Departments of Family Medicine and Community Health and of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA.
J Psychiatr Res. 2021 Mar;135:230-236. doi: 10.1016/j.jpsychires.2021.01.035. Epub 2021 Jan 21.
Drug use disorders (DUD) are associated with psychiatric illness and increased risks of suicide. We examined health care utilization prior to suicide in adults with DUD, which may reveal opportunities to prevent suicide in this high-risk population. A national cohort study was conducted of all 6,947,191 adults in Sweden, including 166,682 (2.4%) with DUD, who were followed up for suicide during 2002-2015. A nested case-control design examined health care utilization among persons with DUD who died by suicide and 10:1 age- and sex-matched controls from the general population. In 86.7 million person-years of follow-up, 15,662 (0.2%) persons died by suicide, including 1946 (1.2%) persons with DUD. Unadjusted and adjusted relative risks of suicide associated with DUD were 11.03 (95% CI, 10.62-11.46) and 2.84 (2.68-3.00), respectively. 30.4% and 52.3% of DUD cases who died by suicide had a health care encounter within 2 weeks or 3 months before the index date, respectively, compared with 5.9% and 24.3% of controls (unadjusted prevalence ratio and difference, <2 weeks: 5.20 [95% CI, 4.76-5.67] and 24.6 percentage points [22.5-26.6]; <3 months: 2.15 [2.05-2.26] and 27.9 [25.6-30.2]). However, after adjusting for psychiatric comorbidities, these differences were much attenuated. Among DUD cases, 72.5% of last encounters within 2 weeks before suicide were in outpatient clinics, mostly for non-psychiatric diagnoses. In this large national cohort, suicide among adults with DUD was often shortly preceded by outpatient clinic encounters. Clinical encounters in these settings are important opportunities to identify suicidality and intervene accordingly in patients with DUD.
药物使用障碍（DUD）与精神疾病和自杀风险增加有关。我们研究了患有 DUD 的成年人在自杀前的医疗保健利用情况，这可能揭示了在这个高风险人群中预防自杀的机会。对瑞典所有 6947191 名成年人进行了一项全国性队列研究，其中包括 166682 名（2.4%）患有 DUD 的成年人，他们在 2002-2015 年期间接受了自杀监测。嵌套病例对照设计研究了 DUD 患者自杀死亡者和 10:1 年龄和性别匹配的普通人群对照者的医疗保健利用情况。在 8670 万个人年的随访中，有 15662 人（0.2%）死于自杀，其中包括 1946 人（1.2%）患有 DUD。未调整和调整后的 DUD 与自杀相关的相对风险分别为 11.03（95%CI，10.62-11.46）和 2.84（2.68-3.00）。在自杀的 DUD 病例中，30.4%和 52.3%在自杀索引日期前 2 周或 3 个月内有一次医疗保健接触，而对照者的比例分别为 5.9%和 24.3%（未调整的流行率比值和差异，<2 周：5.20 [95%CI，4.76-5.67]和 24.6 个百分点[22.5-26.6]；<3 个月：2.15 [2.05-2.26]和 27.9 [25.6-30.2]）。然而，在调整了精神疾病共病后，这些差异大大减弱。在 DUD 病例中，自杀前 2 周内最后一次就诊的 72.5%是在门诊，主要是为了非精神科诊断。在这项大型全国性队列研究中，患有 DUD 的成年人的自杀往往是在门诊就诊前不久发生的。在这些环境中的临床接触是识别自杀倾向并相应干预 DUD 患者的重要机会。
