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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.

SUBMITTER: Lynch FL

PROVIDER: S-EPMC7035727 | biostudies-literature | 2020 Feb

REPOSITORIES: biostudies-literature

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

Lynch Frances L FL Peterson Edward L EL Lu Christine Y CY Hu Yong Y Rossom Rebecca C RC Waitzfelder Beth E BE Owen-Smith Ashli A AA Hubley Samuel S Prabhakar Deepak D Keoki Williams L L Beck Arne A Simon Gregory E GE Ahmedani Brian K BK

Addiction science & clinical practice 20200221 1

<h4>Background</h4>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.<h4>Methods</h4> ...[more]

PMID: 32085800

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Project description:BACKGROUND AND AIMS:Treatment-resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD. DESIGN:Nested case-control study. SETTING:Nation-wide governmental health-care registers in Sweden. CASES AND CONTROLS:Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121?669) from 2006 to 2014. Of these, 15?631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio-demographic data with five controls with depression. MEASUREMENTS:Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio-demographic covariates. FINDINGS:Having any SUD during, or ? 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [? 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70-2.05]. Increased risks for TRD were found ? 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88-2.99), opioids (aOR = 2.02; 1.48-2.75), alcohol (aOR = 1.77; CI = 1.59-1.98) and combined substance use (aOR = 2.31; 1.87-2.99). CONCLUSIONS:Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression.

Project description:ImportanceSuicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.ObjectiveTo 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.ExposuresConfirmed 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.ResultsAmong 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, 23.29-44.64). 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, 13.53-32.90) 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.

Project description:BackgroundImproved knowledge regarding socio-demographic correlates of people with substance use disorders (SUDs) is essential to better plan and provide adequate services for SUD patients and their families, and to improve our understanding of the complex mechanisms underlying progression into and development of various SUDs. This study aimed to: i) describe demographic, economic, and social correlates of people with SUDs in comparison with those of the general population and ii) compare these correlates across SUDs from licit versus illicit substances, as well as across specific SUDs.MethodsA national population-based case-control study included all SUD patients enrolled in specialized drug treatment in Norway in 2009-2010 (N = 31 245) and a population control sample, frequency-matched on age and gender (N = 31 275). Data on education level, labour market participation, income level and sources, and family/living arrangement were obtained by linkages to national registers.ResultsDemographic, economic, and social correlates of SUD patients differed substantially from those of the general population, and across specific SUDs. Among SUD patients, those with illicit - as compared to licit - SUDs were younger (mean quotient = 0.72 [0.71-0.72]), more often had low education level (RR = 1.68 [1.63-1.73]), were less often in paid work (RR = 0.74 [0.72-0.76]) and had lower income (mean quotient = 0.61 [0.60-0.62]). Comparison of patients with different SUD diagnoses revealed substantial demographic differences, including the relatively low mean age among cannabis patients and the high share of females among sedatives/hypnotics patients. Opioid patients stood out by being older, and more often out of work, receiving social security benefits, and living alone. Cocaine and alcohol patients were more often better educated, included in the work force, and had a better financial situation.ConclusionFindings revealed substantial and important differences in socio-demographic correlates between SUD patients and the general population, between SUD patients with illicit and with licit substance use, and across specific SUD patient groups.

Project description:ObjectiveTo explore the separate and joint associations of childhood adversities and 5-HTTLPR polymorphism as risk factors for substance use disorders among adults. : Design : Retrospective case-control study.SettingCases from the substance unit and controls from a representative sample of the adult general population in the metropolitan area of Murcia (Spain).ParticipantsCases were defined as outpatients 18 years old or older currently in the treatment for alcohol, opioids or cocaine use disorders in the clinical unit. Controls were randomly selected among individuals without substance use disorders who participated in the Psychiatric Enquiry to General Population in Southeast Spain-Murcia (PEGASUS-Murcia) project, a cross-sectional study of a representative sample of the adult general population. In all, 142 cases and 531 controls were interviewed and a subsample of 114 cases (80.3%) and 329 controls (62%) provided a biological sample.ExposureA history of 12 childhood adversities, lifetime mental disorders and sociodemographic variables was assessed with the Composite International Diagnostic Interview (CIDI)version 3.0). Buccal swabs were obtained to genotype the 5-HTTLPR polymorphism with the biallelic and the triallelic classification.Main outcome and measureMultivariable logistic regression models were performed to estimate adjusted ORs and 95% CI.ResultsChildhood adversities were associated with an elevated risk of substance use disorders (OR=5.77, 95% CI 3.46 to 9.61). Homozygotes for the short allele of the 5-HTTLPR polymorphism also showed the elevated risk of substance use disorders for the biallelic and triallelic classification: (1.97 (1.10 to 3.55) and 2.01 (1.11 to 3.64), respectively). No evidence for gene × environment interactions was found.ConclusionsChildhood adversities and the 5-HTTLPR polymorphism are involved in the aetiology of substance use disorders though findings exploring the existence of a gene-environment interaction were inconclusive.

Project description:ObjectiveTo study the association between parental depression and maternal antidepressant use during pregnancy with autism spectrum disorders in offspring.DesignPopulation based nested case-control study.SettingStockholm County, Sweden, 2001-07.Participants4429 cases of autism spectrum disorder (1828 with and 2601 without intellectual disability) and 43,277 age and sex matched controls in the full sample (1679 cases of autism spectrum disorder and 16,845 controls with data on maternal antidepressant use nested within a cohort (n=589,114) of young people aged 0-17 years.Main outcome measureA diagnosis of autism spectrum disorder, with or without intellectual disability.ExposuresParental depression and other characteristics prospectively recorded in administrative registers before the birth of the child. Maternal antidepressant use, recorded at the first antenatal interview, was available for children born from 1995 onwards.ResultsA history of maternal (adjusted odds ratio 1.49, 95% confidence interval 1.08 to 2.08) but not paternal depression was associated with an increased risk of autism spectrum disorders in offspring. In the subsample with available data on drugs, this association was confined to women reporting antidepressant use during pregnancy (3.34, 1.50 to 7.47, P=0.003), irrespective of whether selective serotonin reuptake inhibitors (SSRIs) or non-selective monoamine reuptake inhibitors were reported. All associations were higher in cases of autism without intellectual disability, there being no evidence of an increased risk of autism with intellectual disability. Assuming an unconfounded, causal association, antidepressant use during pregnancy explained 0.6% of the cases of autism spectrum disorder.ConclusionsIn utero exposure to both SSRIs and non-selective monoamine reuptake inhibitors (tricyclic antidepressants) was associated with an increased risk of autism spectrum disorders, particularly without intellectual disability. Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. However, assuming causality, antidepressant use during pregnancy is unlikely to have contributed significantly towards the dramatic increase in observed prevalence of autism spectrum disorders as it explained less than 1% of cases.

Dataset Information

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

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

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