Bohnert Kipling M, Ilgen Mark A, Louzon Samantha, McCarthy John F, Katz Ira R
Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, MI, USA.
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA.
Addiction. 2017 Jul;112(7):1193-1201. doi: 10.1111/add.13774. Epub 2017 Mar 16.
Limited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.
A cohort study using national administrative health records.
National VHA system, USA.
All VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).
The primary outcome of suicide mortality was assessed via FY 2006-2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004-2005 VHA National Patient Care Database (NPCD) records.
In unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).
Current substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co-occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.
关于特定物质使用障碍（SUDs）与自杀死亡率之间的联系，现有信息有限；然而，现有的初步证据表明，与SUDs相关的自杀风险在男性和女性中可能有所不同。本研究旨在评估接受退伍军人健康管理局（VHA）护理的男性和女性中SUDs与自杀之间的关联。
一项使用国家行政健康记录的队列研究。
美国国家VHA系统。
2005财年所有在2006财年初仍在世的VHA使用者（n = 4,863,086）。
自杀死亡率的主要结局通过2006 - 2011财年国家死亡指数（NDI）记录进行评估。当前的SUD诊断是主要的研究预测因素，通过2004 - 2005财年VHA国家患者护理数据库（NPCD）记录进行评估。
在未调整的分析中，任何当前SUD的诊断以及酒精、可卡因、大麻、阿片类、苯丙胺和镇静剂使用障碍的特定当前诊断均与男性和女性自杀风险增加显著相关[风险比（HRs）]，男性从可卡因使用障碍的1.35到镇静剂使用障碍的4.74，女性从大麻使用障碍的3.89到镇静剂使用障碍的11.36]。此外，女性中任何SUD、酒精、可卡因和阿片类使用障碍与自杀之间关系的HR估计值比男性显著更强（P < 0.05）。在对其他因素进行调整后，最显著的是共病精神疾病诊断，SUDs与自杀之间的关联明显减弱，仅在任何SUD和阿片类使用障碍中观察到女性自杀风险更高（P < 0.05）。
当前的物质使用障碍（SUDs）表明自杀风险增加，尤其是在女性中，可能是自杀风险评估策略中需要考虑的重要指标。尽管如此，其他同时存在的精神疾病可能部分解释了SUDs与自杀之间的关联，以及在女性中观察到的与SUDs相关的额外自杀风险。
