Abstract
BackgroundPrior 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.MethodsWe 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.ResultsAll 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.ConclusionsSubstance 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.
Highlights
Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortal‐ ity, but most previous work has been conducted among Veterans Health Administration patients
Our study examined the relationship between SUDS and suicide mortality in a general population drawn from 8 large integrated health systems
All individual SUD categories were significantly associated with suicide death
Summary
Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortal‐ ity, but most previous work has been conducted among Veterans Health Administration patients. The majority have focused solely on the relationship between alcohol use disorder and suicide, with few studies exploring the potential role of other SUDs [2, 4]. Most of these studies do not consider whether multiple SUDs contribute greater risk than single SUDs [11]. Most previous research has been limited to men, or to specific populations or risk groups such as veterans or psychiatric patients [12] Most of these studies have had relatively small samples, making it difficult to analyze results by subgroup, such as gender [2, 4, 8]
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