Triple Vulnerability: Suicidal Ideation, Elevated Anxiety, and Alcohol Consumption and Treatment Engagement in a Partial Hospital Setting.

OBJECTIVE: Partial hospitalization programs (PHP) are acute psychiatric settings that commonly treat patients with active suicidal ideation (SI), anxiety, and alcohol use. Alcohol use is common among patients with SI and anxiety, and this triple vulnerability may negatively impact treatment engagement and outcomes in PHP. This study examined whether patients presenting with SI, elevated anxiety, and alcohol use ("triple vulnerability") demonstrated differences in PHP treatment outcomes (completing treatment, number of days attended, number of absences) compared to patients without the vulnerability. METHODS: Participants were 493 patients admitted to an Acceptance and Commitment Therapy-based PHP program in the United States between 2014-2020. Triple vulnerability was defined as reporting (1) active SI, (2) clinically elevated anxiety (CUXOS-D ≥ 20), and (3) consuming ≥ 1 alcoholic drink on a typical drinking day within the past year. Binary and linear regressions were used to assess differences in treatment completion status, number of days attended, and number of absences. RESULTS: The triple vulnerability was not significantly associated with treatment completion status or with the number of absences; it was, however, positively associated with the number of days attended at PHP. CONCLUSION: People who experience SI, clinically elevated anxiety, and who consume at least one alcoholic beverage on a typical drinking day are more likely to attend PHP for a longer duration of time, but are not any more susceptible to not finishing treatment, relative to people who do not have the triple vulnerability. Future work can benefit from exploring additional treatment outcomes that may be impacted by patients with the triple vulnerability.