Patterns and Correlates of Suicidality Among People With Opioid Dependence-A Cross-Sectional, Community-Based Study

Limited data exist on suicidality among non-treatment-seeking individuals with opioid dependence in low- and middle-income countries. The objectives of the study were to assess the prevalence and correlates of suicidality and perceived burdensomeness among community-dwelling individuals with opioid dependence and to assess association of socio-clinical factors with suicidality and perceived burdensomeness.

This cross-sectional study utilized baseline data from a prospective community-based cohort study conducted in an urban socioeconomically disadvantaged area of Delhi, India. Adult males meeting ICD-10 criteria for opioid dependence and not engaged in treatment for at least 6 months were recruited using snowball sampling. Suicidality was assessed using the Ask Suicide-Screening Questions (ASQ). Depressive symptoms (using Patient Health Questionnaire-9), anxiety symptoms (Generalized Anxiety Disorder-7), severity of opioid dependence (Leeds Dependence Questionnaire), and high-risk behaviors were evaluated. Logistic regression analyses were conducted to identify factors independently associated with suicidality and perceived burdensomeness.

Among 396 male participants, 24.5% screened positive for suicidality (presence of either suicidal ideations in past week or self-harm attempt in the past), and 32.8% endorsed perceived burdensomeness (either wish to die or feeling of burden on family). Suicidal ideation was reported by 20.2% (n = 80), among whom 56% (n = 45) had engaged in at least one past self-harm attempt. Significant factors associated with suicidality included younger age at onset of opioid use, injection drug use, concurrent alcohol use, history of family discord, and depressive symptoms (p < .05).

Suicidality is highly prevalent among non-treatment-seeking individuals with opioid dependence in community settings. Co-occurring depressive and anxiety symptoms significantly contribute to suicide risk, underscoring the critical importance of integrated mental health screening within opioid use disorder services. Early identification and intervention targeting psychiatric comorbidity may reduce suicide risk in this vulnerable dual diagnosis population.