Skip to main content

Lund University Publications

LUND UNIVERSITY LIBRARIES

Health care utilization prior to suicide in adults with drug use disorders

Crump, Casey LU ; Kendler, Kenneth S. LU ; Sundquist, Jan LU ; Edwards, Alexis C. LU and Sundquist, Kristina LU (2021) In Journal of Psychiatric Research 135. p.230-236
Abstract

Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002–2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of... (More)

Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002–2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of suicide associated with DUD were 11.03 (95% CI, 10.62–11.46) and 2.84 (2.68–3.00), respectively. 30.4% and 52.3% of DUD cases who died by suicide had a health care encounter within 2 weeks or 3 months before the index date, respectively, compared with 5.9% and 24.3% of controls (unadjusted prevalence ratio and difference, <2 weeks: 5.20 [95% CI, 4.76–5.67] and 24.6 percentage points [22.5–26.6]; <3 months: 2.15 [2.05–2.26] and 27.9 [25.6–30.2]). However, after adjusting for psychiatric comorbidities, these differences were much attenuated. Among DUD cases, 72.5% of last encounters within 2 weeks before suicide were in outpatient clinics, mostly for non-psychiatric diagnoses. In this large national cohort, suicide among adults with DUD was often shortly preceded by outpatient clinic encounters. Clinical encounters in these settings are important opportunities to identify suicidality and intervene accordingly in patients with DUD.

(Less)
Please use this url to cite or link to this publication:
author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Drug abuse, Health care utilization, Substance-related disorders, Suicide
in
Journal of Psychiatric Research
volume
135
pages
7 pages
publisher
Elsevier
external identifiers
  • scopus:85099849354
  • pmid:33508541
ISSN
0022-3956
DOI
10.1016/j.jpsychires.2021.01.035
language
English
LU publication?
yes
id
6f84e0a0-3b17-49f9-a27d-bb2bdaf38cef
date added to LUP
2021-12-23 09:47:50
date last changed
2024-06-15 23:10:30
@article{6f84e0a0-3b17-49f9-a27d-bb2bdaf38cef,
  abstract     = {{<p>Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002–2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of suicide associated with DUD were 11.03 (95% CI, 10.62–11.46) and 2.84 (2.68–3.00), respectively. 30.4% and 52.3% of DUD cases who died by suicide had a health care encounter within 2 weeks or 3 months before the index date, respectively, compared with 5.9% and 24.3% of controls (unadjusted prevalence ratio and difference, &lt;2 weeks: 5.20 [95% CI, 4.76–5.67] and 24.6 percentage points [22.5–26.6]; &lt;3 months: 2.15 [2.05–2.26] and 27.9 [25.6–30.2]). However, after adjusting for psychiatric comorbidities, these differences were much attenuated. Among DUD cases, 72.5% of last encounters within 2 weeks before suicide were in outpatient clinics, mostly for non-psychiatric diagnoses. In this large national cohort, suicide among adults with DUD was often shortly preceded by outpatient clinic encounters. Clinical encounters in these settings are important opportunities to identify suicidality and intervene accordingly in patients with DUD.</p>}},
  author       = {{Crump, Casey and Kendler, Kenneth S. and Sundquist, Jan and Edwards, Alexis C. and Sundquist, Kristina}},
  issn         = {{0022-3956}},
  keywords     = {{Drug abuse; Health care utilization; Substance-related disorders; Suicide}},
  language     = {{eng}},
  pages        = {{230--236}},
  publisher    = {{Elsevier}},
  series       = {{Journal of Psychiatric Research}},
  title        = {{Health care utilization prior to suicide in adults with drug use disorders}},
  url          = {{http://dx.doi.org/10.1016/j.jpsychires.2021.01.035}},
  doi          = {{10.1016/j.jpsychires.2021.01.035}},
  volume       = {{135}},
  year         = {{2021}},
}