Metaanalysis of Mood and Substance Use Disorders in Proximal Risk for Suicide Deaths

Abstract

Evidence for proximal risk factors for suicide is based on case-control psychological autopsy studies, with these reports showing that mood and substance use disorders are the most prevalent mental disorders among suicide decedents worldwide and are associated with marked risk. However, moderators of risk and the degree of risk associated with (nonalcohol) drug use disorder are unknown. A comprehensive search was used to identify 35 case-control psychological autopsy studies published worldwide over a 30-year period that were metaanalyzed using random effects models. Major depression, odds ratio (95% confidence interval) = 9.14 (5.53, 15.09), and drug use disorder, OR (95% CI) = 7.18 (3.22, 16.01), had large effect sizes, among other results. Risk estimates associated with major depression were greater in studies with a larger proportion of women and those conducted in Asia compared with other regions. There was no evidence of publication bias or that any one study had a disproportionate impact on findings. Risk for suicide associated with major depression appears to be moderated by sex and/or world region. Drug use disorder is a potent risk factor, illustrating the importance of assessing drug use in clinical risk assessment.

Gender differences and similarities in aggression, suicidal behaviour, and psychiatric comorbidity in borderline personality disorder

“…Banzhaf et al observed that a higher percentage of men with BPD had comorbid narcissistic (25% vs. 2.63%) and antisocial personality disorders (18% vs. 12%) compared to women with BPD. Lower levels of education, higher aggression and impulsivity, alcohol and other substance use disorders, antisocial, narcissistic, paranoid, and schizotypal personality disorders are associated with an increased risk of dying by suicide .…”

“…Multiple lines of evidence suggest that alcohol and other substance use disorders are associated with suicide mortality . For example, a meta‐analysis of 31 studies showed that alcohol use disorder is significantly associated with death by suicide .…”

“…A study of the use of alcohol before suicide in the United States demonstrated that male and female decedents exhibited, respectively, a sixfold and a 10‐fold increased risk of being intoxicated before their death after confounders were considered . A meta‐analysis of 35 case–control psychological autopsy studies published worldwide demonstrated that in individuals with non‐alcohol drug use disorders, risk of dying by suicide is also significantly increased .…”

Suicide among people treated for drug use disorders: a Danish national record-linkage study

“…presence of a drug use disorder (DUD) was associated with a 7-fold increase in suicide (5). Further, previous studies have reported significant associations between the misuse of prescription drugs and suicidal ideation or suicide (6,7).…”

Challenges Associated with the Use of Policy to Identify and Manage Risk for Suicide and Interpersonal Violence Among Veterans and Other Americans

“…This is not to suggest that there is no value associated with the assessment of risk factors to inform clinical or preventive services. For instance, major depression is widely recognized as a strong indicator of proximal risk for suicide and continued support for routine assessment is warranted (Conner et al 2017). While associations between impaired decision making and risk for suicide have been found (Deisenhammer et al 2018; Szanto et al 2018) and preliminary evidence support the use of strategies to encourage healthy decision making for suicide prevention (Barnes et al 2017), evidence supporting a link between financial management and imminent risk for suicide is lacking.…”