dependence to
benzodiazepines (BZD).
. CONCLUSIONS 1
We can confirm that the homeless alcoholics
population has a higher risk of attempted
suicides than general alcoholic population,
specially the subgroup with alcohol, tobacco and
cocaine dependence.
This population presents most of the risk factors
associated to suicide.
CONCLUSIONS 2
We recommend to institutions, authorities,
decision making administrators and health and
social professionals to take these facts into
account, in order to offer adequate and prompt
diagnosis and treatment of alcohol and other
drugs dependence to avoid suffering and human
losses.