University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.
Institut national de santé publique du Québec, Montreal, Quebec, Canada.
JAMA Psychiatry. 2022 Jul 1;79(7):710-717. doi: 10.1001/jamapsychiatry.2022.1025.
Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.
To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders.
DESIGN, SETTING, AND PARTICIPANTS: In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders.
Confirmed suicide attempts among females 8 to 19 years of age.
The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up.
Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders.
In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.
自杀未遂在女性青少年中很常见，但对于自杀未遂后物质使用障碍的后续发展知之甚少。
评估女性在 20 岁之前自杀未遂与未来物质使用障碍风险之间的关联。
设计、地点和参与者：在这项纵向队列研究中，8 至 19 岁的女性（此后称为青少年）自杀未遂者与 1989 年 4 月 1 日至 2019 年 3 月 31 日期间无自杀企图的女性青少年相匹配。在魁北克，加拿大，对队列进行了 31 年的随访，总随访时间为 2409396 人年，以确定随后发生的物质使用障碍。
8 至 19 岁女性确认的自杀未遂。
主要结局是以后生活中因物质使用障碍住院。使用 Cox 比例风险回归模型估计自杀未遂与物质使用障碍之间的关联的风险比（HR）和 95%置信区间，并根据基线年龄、精神疾病、资源有限的社会经济地位和随访开始时的年份进行调整。
在 122234 名女性青少年（平均[SD]年龄 15.6[1.9]岁）中，5840 名（4.8%）自杀未遂，4341 名（3.6%）发生物质使用障碍。与 116394 名未尝试自杀的匹配女性青少年（95.2%）相比，尝试自杀者在随访期间因任何物质使用障碍住院的风险更高（HR，6.03；95%CI，5.39-6.77），尤其是镇静或催眠药物使用障碍（HR，32.24；95%CI，23.29-44.64）。自杀未遂与镇静或催眠药物使用障碍的发生相关，长达 5 年（HR，66.69；95%CI，34.72-128.09），尽管所有物质的风险在 30 年后仍居高不下。与没有自杀企图的女性青少年相比，有 3 次或更多次自杀企图的女性青少年物质使用障碍的风险增加 21.20 倍（95%CI，13.53-32.90），而有 1 次自杀企图的女性青少年物质使用障碍的风险增加 5.70 倍（95%CI，5.08-6.41）。
在这项队列研究中，与未尝试自杀的女性青少年相比，自杀未遂的女性青少年随后发生物质使用障碍的风险增加。这些发现表明，对自杀未遂的女性青少年进行更密切的管理和预防物质使用可能是有益的。
