Results from a cohort study published in JAMA Psychiatry suggest that young women with a history of prior suicide attempt were at greater risk for subsequent substance use disorder. While the high prevalence of suicidality among female youths is well-established, this is the first analysis to describe the related risk of substance use in the years following an attempt.
This longitudinal cohort study enrolled female patients who were hospitalized for a suicide attempt in Quebec, Canada between April 1, 1989 and March 31, 2019. Eligible patients were aged 8 to 20 years at the time of attempt.
Patients with a prior suicide attempt were matched in a 1:20 ratio to female youth with no attempt. The main outcome measure was hospitalization for a substance use disorder.
Cox proportional hazard models were used to assess the relative risk for substance use disorder among patients with and without prior suicide attempt. Models were adjusted for preexisting mental illness and socioeconomic status. The incidence rates of substance use disorders were also calculated for each study group.
The study cohort comprised 122,234 female youth of aged a mean of 15.6±1.9 years, among whom 5840 (4.8%) attempted suicide between 1989 and 2019. Over a cumulative follow-up of 2,409,396 person-years, 4341 patients (3.6%) were hospitalized for substance use disorders, including 1104 (25.4%) with a prior suicide attempt. Among women with a prior suicide attempt, the incident rate of hospitalization for substance use disorder was 106.9 events per 10,000 person-years (95% confidence interval [CI], 100.7-113.4).
Among women with no prior attempt, the rate was just 14.0 (95% CI, 13.6-14.5) per 10,000 person-years. In adjusted regression models, female youths who attempted suicide were over 6 times more likely to develop a substance use disorder (hazard ratio [HR], 6.03; 95% CI, 5.39-6.77). The risk for substance use disorder was greatest in the 5-year period after the attempt, though remained elevated throughout follow-up. Women with 3 or more suicide attempts had the greatest risk for substance use disorder compared with women with no attempts (HR, 21.10; 95% CI, 13.53-32.90).
Regarding specific substances, suicide attempt was most strongly associated with sedative or hypnotic (HR, 32.24; 95% CI, 23.29-44.64) and hallucinogen (HR, 16.65; 95% CI, 8.26-33.59) use disorders. Risk was also substantially elevated for cocaine (HR, 7.89; 95% 5.93-10.49), stimulant (HR, 8.23; 95% CI, 6.26-10.81), alcohol (HR, 9.46; 95%CI, 8.00-11.18), opioid (HR, 4.93; 95% CI, 3.63-6.70), and cannabis (HR, 5.80; 95% CI, 4.68-7.18) use disorders.
Results from this large cohort study underline the risk for substance use disorder among female youth with a prior suicide attempt. Compared with the general population, women with a prior suicide attempt remained at increased risk for substance use disorder for 15 or more years after the attempt. As study limitations, investigators noted that only hospital discharge data were used, thus, results may not be generalizable to patients treated in an outpatient setting.
“The findings of this cohort study suggest that suicide attempts by female youths may be associated with short- and long-term risk for developing substance use disorders, especially sedative or hypnotic, hallucinogen, and alcohol use disorders,” the authors wrote.
“Susceptible youths may benefit from long-term psychosocial or pharmaceutical therapy by a multidisciplinary team beginning immediately after their first suicide attempt to address mental health problems and prevent later substance misuse.”
Auger N, Chadi N, Ayoub A, Brousseau É, Low N. Suicide attempt and risk of substance use disorders among female youths. JAMA Psychiatry. Published online May 11, 2022. doi:10.1001/jamapsychiatry.2022.1025