John Robins

John Robins is based at the National Addiction Centre at King’s College London, where he was awarded departmental funding to complete his PhD. Previously John spent seven years as a practitioner in community drug and alcohol treatment services in Tottenham, London, working in criminal justice drug treatment, aftercare and outreach teams. He was awarded a student bursary from the SSA to complete an MSc at the National Addiction Centre focussing on the role of substance use in psychiatric crisis. He is currently researching the profile of alcohol use disorder in suicidal crisis and its impact on risk and care.


One size fits all? The different forms of alcohol use in suicidal crisis and their associations with repeated crisis care and death


Background
Despite alcohol being the most common drug used by suicidal patients accessing emergency psychiatric care, suicide prevention strategies often take ‘one-size-fits-all’ approaches to alcohol use, failing to account for disparate drinking patterns or severity. Our study aimed to capture the spectrum of alcohol use in suicidal crisis, and associated levels of post-crisis risk.

Methods
We analysed Electronic Health Record data from 650 suicidal adults detained under the Mental Health Act (1983, amended 2007) at a Health-Based Place of Safety in London. We used Latent Class Analysis to identify different classes of alcohol-using behaviour, and logistic regression to estimate the association of each identified class with subsequent death or recontact with emergency psychiatric care.

Results
Three classes of alcohol use were identified: low-risk drinkers, binge drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low-risk drinking class (OR=2.32, 95%CI=1.62-3.32). Conversely, the binge drinking class was associated with lower odds of death or recontact than the low-risk drinking class (OR=0.66, 95%CI=0.53-0.81).

Conclusions
The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention should be tailored accordingly.

Funding
This work was supported by the Clinical Record Interactive Search (CRIS) platform funded and developed by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, and a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity (grant number BRC-2011-10035).

John Robins receives a PhD scholarship from the King’s College London Institute of Psychiatry, Psychology and Neuroscience.