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Substance abuse may indicate suicide risk in women

Among individuals receiving care within the Veterans Health Administration, substance use disorders were associated with higher risk for suicide, particularly among women.

“It is currently unknown whether the observed sex difference in suicide risk is uniform across all types of [substance use disorders]. In addition, prior analyses have not adjusted for important potential confounding factors, in particular co-occurring psychiatric conditions, which are more common among individuals with [substance use disorder],” Kipling M. Bohnert, PhD, of Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan, and colleagues wrote. “To inform [Veterans Health Administration] suicide risk assessment strategies and suicide prevention activities, a greater understanding of the sex-specific associations between [substance use disorders] and suicide is needed.”

To determine associations between substance use disorders and suicide among men and women receiving Veterans Health Administration care, researchers conducted a cohort study of national administrative health records for all Veterans Health Administration users in 2005 (n = 4,863,086).

Unadjusted analyses indicated a diagnosis of any current substance use disorder and diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were associated with increased risk for suicide. Hazard ratios ranged from 1.35 for cocaine use disorder to 4.74 for sedative use disorder among men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder among women.

Hazard ratio estimates for associations between any substance use disorder, alcohol, cocaine and opioid use disorders and suicide were significantly higher among women (P < .05).

When adjusting for other factors, including comorbid psychiatric disorders, associations between substance use disorder and suicide were significantly weakened and greater risk for suicide among females was only associated with any substance use disorder and opioid use disorder (P < .05).

“[Substance use disorders] may be important markers of suicide risk, especially among women, and may be important factors for health systems and clinicians to consider including in suicide risk assessment strategies. Nevertheless, other co-occurring psychiatric disorders may partially explain associations between [substance use disorders] and suicide, as well as the observed excess suicide risk associated with [substance use disorders] among women,” the researchers concluded. – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.