Substance use disorders and risk of suicide in a general US population: a case control study

Abstract

Background: Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortality, but most previous work has been conducted among Veterans Health Administration patients. Few studies have examined the relationship between SUDs and suicide mortality in general populations. Our study estimates the association of SUDs with suicide mortality in a general US population of men and women who receive care across eight integrated health systems. Methods:We conducted a case-control study using electronic health records and claims data from eight integrated health systems of the Mental Health Research Network. Participants were 2674 men and women who died by suicide between 2000-2013 and 267,400 matched controls. The main outcome was suicide mortality, assessed using data from the health systems and confirmed by state death data systems. Demographic and diagnostic data on substance use disorders and other health conditions were obtained from each health system. First, we compared descriptive statistics for cases and controls, including age, gender, income, and education. Next, we compared the rate of each substance use disorder category for cases and controls. Finally, we used conditional logistic regression models to estimate unadjusted and adjusted odds of suicide associated with each substance use disorder category.Results: All categories of substance use disorders were associated with increased risk of suicide mortality. Adjusted odds ratios ranged from 2.0 (CI 1.7, 2.3) for patients with tobacco use disorder only to 11.2 (CI 8.0, 15.6) for patients with multiple alcohol, drug, and tobacco use disorders. Substance use disorders were associated with increased relative risk of suicide for both women and men across all categories, but the relative risk was more pronounced in women. Conclusions:Substance use disorders are associated with significant risk of suicide mortality, especially for women, even after controlling for other important risk factors. Experiencing multiple substance use disorders is particularly risky. These findings suggest increased suicide risk screening and prevention efforts for individuals with substance use disorders are needed.

Substance Use Disorder in the COVID-19 Pandemic: A Systematic Review of Vulnerabilities and Complications

“…Suicide mortality associated with SUDs is significantly higher compared to the general population across all categories, including age, gender, income, and education, and the relative risk of suicide is more prominent in women. People with multiple alcohol, drug, and tobacco use disorders are at a particularly heightened risk of suicide [ 17 ]. In a position paper, the International Society of Addiction Medicine (ISAM) Practice and Policy Interest Group noted that people with SUDs suffer from serious health complications, including chronical infections, weakened immune systems, various respiratory, cardiovascular, and metabolic disorders, and a range of psychiatric comorbidities.…”

The Suicidal Patient

“…Psychiatric disorders, especially depression with anhedonia and/or anxiety, bipolar disorder with a mixed episode, and personality disorders, also confer a significantly increased risk [10]. Finally, any patient with a known or suspected substance use disorder should receive special attention during episodes of depression, stress, or following stated suicidal ideation [11]. Substances are believed to contribute to suicide risk either by enabling actions the victim may otherwise be unable or too afraid to take or by their effects of impairing judgment, increasing impulsivity, and worsening depressive symptoms.…”

Impact of a shelter-in-place order during the COVID-19 pandemic on the incidence of opioid overdoses

“…Previous studies have also demonstrated that economic conditions may be a strong predictor of drug-related deaths [ 18 ]. Additionally, people with SUDs are also at a particularly heightened risk of suicide [ 19 ]. While efforts to physically distance are vital to slow the spread of the virus, this may have unintended consequences on mental health and persons with SUDs are likely to suffer more greatly from the psychosocial burden [ 20 ].…”