Depressive Symptoms Moderate the Association Between the Recent History of Alcohol Use Severity and Suicide Attempt History Among Adults in a Pretrial Jail Diversion Program

Abstract

Background: Justice-involved individuals are at elevated risk for suicidal behavior; however, research examining risk for suicidal behavior in pretrial jail diversion programs (pretrial diversion) is limited. Aims: We aimed to test (1) associations between depressive symptoms and alcohol and drug use, and suicide attempt history (SAH), and (2) interactions between depressive symptoms and alcohol and drug use in relation to SAH among adults in an urban pretrial jail diversion program. Method: The design was cross-sectional, including self-report assessments and file reviews of historical information. Adults (N = 274; M_age = 33.72; 73.7% men; 52.6% non-Hispanic Black) completed assessments within two weeks of beginning the pretrial program. Results: Depressive symptoms were positively associated with SAH after adjusting for other covariates. The significant depressive symptoms by alcohol use interaction indicated that adults with low to average depressive symptoms evidenced a similar likelihood of SAH to those with high depressive symptoms when they also had elevated alcohol use scores. Limitations: We used cross-sectional self-report data. Conclusion: It may be important to conduct suicide risk assessments for justice-involved people who use alcohol even when depressive symptoms are low.

Keywords: alcohol use; depression; drug use; pretrial setting; suicide attempt.

Figure 1.

The association between the Psychiatric Diagnostic Screening Questionnaire (PDSQ) alcohol severity scores and suicide attempt history (SAH) status across different levels of PDSQ depressive symptoms. The lines in the graph and corresponding 95% CI bands are the estimated probability values of a SAH across PDSQ recent history of alcohol use severity when PDSQ depressive symptoms are a score of 0, average (M), or at the clinical cutoff score of 9, holding the other variables in the model constant. Given sex is dummy coded (impacting only model intercepts), we graphed men (left graph) and women (right graph) separately. We used the mean-centered PDSQ alcohol scores when calculating the estimated probability of suicide attempt(s); however, for better translation of the PDSQ to clinical practice, we provide the noncentered raw scores on the x-axis. See ESM 1 for each graph separated by PDSQ depressive symptoms level and sex.