Suicidal ideation, mental health services, and barriers to care among syringe services program clients who use opioids.

Authors

Kiran Paudel, Kamal Gautam, Sherry Pagoto, Ran Xu, Jeffrey A Wickersham, Frederick L Altice, Sandesh Bhusal, Md Safaet Hossain Sujan, Michael Copenhaver, Chenglin Hong, Roman Shrestha

Published in

PloS one. Volume 21. Issue 7. Pages e0354745. Epub Jul 30, 2026.

Abstract

People who use opioids (PWUO) experience a disproportionately high burden of suicidal risk. Syringe services programs (SSPs) are a critical point of contact for this population, providing low-threshold, harm-reduction services. However, gaps persist in understanding suicidal risk among individuals attending SSPs and the extent to which such risk is associated with mental health service utilization in this setting. This study aimed to assess the prevalence and specific risk factors for suicidal ideation (SI) in PWUO, as well as their use of and barriers to accessing mental health services.
We conducted a cross-sectional survey between April and June 2024 among PWUO (N = 199) who were utilizing services in the SSP in New Haven, Connecticut. We used the ninth item from the Patient Health Questionnaire (PHQ-9) scale, which assesses passive thoughts of death and self-harm in the past two weeks, as a proxy measure for the SI. Additionally, participants reported their use of and barriers to accessing mental health services in the past six months. Bivariate and multivariable logistic regression were conducted to examine factors associated with SI.
Approximately 84% of participants met the criteria for opioid dependence, and more than two-thirds (71.9%) were currently receiving medication for opioid use disorder. Over one-third of the sample reported SI in the past two weeks (34.7%). Additionally, over one-third of participants (36.2%) reported unmet mental health needs, and 84.4% reported experiencing at least one barrier to accessing mental health services. Individuals with depressive symptoms (aOR: 5.4; 95% CI: 2.5-11.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1-0.6) were less likely to report SI in the past two weeks.
Our study showed a high prevalence of SI among SSP clients who use opioids and a low use of mental health services due to access barriers. These findings support incorporating a brief suicide risk screening and referral options within SSPs and other settings serving PWUO and addressing key access issues like cost and transportation that can prevent timely linkage to mental health services.

PMID:
42531221
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

Read full publication at:
Please sign in to see all details.

Stats

1-terrible, 9-excellent. How would you rate this publication? Sign in in to submit your rating.

Post a comment

You need to be signed in to post comments. You can sign in here.

Comments

There are no comments yet.