Author/Authors :
Lynch, Frances L. Kaiser Permanente Northwest - Center for Health Research, Portland, USA , Peterson, Edward L. Public Health Sciences - Henry Ford Health System, Detroit, USA , Lu, Christine Y. Department of Population Medicine - Harvard Medical School, Boston, USA , Hu, Yong Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI 48116 USA , Rossom, Rebecca C. HealthPartners - Institute for Education and Research, Bloomington, USA , Waitzfelder, Beth E. Kaiser Permanente Hawaii - Center for Health Research, Honolulu, USA , Owen-Smith, Ashli A. School of Public Health - Georgia State University - Urban Life Building, Atlanta, USA , Hubley, Samuel Department of Family Medicine - University of Colorado, Denver, USA , Prabhakar, Deepak Behavioral Health Services - Henry Ford Health System, Detroit, USA , Keoki Williams, L. HealthPartners - Institute for Education and Research, Bloomington, USA , Beck, Arne HealthPartners - Institute for Education and Research, Bloomington, USA , Simon, Gregory E. HealthPartners - Institute for Education and Research, Bloomington, USA , Ahmedani, Brian K. HealthPartners - Institute for Education and Research, Bloomington, USA
Abstract :
Background
Prior 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.
Methods
We 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.
Results
All 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.
Conclusions
Substance 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.
