Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration

Bohnert, Kipling M.; Ilgen, Mark A.; Louzon, Samantha A.; McCarthy, John F.; Katz, Ira R.

doi:10.1111/add.13774

Cited by 226 publications

(167 citation statements)

References 26 publications

(27 reference statements)

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“…In this nested case–control study performed in a large French cohort of PLHIV in the cART era, we found that most factors associated with suicide mortality among PLHIV were similar to those of the general population . Not having children and psychological morbidity such as active or substituted drug consumption, alcohol intake > 20 g/day or a history of abuse, a history of depressive disorder and/or of attempted suicide, and intake of psychotropic drugs were significantly associated with death by suicide, whereas age, gender, country of birth, positive HCV serology and HIV‐related factors, such as AIDS status, use of cART, nadir and current CD4 counts and HIV viral load, were not found to be associated with an increased risk of suicide.…”

Section: Discussionmentioning

confidence: 78%

“…In the general population, severe mental illness and substance use disorders have previously been associated with excess suicide mortality . In a British cohort of 18 201 patients with severe mental illness, the age‐ and sex‐standardized mortality ratio for suicide was seven‐fold higher than in the general population .…”

Section: Discussionmentioning

confidence: 96%

“…In a British cohort of 18 201 patients with severe mental illness, the age‐ and sex‐standardized mortality ratio for suicide was seven‐fold higher than in the general population . In a cohort of > 4.8 million men and women receiving Veterans Health Administration care in the USA, a current diagnosis of any substance use disorder, and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine or other psychostimulant, sedative hypnotic and anxiolytic use disorders were all associated with an elevated risk of suicide in both men and women . Among PLHIV, histories of injecting drug use, psychiatric treatment and suicidal ideation have also been independently associated with suicide mortality .…”

Section: Discussionmentioning

confidence: 99%

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Factors associated with deaths from suicide in a French nationwide HIV‐infected cohort

et al. 2018

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Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Factors associated with deaths from suicide in a French nationwide HIV‐infected cohort

et al. 2018

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“…This provides food for thought that the lack of adequate treatment modalities might lead to societal exclusion, and even criminalization, of this group [6]. This leads to an extremely problematic situation, as there is apparently lack of attention from scholars, clinical agencies, donors and governmental-funded bodies to invest in the development and adaptation of evidence-based treatment modalities for this group.…”

Section: Intellectually Disabled and Addicted: A Call For Evidence Bamentioning

confidence: 99%

Response to Aubin et al. (2017)

2017

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The journal publishes both invited and unsolicited letters. ASSOCIATIONS BETWEEN SUBSTANCE USE DISORDERS AND SUICIDE MORTALITY RISK SHOULD BE ADJUSTED FOR TOBACCO USE DISORDERIn January 2014, Bohnert et al. [1] reported in Addiction an excess risk of death by suicide in individuals diagnosed with tobacco use disorder. Their findings derived from a cohort of the US Veterans Health Administration (VHA) records and included all individuals who received VHA services in fiscal year (FY) 2005 and who were alive at the beginning of FY 2006 (n = 4 863 086). In an unadjusted, bivariate model, tobacco use disorder was associated significantly with an increased risk of suicide [hazard ratio (HR) = 1.88; 95% confidence interval (CI) = 1.76-2.02). After adjustment for a number of confounders-including substance use disorders-the association, although attenuated, remained significant (HR = 1.36; 95% CI = 1.27-1.46). This paper added strong evidence to the already well-demonstrated increased independent risk of suicide death among smokers [2][3][4][5].The reading of the recent paper of Bohnert et al.[6] in the same journal triggered some level of surprise. The authors, reportedly using the same database of individuals who received VHA services in FY 2005 and who were alive at the beginning of FY 2006 (n = 4 863 086), aimed to estimate associations between substance use disorders and suicide. The authors specified HRs between each alcohol, cocaine, cannabis, opioid, amphetamine, psychostimulant and sedatives use disorders, but not tobacco use disorder and death by suicide, in unadjusted and adjusted models. In the adjusted models, adjustment was made for many possible confounders (age, Charlson comorbidity index, co-occurring psychiatric conditions such as depression, schizophrenia, bipolar disorder, post-traumatic stress disorder and other anxiety disorders) but, astonishingly, not for tobacco use disorder or smoking.Thus, the authors demonstrated in 2014 [1] that tobacco use disorder was associated significantly with suicide mortality after adjusting for substance use disorders. The 2017 paper by the same authors [2] using the same database seems to ignore their own previous finding. Declarations of interestNone.Keywords Cohort, epidemiology, methods, psychiatric disorders, smoking, substance use, suicide, tobacco use. RESPONSE TO AUBIN ET AL. (2017)We appreciate the comments on our paper by Aubin and colleagues [1], and agree that tobacco use disorder is a potentially important risk factor for suicide. Nonetheless, given preliminary evidence suggesting potential male-female differences with respect to other substance use disorders (SUDs) and the risk of suicide, the primary objectives of our most recent paper [2] were to estimate and compare other SUD-suicide associations between men and women in the US Veterans Health Administration (VHA). Within the paper, we acknowledged that incomplete adjustment for confounding factors, measured or unmeasured, was a potential study limitation. We elaborated further that,

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“…Opioids, a class of drugs that includes both illicit substances (e.g., heroin) and prescription medications (e.g., morphine, oxycodone, and codeine), account for over 2.5 million substance use disorders in the United States every year (American Society of Addiction Medicine [ASAM, ]) and resulted in over 33,000 overdose deaths in 2015 and 34,000 in 2016 (ASAM, ). In addition, although individuals with substance use disorders in general have been found to exhibit a 54% increase in risk for death by suicide (Bohnert, Ilgen, Louzon, McCarthy, & Katz, ; Poorolajal, Haghtalab, Farhadi, & Darvishi, ; Schneider, ), there is increasing evidence that opioid use disorders in particular are associated with heightened suicidal ideation, suicide attempts, and completed suicide (Ashrafioun, Bishop, Conner, & Pigeon, ; Bohnert et al., ; Kuramoto, Chilcoat, Ko, & Martins, ; Wilcox, Conner, & Caine, ). For example, it is estimated that 32–48% of opioid‐dependent individuals attempt suicide at least once (Roy, ; Trémeau et al., ), and individuals who seek treatment for opioid dependence are 13.5 times more likely to die by suicide than the general population (Wilcox et al., ).…”

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confidence: 99%

The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts

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Tull

Butterworth

et al. 2019

Suicide & Life Threat Behav

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Objective Opioid use disorders are associated with heightened suicidal ideation, suicide attempts, and suicide death. This study aimed to examine the extent to which opioid differentiates between those with suicide attempts from those with lifetime suicidal ideation but no history of attempt. Methods Participants were drawn from the US National Guard and a residential substance use treatment facility. Multinomial logistic regression was utilized to determine the extent to which a lifetime history of nonmedical opioid use differentiated between (1) individuals with no lifetime history of suicidal ideation or attempt, (2) individuals with a history of suicidal ideation but no attempt, and (3) individuals with a history of at least one suicide attempt. Results History of opioid use among National Guard personnel and opioid use disorders among substance‐dependent patients were associated with an increased likelihood of having at least one suicide attempt relative to both a history of suicidal ideation but no attempts and no history of ideation or attempts. Findings held when accounting for lifetime nonmedical use of other substances and the presence of other lifetime substance use disorders. Conclusions Results highlight the importance of assessing for suicide risk among opioid users.

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Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration

Cited by 226 publications

References 26 publications

Factors associated with deaths from suicide in a French nationwide HIV‐infected cohort

Factors associated with deaths from suicide in a French nationwide HIV‐infected cohort

Response to Aubin et al. (2017)

The Role of Opioid Use in Distinguishing between Suicidal Ideation and Attempts

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