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The role of substance use disorders in the transition from suicide attempt to suicide death : a record linkage study of a Swedish cohort

Edwards, Alexis C. LU ; Ohlsson, Henrik LU ; Sundquist, Jan LU ; Crump, Casey LU ; Mościcki, Eve ; Sundquist, Kristina LU and Kendler, Kenneth S. (2024) In Psychological Medicine 54(1). p.90-97
Abstract

BACKGROUND: Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts. METHODS: We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt. RESULTS: In... (More)

BACKGROUND: Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts. METHODS: We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt. RESULTS: In univariate models, risk of suicide death was higher among individuals with any SUD registration [hazard ratios (HRs) = 2.68-3.86]. In multivariate models, effects of specific SUDs were attenuated, but remained elevated for AUD (HR = 1.86 95% confidence intervals 1.68-2.05), opiates [HR = 1.58 (1.37-1.82)], sedatives [HR = 1.93 (1.70-2.18)], and multiple substances [HR = 2.09 (1.86-2.35)]. In secondary analyses, the effects of most, but not all, SUD were exacerbated by higher levels of genetic liability to suicide death, and among individuals who were younger at their index suicide attempt. CONCLUSIONS: In the presence of a strong predictor of suicide death - a prior attempt - substantial predictive power is still attributable to SUDs. Individuals with SUDs may warrant additional suicide screening and prevention efforts, particularly in the context of a family history of suicidal behavior or early onset of suicide attempt.

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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
cohort study, registry, substance use disorders, suicide attempt, suicide death
in
Psychological Medicine
volume
54
issue
1
pages
8 pages
publisher
Cambridge University Press
external identifiers
  • pmid:36349370
  • scopus:85184136560
ISSN
1469-8978
DOI
10.1017/S0033291722002240
language
English
LU publication?
yes
id
b0146fde-e5e7-4af3-8ede-d950adf4637c
date added to LUP
2024-02-27 14:24:05
date last changed
2024-04-26 18:04:35
@article{b0146fde-e5e7-4af3-8ede-d950adf4637c,
  abstract     = {{<p>BACKGROUND: Suicidal behavior and substance use disorders (SUDs) are important public health concerns. Prior suicide attempts and SUDs are two of the most consistent predictors of suicide death, and clarifying the role of SUDs in the transition from suicide attempt to suicide death could inform prevention efforts. METHODS: We used national Swedish registry data to identify individuals born 1960-1985, with an index suicide attempt in 1997-2017 (N = 74 873; 46.7% female). We assessed risk of suicide death as a function of registration for a range of individual SUDs. We further examined whether the impact of SUDs varied as a function of (i) aggregate genetic liability to suicidal behavior, or (ii) age at index suicide attempt. RESULTS: In univariate models, risk of suicide death was higher among individuals with any SUD registration [hazard ratios (HRs) = 2.68-3.86]. In multivariate models, effects of specific SUDs were attenuated, but remained elevated for AUD (HR = 1.86 95% confidence intervals 1.68-2.05), opiates [HR = 1.58 (1.37-1.82)], sedatives [HR = 1.93 (1.70-2.18)], and multiple substances [HR = 2.09 (1.86-2.35)]. In secondary analyses, the effects of most, but not all, SUD were exacerbated by higher levels of genetic liability to suicide death, and among individuals who were younger at their index suicide attempt. CONCLUSIONS: In the presence of a strong predictor of suicide death - a prior attempt - substantial predictive power is still attributable to SUDs. Individuals with SUDs may warrant additional suicide screening and prevention efforts, particularly in the context of a family history of suicidal behavior or early onset of suicide attempt.</p>}},
  author       = {{Edwards, Alexis C. and Ohlsson, Henrik and Sundquist, Jan and Crump, Casey and Mościcki, Eve and Sundquist, Kristina and Kendler, Kenneth S.}},
  issn         = {{1469-8978}},
  keywords     = {{cohort study; registry; substance use disorders; suicide attempt; suicide death}},
  language     = {{eng}},
  number       = {{1}},
  pages        = {{90--97}},
  publisher    = {{Cambridge University Press}},
  series       = {{Psychological Medicine}},
  title        = {{The role of substance use disorders in the transition from suicide attempt to suicide death : a record linkage study of a Swedish cohort}},
  url          = {{http://dx.doi.org/10.1017/S0033291722002240}},
  doi          = {{10.1017/S0033291722002240}},
  volume       = {{54}},
  year         = {{2024}},
}