Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Department of Psychiatry, Virginia Commonwealth University, Richmond, Virginia, USA.
Br J Psychiatry. 2020 Dec;217(6):710-716. doi: 10.1192/bjp.2020.122.
Alcohol use disorder (AUD) is common and associated with increased risk of suicide.
To examine healthcare utilisation prior to suicide in persons with AUD in a large population-based cohort, which may reveal opportunities for prevention.
A national cohort study was conducted of 6 947 191 adults in Sweden in 2002, including 256 647 (3.7%) with AUD, with follow-up for suicide through 2015. A nested case-control design examined healthcare utilisation among people with AUD who died by suicide and 10:1 age- and gender-matched controls.
In 86.7 million person-years of follow-up, 15 662 (0.2%) persons died by suicide, including 2601 (1.0%) with AUD. Unadjusted and adjusted relative risks for suicide associated with AUD were 8.15 (95% CI 7.86-8.46) and 2.22 (95% CI 2.11-2.34). Of the people with AUD who died by suicide, 39.7% and 75.6% had a healthcare encounter <2 weeks or <3 months before the index date respectively, compared with 6.3% and 25.4% of controls (adjusted prevalence ratio (PR) and difference (PD), <2 weeks: PR = 3.86, 95% CI 3.50-4.25, PD = 26.4, 95% CI 24.2-28.6; <3 months: PR = 2.03, 95% CI 1.94-2.12, PD = 34.9, 95% CI 32.6-37.1). AUD accounted for more healthcare encounters within 2 weeks of suicide among men than women (P = 0.01). Of last encounters, 48.1% were in primary care and 28.9% were in specialty out-patient clinics, mostly for non-psychiatric diagnoses.
Suicide among persons with AUD is often shortly preceded by healthcare encounters in primary care or specialty out-patient clinics. Encounters in these settings are important opportunities to identify active suicidality and intervene accordingly in patients with AUD.
酒精使用障碍（AUD）很常见，并且与自杀风险增加有关。
在一个大型基于人群的队列中，检查有 AUD 的人自杀前的医疗保健利用情况，这可能揭示预防的机会。
对 2002 年瑞典的 6947191 名成年人进行了一项全国性队列研究，其中包括 256647 名（3.7%）有 AUD 的成年人，通过 2015 年追踪自杀情况。嵌套病例对照设计检查了 AUD 患者自杀死亡的医疗保健利用情况，并与 10：1 年龄和性别匹配的对照进行了比较。
在 8670 万个人随访年中，有 15662 人（0.2%）死于自杀，其中 2601 人（1.0%）有 AUD。未经调整和调整后的 AUD 与自杀相关的相对风险分别为 8.15（95%CI 7.86-8.46）和 2.22（95%CI 2.11-2.34）。在 AUD 自杀患者中，分别有 39.7%和 75.6%的人在指数日期前 2 周或 3 个月内有医疗接触，而对照者中分别有 6.3%和 25.4%（调整后的患病率比（PR）和差异（PD），<2 周：PR = 3.86，95%CI 3.50-4.25，PD = 26.4，95%CI 24.2-28.6；<3 个月：PR = 2.03，95%CI 1.94-2.12，PD = 34.9，95%CI 32.6-37.1）。AUD 导致男性自杀前 2 周内的医疗保健接触次数多于女性（P = 0.01）。在最后一次就诊中，48.1%在初级保健就诊，28.9%在专科门诊就诊，主要是为了非精神科诊断。
AUD 患者的自杀通常在自杀前不久就有初级保健或专科门诊就诊。这些环境中的就诊是识别活动性自杀倾向并相应干预 AUD 患者的重要机会。
