An evaluation of a multi-site fetal alcohol spectrum disorder models of care project

Analysis of risk factors associated with suicidality in children and adolescents with fetal alcohol spectrum disorder in Western Australia

BACKGROUND

Individuals with fetal alcohol spectrum disorder (FASD) are at an elevated suicide risk compared with those in the general population. This public health issue warrants further research attention to help inform the development of prevention and intervention efforts. Our study is the first to characterize suicidality (i.e., suicidal ideation/suicide attempt) and explore associated risk factors in young individuals with FASD within the Australian context.

METHODS

Retrospective file reviews from a diagnostic clinic in Western Australia obtained data on demographic variables and risk factors, including psychosocial stressors (i.e., child protection and justice system involvement, history of abuse/neglect) and comorbid diagnoses (i.e., attention-deficit-hyperactivity disorder (ADHD), attachment disorder, conduct disorder, anxiety disorder, depression, substance use disorder, and sleep disorder). Data on suicidality were collected via formal suicide risk assessments and source documentation.

RESULTS

One hundred and ninety-five participants diagnosed with FASD were included in the study (Mage = 11.75 years, range = 5-21 years). Of these, 40 (21%) reported suicidality, with the youngest being 5 years old. There was a significant positive correlation between suicidality and age. A greater proportion of individuals with FASD who had been involved with the justice system (n = 30, 35%) reported suicidality. Participants with attachment disorder (n = 19, 34%), conduct disorder (n = 10, 40%), substance use disorder (n = 14, 50%), and depression (n = 12, 60%) had significantly higher rates of suicidality than individuals without these comorbidities. The risk of suicidality increased in participants with comorbid depression (OR = 4.20) after controlling for age as a covariate.

CONCLUSION

These findings add to the growing body of evidence that highlights the vulnerability of individuals with FASD to suicidality compared with the general population, underscoring the need for targeted, culturally safe suicide intervention/prevention efforts.

Exploring resource implications and models of care for assessment and diagnosis of fetal alcohol spectrum disorder: A scoping review

Previous reviews have examined annual mean costs of care for individuals with fetal alcohol spectrum disorder (FASD), costs of the health burden, costs to the justice system, productivity losses for caregivers, and both the monetary and nonmonetary costs of reduced quality of life. However, because there have been no published reviews focused on understanding the resource implications and specific service features for the assessment and diagnostic process for FASD, the current scoping review investigated the available evidence on these topics. Eligible studies were identified through a systematic search of six databases and included if they contained information on the potential costs or models of care associated with undertaking an assessment for FASD. Data were charted, underwent content analysis, and were reported according to the PRISMA extension for scoping reviews. Eleven studies were included in the final qualitative synthesis. The primary patient costs were attributed to the lengthy time required for diagnosis (up to 47 h). The primary service costs were attributed to costs of clinicians and support personnel and the involvement of multidisciplinary teams in the assessment process. Estimates of the specific dollar values of diagnostic costs were limited and varied between studies. Several models of care were explored, primarily in Canadian clinics, which aimed to capitalize on available services to improve accessibility and patient care and reduce service costs. This study provides important preliminary insights into the resource implications and models of care involved in the diagnostic assessment of FASD. However, the low number of available studies and variability in available data highlight the need for formal costing studies and detailed information gathering on available models of care to inform future clinical practice and policy development.