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Healthcare utilisation prior to suicide in persons with alcohol use disorder : National cohort and nested case-control study

Crump, Casey LU ; Edwards, Alexis C. LU ; Kendler, Kenneth S. ; Sundquist, Jan LU and Sundquist, Kristina LU (2020) In British Journal of Psychiatry 217(6). p.710-716
Abstract

Background Alcohol use disorder (AUD) is common and associated with increased risk of suicide. Aims To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention. Method A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls. Results In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated... (More)

Background Alcohol use disorder (AUD) is common and associated with increased risk of suicide. Aims To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention. Method A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls. Results In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86-8.46) and 2.22 (95% CI 2.11-2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50-4.25, PD = 26.4, 95% CI 24.2-28.6; <3 months: PR = 2.03, 95% CI 1.94-2.12, PD = 34.9, 95% CI 32.6-37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses. Conclusions Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.

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author
; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Alcohol disorders, cohort studies, healthcare utilisation, prevention, suicide
in
British Journal of Psychiatry
volume
217
issue
6
pages
7 pages
publisher
Cambridge University Press
external identifiers
  • scopus:85097003025
  • pmid:32583752
ISSN
0007-1250
DOI
10.1192/bjp.2020.122
language
English
LU publication?
yes
id
e591a8ac-6a95-4826-988a-1b6a44632e04
date added to LUP
2020-12-10 06:57:48
date last changed
2024-05-01 22:24:27
@article{e591a8ac-6a95-4826-988a-1b6a44632e04,
  abstract     = {{<p>Background Alcohol use disorder (AUD) is common and associated with increased risk of suicide. Aims To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention. Method A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls. Results In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86-8.46) and 2.22 (95% CI 2.11-2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter &lt;2 weeks or &lt;3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), &lt;2 weeks: PR = 3.86, 95% CI 3.50-4.25, PD = 26.4, 95% CI 24.2-28.6; &lt;3 months: PR = 2.03, 95% CI 1.94-2.12, PD = 34.9, 95% CI 32.6-37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses. Conclusions Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.</p>}},
  author       = {{Crump, Casey and Edwards, Alexis C. and Kendler, Kenneth S. and Sundquist, Jan and Sundquist, Kristina}},
  issn         = {{0007-1250}},
  keywords     = {{Alcohol disorders; cohort studies; healthcare utilisation; prevention; suicide}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{710--716}},
  publisher    = {{Cambridge University Press}},
  series       = {{British Journal of Psychiatry}},
  title        = {{Healthcare utilisation prior to suicide in persons with alcohol use disorder : National cohort and nested case-control study}},
  url          = {{http://dx.doi.org/10.1192/bjp.2020.122}},
  doi          = {{10.1192/bjp.2020.122}},
  volume       = {{217}},
  year         = {{2020}},
}