Care Trajectories Among Patients With Substance-Related Disorders in the 3 Years Before Their Last Suicide Attempt

Among patients with substance-related disorders (SRDs) and suicide attempts in 2014-2021, we identified care trajectories within a 3-year period preceding their last suicide attempt (index date). We also determined associations between care trajectories and patients sociodemographic and clinical characteristics, quality of care received, and risk of death in the following year.

Using Quebec (Canada) medical databases, we produced Group-based Multi-Trajectory Modeling, Multinomial Logistic Regression, and Cox Proportional Hazards models.

We identified five care trajectories (profiles) among the 2297 study patients. Profile 1 (31%, reference profile) had low outpatient care with late increase in acute care use. It included more men, younger patients and individuals with overall better conditions. Profile 2 (22%) received high physical healthcare and had more chronic physical illnesses. Profile 3 (19%), with more serious mental disorders, and Profile 4 (16%), with more polysubstance-related disorders, used more outpatient mental health (MH) or SRD care, decreasing before index date. Profiles 2, 3 and 4 increasingly used acute care before index date. Profile 5 patients (12%) had more health problems, and so showed the highest overall care use and highest risk of death.

Tailored interventions are suggested for all profiles, with improved screening and SRD-MH care.