Abstract
BackgroundSubstance use disorders are a major risk factor for suicide. However, less is known about specific risk factors for suicide in people with substance use disorders.MethodsThis population cohort study assessed suicide among people treated for drug use disorders in Denmark 2000–2010, and described risk factors for completed suicide. Data from 27,942 individuals enrolled in treatment were linked to national registers and matched with controls without drug use disorder and with (n = 138,136) or without psychiatric history (n = 1574). Competing risk regression was used to identify risk factors of completed suicide.ResultsThere were 163 suicides among patients with a history of drug treatment (0.6% of patients). Increased risk was associated with younger age at enrolment (hazard ratio [HR] = 0.97, 95% confidence interval (CI): 0.95, 0.98), history of psychiatric care (HR = 1.96, CI 95%: 1.39, 2.77), opioid use (HR = 1.81, 95% CI: 1.23, 2.68), and alcohol use (HR = 1.56, 95% CI: 1.09, 2.23). Lower risk was associated with cannabis use (HR = 0.69, 95% CI: 0.50, 0.96). Compared with age- and gender-matched controls without a history of treatment for substance use disorders or recent psychiatric care, the standardized mortality ratio due to suicide was 7.13 for people with drug use disorder without a history of psychiatric care (95% CI: 5.81, 8.44), 13.48 for people with drug use disorder and psychiatric history (95% CI: 9.75, 17.22), and 13.61 for people with psychiatric history only (95% CI: 6.72, 20.50).ConclusionsRisk of suicide is increased among people with drug use disorders. Access to treatment for co-morbid mental health problems for people with drug use disorders could potentially reduce risk of suicide.
Highlights
Substance use disorders are a major risk factor for suicide
In the sample of people treated for drug use disorder (DUD), 163 (0.6%) patients had completed suicide, of which 52.1% had used violent methods, and 47.9% had died from poisonings
Summary of findings Using multiple Danish national registers, we examined whether excess mortality due to suicide exists among people treated for DUD, and identified risk factors associated with completed suicide between 2000 and 2010
Summary
Substance use disorders are a major risk factor for suicide. Less is known about specific risk factors for suicide in people with substance use disorders. Several meta-analytic studies have reported an association between substance use, including alcohol and illicit drug use on the one hand, and suicidal ideation, suicide attempts, and suicide death on the other [3, 4]. A recent meta-analysis found that in case-control psychological autopsy studies, the presence of a drug use disorder (DUD) was associated with a 7-fold increase in suicide [5]. Previous studies have reported significant associations between the misuse of prescription drugs and suicidal ideation or suicide [6, 7].
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