Suicide Attempt and Risk of Substance Use Disorders Among Female Youths

Abstract

IMPORTANCE Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.OBJECTIVE To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders. DESIGN, SETTING, AND PARTICIPANTSIn this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders.EXPOSURES Confirmed suicide attempts among females 8 to 19 years of age. MAIN OUTCOMES AND MEASURESThe main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up. RESULTS Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI,. Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders. CONCLUSIONS AND RELEVANCEIn this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.

Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders

“…Our study provides novel evidence that adolescent girls who attempt suicide have a greater risk of hospitalization for anorexia nervosa, bulimia nervosa, and other eating disorders up to three decades later. There is mounting evidence that adolescents who attempt suicide are more likely to have psychosocial dysfunction in adulthood (Auger et al, 2022; Goldman‐Mellor et al, 2014; Iorfino et al, 2018), as well as lower earnings, need for welfare support, and higher rates of celibacy (Orri et al, 2022). Adolescent suicide attempts have been linked with the development of substance use, mood, and personality disorders (Auger et al, 2022; Goldman‐Mellor et al, 2014; Iorfino et al, 2018).…”

“…We identified suicide attempts using codes from the 9th and 10th revisions of the International Classification of Diseases (ICD‐9 E950‐E959; ICD‐10 X60‐X84, Y87.0). These codes are for intentional self‐harm, but are used to identify suicide attempts because patients with non‐suicidal self‐injuries rarely require hospitalization and are not contained in the data (Auger et al, 2022).…”

“…We identified these confounders at the initial suicide attempt admission or during prior hospitalizations. We also measured socioeconomic deprivation at the start of follow‐up (yes, no, unknown), using a composite indicator for the most materially deprived quintile of neighborhoods based on income, education, and employment (Auger et al, 2022). These factors are potential confounders of the association between suicide attempts and eating disorders (Goldman‐Mellor et al, 2014; Goldstein & Gvion, 2019; Miranda‐Mendizabal et al, 2019).…”

“…In studies of long-term trajectories, adolescents who attempt suicide have a higher lifelong risk of psychiatric and substance use disorders (Auger et al, 2022;Goldman-Mellor et al, 2014;Iorfino et al, 2018).…”

“…In the United States, the prevalence of suicide attempts among high school girls reached 11.0% in 2019, compared with 6.6% among boys (Ivey‐Stephenson et al, 2020). In studies of long‐term trajectories, adolescents who attempt suicide have a higher lifelong risk of psychiatric and substance use disorders (Auger et al, 2022; Goldman‐Mellor et al, 2014; Iorfino et al, 2018). Early suicide attempts frequently occur in settings of emotional dysregulation and maladaptive behavior that can predispose patients to mental disorders (Smith et al, 2018).…”