{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:05:47Z","timestamp":1785434747489,"version":"3.56.0"},"reference-count":51,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a cross-sectional survey between April and June 2024 among PWUO (N\u2009=\u2009199) 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u201311.7) were more likely to report SI, while those who were aware of naloxone (aOR: 0.2; 95% CI: 0.1\u20130.6) were less likely to report SI in the past two weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354745","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:30:52Z","timestamp":1785432652000},"page":"e0354745","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Suicidal ideation, mental health services, and barriers to care among syringe services program clients who use opioids"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5590-4133","authenticated-orcid":true,"given":"Kiran","family":"Paudel","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7121-7421","authenticated-orcid":true,"given":"Kamal","family":"Gautam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sherry","family":"Pagoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ran","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Wickersham","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frederick L.","family":"Altice","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandesh","family":"Bhusal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. 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Provisional Numbers and Rates of Suicide by Month and Demographic Characteristics: United States, 2020 2025. 2025."},{"issue":"1","key":"pone.0354745.ref006","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1056\/NEJMra1802148","article-title":"Understanding Links among Opioid Use, Overdose, and Suicide","volume":"380","author":"ASB Bohnert","year":"2019","journal-title":"N Engl J Med"},{"key":"pone.0354745.ref007","doi-asserted-by":"crossref","first-page":"115821","DOI":"10.1016\/j.psychres.2024.115821","article-title":"Substance addictions and suicidal thoughts and behaviors: Evidence from a multi-wave epidemiological study","volume":"334","author":"A Giugovaz","year":"2024","journal-title":"Psychiatry Res"},{"issue":"1","key":"pone.0354745.ref008","article-title":"Suicide, opioids, chronic pain, and mental health disorders: a narrative review","volume":"1","year":"2022","journal-title":"Addiction and Substance Abuse"},{"key":"pone.0354745.ref009","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1353\/eca.2017.0005","article-title":"Mortality and morbidity in the 21st century","volume":"2017","author":"A Case","year":"2017","journal-title":"Brookings Pap Econ Act"},{"key":"pone.0354745.ref010","doi-asserted-by":"crossref","first-page":"101696","DOI":"10.1016\/j.eclinm.2022.101696","article-title":"National trends of suicidal ideation and mental health services use among US adults with opioid use disorder, 2009\u20132020","volume":"54","author":"PJ Na","year":"2022","journal-title":"EClinicalMedicine"},{"issue":"2","key":"pone.0354745.ref011","doi-asserted-by":"crossref","first-page":"178","DOI":"10.15288\/jsad.2012.73.178","article-title":"Suicidal ideation and suicide attempt across stages of nonmedical prescription opioid use and presence of prescription opioid disorders among U.S. adults","volume":"73","author":"SJ Kuramoto","year":"2012","journal-title":"J Stud Alcohol Drugs"},{"key":"pone.0354745.ref012","doi-asserted-by":"crossref","first-page":"209270","DOI":"10.1016\/j.josat.2023.209270","article-title":"\u201cI think we\u2019re getting better but we\u2019re still not there\u201d: Provider-based stigma and perceived barriers to care for people who use opioids (PWUO)","volume":"159","author":"K McLean","year":"2024","journal-title":"J Subst Use Addict Treat"},{"issue":"7","key":"pone.0354745.ref013","article-title":"Racial and Ethnic Factors and Opioid Use Disorder Treatment After an Emergency Department Visit","volume":"8","author":"Jr Coupet E","year":"2025","journal-title":"JAMA Netw Open"},{"key":"pone.0354745.ref014","doi-asserted-by":"crossref","DOI":"10.1177\/0033354920936233","article-title":"Making the case for syringe services programs","volume":"135","author":"JM Adams","year":"2020","journal-title":"Public Health Reports"},{"issue":"1","key":"pone.0354745.ref015","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s13722-023-00394-x","article-title":"Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature","volume":"18","author":"A Jakubowski","year":"2023","journal-title":"Addict Sci Clin Pract"},{"issue":"4","key":"pone.0354745.ref016","doi-asserted-by":"crossref","first-page":"435","DOI":"10.2105\/AJPH.2024.307583","article-title":"Funding and delivery of syringe services programs in the United States, 2022","volume":"114","author":"SN Facente","year":"2024","journal-title":"American Journal of Public Health"},{"key":"pone.0354745.ref017","doi-asserted-by":"crossref","first-page":"100421","DOI":"10.1016\/j.ssmqr.2024.100421","article-title":"Financial barriers, facilitators, and strategies among syringe services programs in the U.S., and their impact on implementation and health outcomes","volume":"5","author":"CF Akiba","year":"2024","journal-title":"SSM Qual Res Health"},{"issue":"2","key":"pone.0354745.ref018","first-page":"145","article-title":"Screening and Assessing Suicide Risk in Medical Settings: Feasible Strategies for Early Detection","volume":"21","author":"LM Horowitz","year":"2023","journal-title":"Focus (Am Psychiatr Publ)"},{"key":"pone.0354745.ref019","author":"EK Cheng","year":"2017"},{"issue":"10","key":"pone.0354745.ref020","article-title":"Risk for Suicide Attempts Assessed Using the PHQ-9M. 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Archives of Internal Medicine","volume":"158","author":"K Bush","year":"1998"},{"issue":"7","key":"pone.0354745.ref034","doi-asserted-by":"crossref","first-page":"1208","DOI":"10.1111\/j.1530-0277.2007.00403.x","article-title":"AUDIT-C as a brief screen for alcohol misuse in primary care","volume":"31","author":"KA Bradley","year":"2007","journal-title":"Alcohol Clin Exp Res"},{"issue":"1","key":"pone.0354745.ref035","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1177\/1078345814557513","article-title":"Validation of a Brief Measure of Opioid Dependence: The Rapid Opioid Dependence Screen (RODS)","volume":"21","author":"JA Wickersham","year":"2015","journal-title":"J Correct Health Care"},{"key":"pone.0354745.ref036","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/1751-0473-3-17","article-title":"Purposeful selection of variables in logistic regression","volume":"3","author":"Z Bursac","year":"2008","journal-title":"Source Code Biol 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