mardi 26 septembre 2017

ETUDE RECHERCHE tentatives de suicide graves chez les patients ambulatoires souffrant de troubles liés à la consommation de plusieurs substances

les tentatives de suicide graves chez les patients ambulatoires souffrant de troubles liés à la consommation de plusieurs substances
titre original Serious suicide attempts in outpatients with multiple substance use disorders

R. Icick a, b, c, d, h, , , E. Karsinti a, b, c, d, J-P. Lépine a, b, c, d, V. Bloch b, c, d, e,
G. Brousse f, g, F. Bellivier a, b, c, d, h,  F. Vorspan a, b, c, d
a Assistance Publique – Hôpitaux de Paris (AP-HP), Department of Psychiatry and Addiction Medicine, Groupe Hospitalier Saint-Louis – Lariboisière – Fernand Widal, Paris F-75010, France
b INSERM U1144, Paris, F-75006, France
c Paris Descartes University, Inserm UMR-S1144, Paris, F-75006, France
d Paris Diderot University, Sorbonne Paris Cité, Inserm UMR-S1144, Paris, F-75013, France
e Hospital Pharmacy, Groupe Hospitalier Saint-Louis – Lariboisière – Fernand Widal, Paris F-75010, France
f Psychiatry B-Department of Addiction Psychiatry, Université Clermont 1, UFR Médecine, EA7280, Clermont-Ferrand, France
g CHU Clermont-Ferrand, Clermont-Ferrand, F-63003, France
h FondaMental Foundation, Créteil, F-94000, France
disponible en ligne le 23 septembre 2017

Abstract
Background
Suicide is a major public health concern and suicide attempts (SA) are frequent and burdensome in people suffering from substance use disorders (SUDs). In particular, serious SAs are a preoccupying form of attempt, which remain largely overlooked in these populations, especially regarding basic risk factors such as gender, addictive comorbidity and substance use patterns. Thus, we undertook a gender-specific approach to identify the risk factors for serious SAs in outpatients with multiple SUDs.
Material and methods
433 Treatment-seeking outpatients were consecutively recruited in specialized care centers and reliably classified as serious, non-serious and non-suicide attempters. We also characterized lifetime exposure to SUDs, including tobacco smoking, with standardized instruments. Current medication, including psychotropic treatments were collected, which informed psychiatric diagnoses. Multinomial regression identified independent factors specifically associated with serious SAs in each gender, separately.
Results
32% Participants (N = 139, 47% Women and 27% Men) reported lifetime SA. There were 82 serious attempters (59% of attempters), without significant gender difference. Sedative dependence was an independent risk factor for serious SA compared to non-SA in Women and compared to non-serious SA in Men, respectively. Other risk factors included later onset of daily tobacco smoking in Men and history of psychiatric hospitalizations in Women, whose serious SA risk was conversely lower when reporting opiate use disorder or mood disorder, probably because of treatment issues.
Conclusions
Despite several study limitations, we identified subgroups for a better-tailored prevention of serious SAs among individuals with SUDs, notably highlighting the need to better prevent and treat sedative dependence.
Keywords
  • substance use disorders;
  • serious suicide attempt;
  • gender;
  • benzodiazepine;
  • sedative use disorder;
  • comorbid addiction
Corresponding author at: CSAPA « Espace Murger » Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, 200 rue du Faubourg Saint-Denis, 75010 Paris, France.

http://www.sciencedirect.com/science/article/pii/S0376871617304787

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