JMIR Publications

ABSTRACT

Background:

Abstract Introduction: Dependence on stimulants such as cocaine and crack produces neurobiological changes that increase impulsivity, emotional vulnerability, and the risk of violence and suicide. Understanding these factors among users in public treatment services is essential for improving mental health interventions.

Objective:

To compare the prevalence of impulsivity and suicidal ideation, and their correlations with sociodemographic characteristics, between drug-dependent and non–drug-dependent individuals treated at a CAPS/ad.

Methods:

This cross-sectional study was conducted at a CAPS/ad in Betim, Minas Gerais, with 39 drug-dependent individuals, and in a primary care service, with 39 non–drug-dependent individuals. A sociodemographic questionnaire, the Barratt Impulsiveness Scale (BIS-11), and the Suicidal Ideation Questionnaire (QIS) were administered. Variables were analyzed using chi-square tests and logistic regression (p < 0.05).

Results:

Drug-dependent participants showed greater exposure to domestic violence, lower income, less parental presence, and lower employment rates. Clinically, they exhibited significantly higher impulsivity (89.7% highly impulsive) and a higher prevalence of suicidal ideation (56.4%) compared with non–drug-dependent individuals (15.4%). Logistic regression indicated dependence as the only significant predictor, increasing the odds of suicidal ideation by 7.1 times. Conclusion: Dependence on stimulants such as cocaine and crack is associated with marked impulsivity and a high risk of suicidal ideation, underscoring the need for systematic screening and integrated interventions in services such as CAPS/ad. Adverse social factors further exacerbate vulnerability, highlighting the importance of public policies that expand psychosocial support and suicide prevention strategies.

Objective:

Investigations that assess the association between impulsivity and suicidal ideation in individuals dependent on cocaine/crack in public health services, as well as their possible sociodemographic correlations.

Methods:

Methodology Ethical Aspects This study was approved by the Research Ethics Committee of the Federal University of Minas Gerais (COEP/UFMG), under the opinion CAAE nº 75266823.70000.5149. All participants were invited to take part voluntarily and signed the Free and Informed Consent Form (Termo de Consentimento Livre e Esclarecido – TCLE), ensuring data confidentiality and the freedom to withdraw at any time without any harm to their treatment. Study Setting The research was conducted at the Psychosocial Care Center for Alcohol and Other Drugs (Centro de Atenção Psicossocial Álcool e Drogas – CAPS/ad), located in the municipality of Betim, Minas Gerais. This is a municipal public health service, fully funded by the Brazilian Unified Health System (Sistema Único de Saúde – SUS), which assists, on average, 290 patients undergoing treatment for dependence on alcohol and other psychoactive substances. CAPS/ad offers care in three modalities: intensive, semi-intensive, and non-intensive, in accordance with the guidelines of the Ministry of Health (BRASIL, 2004). Study Design This was an analytical, cross-sectional study with a quantitative approach. The design sought to identify prevalences and possible correlations among variables from a biopsychosocial perspective. For data collection, structured and validated instruments were applied: a sociodemographic questionnaire, the Barratt Impulsiveness Scale (BIS-11), and the Suicidal Ideation Questionnaire (QIS). Sample Participant selection was conducted through the review of medical records, following previously established inclusion and exclusion criteria. The dependent group consisted of 39 individuals, a number equivalent to that of the comparison group. Although a larger total number of participants was initially eligible, sample losses occurred until the final composition of the groups. Inclusion and Exclusion Criteria Individuals over 18 years of age, of both sexes, literate, with a minimum abstinence of 15 days, not dependent on nicotine, and in follow-up at CAPS/ad in any treatment modality were included. In addition, they were required to have a diagnosis of dependence on stimulants (cocaine and crack), according to DSM-5 and ICD-11 criteria, and no history of psychiatric disorders prior to substance use. Individuals with incomplete medical records or with a previous diagnosis of primary psychiatric disorders, such as mood disorders, anxiety disorders, schizophrenia, eating disorders, personality disorders, and somatoform disorders, as described in clinical records, were excluded. Data Collection Procedures Data collection took place on days and at times agreed upon with the CAPS/ad management team. After reviewing medical records and inviting eligible patients, participants were informed about the objectives of the study and, upon signing the Free and Informed Consent Form (TCLE), answered the questionnaires in a reserved, individual, and quiet setting, with the researcher present. The average time required to complete the instruments was approximately 20 minutes. Instruments Sociodemographic Questionnaire: developed by the researchers to characterize the participants’ profile. Barratt Impulsiveness Scale (BIS-11): Portuguese-validated version (MALLOY-DINIZ et al., 2010), composed of 30 items distributed across three domains (motor impulsivity, attentional impulsivity, and non-planning impulsivity). Scores range from 30 to 120 points, with values ≥72 indicating high impulsivity. Suicidal Ideation Questionnaire (QIS): instrument validated by (FERREIRA E CASTELA 1999), composed of 30 items with seven response options on a Likert scale (0 to 6 points). Total scores range from 0 to 180, with scores ≥80 indicating a high frequency of suicidal ideation. Statistical Analysis The study includes only quantitative variables. Both the Suicidal Ideation Questionnaire (QIS) and the Barratt Impulsiveness Scale (BIS) had their scores transformed into categories. The first was categorized into two groups – with and without suicidal ideation – and the second into a three-level categorical scale – highly controlled, within normal limits, and highly impulsive. The remaining variables were already collected in categorical format. The association between group (non-dependent and dependent) and all other variables collected was assessed using the chi-square test. In specific cases in which the number of response options was limited to two and the cell counts were lower than five, Fisher’s exact test was used to adjust the results. To assess which variables influence suicidal ideation, logistic regression was performed. All other variables, including group, were initially selected as independent variables. Using the backward elimination technique, variables were removed one by one – from the least significant – until only significant variables remained in the model (p < 0.05). All analyses were performed in SPSS version 25, with a significance level of 5%.

Results:

Results Table 1 shows that there is no difference in the distribution of sex (p = 0.761), race (p = 0.893), age (p = 0.583), having children or not (p = 0.456), and occupation (p = 0.163) between the non-dependent and dependent groups. In other words, these variables do not differ between the two groups. The non-dependent group is predominantly composed of married individuals, people who are employed, have better economic income (p < 0,0001), and have parents present in a higher proportion (p = 0,042). By contrast, the dependent group is predominantly composed of single individuals (p = 0,007), who present higher suicidal ideation and impulsivity (p < 0,0001), and come from households in which violence is prevalent (p < 0,0001). From this initial characterization, it was possible to establish the model of influence on suicidal ideation (Table 2), that is, whether the set of variables – including the group – influences suicidal behavior. The following were included as explanatory variables: group (dependent and non-dependent), impulsivity, sex, race/ethnicity, age group, children, parents present, violence in the home, employment status, occupation, and monthly income. Based on the Backward criterion, the variables were excluded one by one.

Conclusions:

Only the group variable, whose result is shown in Table 1 (indicating that there is a difference in ideation between non-dependent and dependent individuals), remained in the model. According to the odds ratio, being in the dependent group increases by 7,1 times the likelihood of having suicidal ideation. The other variables were not significant and were therefore automatically excluded from the model.