Suicide prevention in clinical populations with substance use problems

Student thesis: Doctoral ThesisDoctor of Philosophy (PhD)


People with substance use problems are at substantially greater risk of suicide than the general population. Yet within clinical services, the provision of care to prevent suicide and reduce self-harm in this population can be challenging. This thesis aims to broaden the evidence base for such care.

First, I describe a cohort study that used national primary care data (n=8,070 patients) to investigate the risk of suicide and self-harm during and after opioid agonist treatment (OAT) for opioid dependence. OAT was associated with a reduced risk of self-harm (adjusted risk ratio in periods off treatment: 1.50; 95% confidence intervals: 1.21, 1.88). Risk of self-harm (aRR: 2.60; 95% CI: 1.83, 3.70) and suicide (aRR: 4.68; 95% CI: 1.63, 13.42) were both elevated in the first four weeks after stopping OAT compared with stable periods on treatment. The findings indicate that OAT has an important role in suicide prevention.

Next, I report a systematic review that aimed to evaluate the effectiveness of suicide prevention interventions among people with substance use problems. Six randomised controlled trials (n=468 participants) were identified, which were all likely to have been underpowered to detect differences between groups. Several feasibility trials of interventions involving cognitive behavioural therapy, dialectical behavioural therapy, and dynamic deconstructive psychotherapy showed promise. However, adequately powered trials investigating effectiveness are required.

Finally, I describe a Delphi method study that included people with lived and occupational experience in the development of a brief psychosocial intervention for people attending hospital with self-harm and substance use problems. The developed intervention consists of weekly follow-up phone calls for up to one month, delivered by Liaison Psychiatry practitioners, in which both self-harm and substance use problems are explored, and patients are supported in accessing community services. A case series testing the acceptability and feasibility of this intervention is currently underway.
Date of Award21 Jun 2022
Original languageEnglish
Awarding Institution
  • University of Bristol
SupervisorDavid Gunnell (Supervisor), Paul A Moran (Supervisor) & Matt Hickman (Supervisor)

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