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Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study.

ABSTRACT: Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011-2015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD ± 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (n = 27, 64.3%) followed by accidents (n = 15; 35.7%). Among the suicide cases, alcohol was the main substance used (33.3%) followed by opioids (25.9%). A total of 58.5% (n = 24) deaths occurred within a year of their last visit while 41.5% (n = 17) were dead more than a year after their last visit. Of the total cases (n = 41), 63% had a history of mental illness with depressive disorder (53.8%) being the most common. History of suicide attempts were reported in 34.1% (n = 14) of cases and 50% of the subjects (n = 21) had a history of suicidal ideation. Drug related offences were reported in 57.1% of the subjects, of which 60% (n = 18) committed suicide. The findings support the need for appropriate treatment resources to reduce the untimely deaths among substance users.

SUBMITTER: Pv A

PROVIDER: S-EPMC6695629 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study.

Pv Asharani A Jun Wen Tan T Karuvetil Mohamed Zakir MZ Cheong Alvin A Cheok Christopher C Kandasami Gomathinayagam G

International journal of environmental research and public health 20190731 15

Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011-2015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD ± 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (<i>n</i> = 27, 64.3%) fo ...[more]

PMID: 31370374

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Project description:BackgroundPatient-facing digital health tools have been promoted to help patients manage concerns related to COVID-19 and to enable remote care and self-care during the COVID-19 pandemic. It has also been suggested that these tools can help further our understanding of the clinical characteristics of this new disease. However, there is limited information on the characteristics and use patterns of these tools in practice.ObjectiveThe aims of this study are to describe the characteristics of people who use digital health tools to address COVID-19-related concerns; explore their self-reported symptoms and characterize the association of these symptoms with COVID-19; and characterize the recommendations provided by digital health tools.MethodsThis study used data from three digital health tools on the K Health app: a protocol-based COVID-19 self-assessment, an artificial intelligence (AI)-driven symptom checker, and communication with remote physicians. Deidentified data were extracted on the demographic and clinical characteristics of adults seeking COVID-19-related health information between April 8 and June 20, 2020. Analyses included exploring features associated with COVID-19 positivity and features associated with the choice to communicate with a remote physician.ResultsDuring the period assessed, 71,619 individuals completed the COVID-19 self-assessment, 41,425 also used the AI-driven symptom checker, and 2523 consulted with remote physicians. Individuals who used the COVID-19 self-assessment were predominantly female (51,845/71,619, 72.4%), with a mean age of 34.5 years (SD 13.9). Testing for COVID-19 was reported by 2901 users, of whom 433 (14.9%) reported testing positive. Users who tested positive for COVID-19 were more likely to have reported loss of smell or taste (relative rate [RR] 6.66, 95% CI 5.53-7.94) and other established COVID-19 symptoms as well as ocular symptoms. Users communicating with a remote physician were more likely to have been recommended by the self-assessment to undergo immediate medical evaluation due to the presence of severe symptoms (RR 1.19, 95% CI 1.02-1.32). Most consultations with remote physicians (1940/2523, 76.9%) were resolved without need for referral to an in-person visit or to the emergency department.ConclusionsOur results suggest that digital health tools can help support remote care and self-management of COVID-19 and that self-reported symptoms from digital interactions can extend our understanding of the symptoms associated with COVID-19.

Project description:To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse.Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study.Forty-seven centres of SUD treatment in 10 countries.A total of 1205 treatment-seeking SUD patients.Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II).The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR)?=?2.8, 95% confidence interval (CI)?=?1.8-4.2], BPD (OR?=?7.0, 95% CI?=?3.1-15.6 for alcohol; OR?=?3.4, 95% CI?=?1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR?=?4.1, 95% CI?=?2.1-7.8) and HME (OR?=?4.3, 95% CI?=?2.1-8.7) were all more prevalent in ADHD(+) compared with ADHD(-) patients (P?<?0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P?<?0.01), increased HME and ASPD in the hyperactive/impulsive (P?<?0.01) and combined subtypes (P?<?0.001) and increased BPD in all subtypes (P?<?0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD.Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.

Dataset Information

Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study.

Publications

Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study.

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