Mental health behaviors and suicide risk among White and Black adults with Opioid Use Disorder

This study explores differences in depression and anxiety symptoms and suicidal behaviors by symptom severity and race among White and Black adults with Opioid Use Disorder (OUD). We examine the viability of using PHQ-9 and GAD-7 symptoms scores to indicate past suicidal behavior by race. We analyze baseline data among individuals who were enrolled in a supplemental digital intervention intended to support adults with OUD in recovery. White (n = 345) or Black (n = 76) individuals were included in the analytic sample. Participants completed an online survey on depression (PHQ-9) and anxiety (GAD-7) symptoms, past 30-day (P30D) suicidal ideation (yes/no), and lifetime suicide attempts (yes/no). Descriptive statistics were calculated; mean symptom scores were compared by race. Race-stratified precision-recall (PR) curves were used to determine the extent to which mental health scores indicated P30D suicidal ideation and the optimal cut points for each measure. Whites had significantly higher depression and anxiety scores than Black participants. When comparing past suicidal behaviors, there were no significant differences by race. A larger proportion of Black participants with moderate or severe depression and anxiety endorsed past suicidal behavior compared to Whites. PR curves and area under the curve values suggested that optimal cut-points for mental health scores as an indicator for suicidal ideation differed by race. Alone, mental health symptom severity and total scores may not be ideal indicators of suicide risk. Mental health screenings plus suicide risk evaluations are recommended for OUD patients, especially Black Americans.