Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France; FondaMental Foundation, Créteil, F-94000, France.
Assistance Publique - Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris F-75010, France; INSERM U1144, Paris, F-75006, France; Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France; Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France.
Drug Alcohol Depend. 2017 Dec 1;181:63-70. doi: 10.1016/j.drugalcdep.2017.08.037. Epub 2017 Sep 23.
Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs.
433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately.
32% Participants (N=139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues.
Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence.
自杀是一个主要的公共卫生关注点，物质使用障碍（SUD）患者经常尝试自杀，且自杀尝试的负担沉重。特别是严重的自杀尝试是一种令人担忧的尝试形式，在这些人群中，尤其是在涉及性别、成瘾合并症和物质使用模式等基本风险因素方面，基本上被忽视了。因此，我们采用了一种性别特异性方法，以确定患有多种 SUD 的门诊患者发生严重自杀尝试的风险因素。
433 名寻求治疗的门诊患者连续在专门的护理中心招募，并通过可靠的方法可靠地分类为严重、非严重和非自杀尝试者。我们还使用标准化工具描述了终生接触 SUD 的情况，包括吸烟。收集了当前的药物治疗情况，包括精神治疗情况，这些信息为精神科诊断提供了依据。使用多项回归分析确定了与每种性别中严重自杀尝试具体相关的独立因素。
32%的参与者（N=139，47%为女性，27%为男性）报告有过自杀尝试。共有 82 名严重自杀尝试者（占尝试者的 59%），男女之间无显著差异。与非自杀尝试相比，镇静剂依赖是女性发生严重自杀尝试的独立危险因素，而与非严重自杀尝试相比，镇静剂依赖是男性发生严重自杀尝试的独立危险因素。其他危险因素包括男性开始每日吸烟的时间较晚，女性有精神科住院治疗史，而当报告阿片类药物使用障碍或心境障碍时，女性发生严重自杀尝试的风险反而较低，这可能是因为治疗问题。
尽管存在一些研究局限性，但我们确定了亚组，以便更好地针对 SUD 患者进行严重自杀尝试的预防，特别是强调需要更好地预防和治疗镇静剂依赖。
