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Vincent Grote,1,* Tim Wagner,1,2,* David Riedl,1,3 Alexandra Kautzky-Willer,4 Michael J Fischer,1,5,6 Oliver Scheibenbogen,2 Michael Musalek7– 9 1Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria; 2Anton Proksch Institute, Vienna, Austria; 3University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria; 4Division of Endocrinology and Metabolism, Medical University of Vienna, Vienna, Austria; 5Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria; 6Clinic for Rehabilitation Medicine, Hannover Medical School MHH, Hannover, Germany; 7Department of General Psychiatry, Sigmund Freud University, Vienna, Austria; 8Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Vienna, Austria; 9Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Berlin, Germany*These authors contributed equally to this workCorrespondence: Vincent Grote; Oliver Scheibenbogen, Email vincent.grote@rehabilitation.lbg.ac.at; oliver.scheibenbogen@api.or.atBackground: Substance use disorders (SUD) are prevalent disorders worldwide. Among other associated health problems, patients with SUD are at an increased risk of dying of suicide, with females displaying an even higher risk than males. Therefore, the aim of this study was to conduct a gender-sensitive evaluation of changes in suicidal ideation during multimodal inpatient treatment at a hospital facility specialized in treating addiction.Methods: A total of 694 patients (68.2% male) completed routine assessment including suicidal ideation, abstinence confidence, impulsivity, emotion regulation, self-efficacy and autonomy and joy both before (T1) and at the end (T2) of treatment. Mean changes were evaluated with repeated measures MANOVAs.Results: Before treatment, a total of n=127 (18.3%) of the respondents reported suicidal ideation, which was reduced to n=72 (10.4%) by the end of treatment. Among female patients, the change in reported suicidal ideation compared from T1 to T2 (21.7% vs 7.7%) was significantly higher than among male patients (T1: 16.7%%, T2: 11.6%; p=0.040). Generally, females reported worse symptoms scores and slightly higher numbers of suicidal thoughts at baseline (effect sizes ranging from η²=.008 – 0.044). While both genders significantly profited from the treatment, female patients generally showed larger improvements than male.Discussion: Our study underscores the beneficial effect of addiction-specialized inpatient treatment on suicidal ideation. Additionally, we found a substantial gender effect: while female patients generally were more distressed before treatment, they also reported higher symptom reduction during the treatment. This result highlights the need to perform more gender-sensitive research and develop more gender-sensitive treatment programs.Keywords: addiction, inpatient therapy, alcohol, drugs, gender medicine

The problem of inhomogeneous categories and the difficulty of drawing boundaries as well as individual progression of the severity of psychopathologic phenomena necessitate a change of paradigm from categorical to dimensional diagnostics. Not only pathogenetic factors but also disorder maintaining factors such as the stigmatization and the significance of the disorder for the patient must be factored into the diagnostic process to ensure therapy relevancy. In addition to this deficiency-oriented approach holistic person-centred diagnostics focuses on the integration of resources, i.e. the abilities and skills, talents and inclinations of the patient, in order to adequately help a patient to resume/live an autonomous life that is as happy as possible.