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
© 2017 Elsevier B.V. All rights reserved.
http://www.sciencedirect.com/science/article/pii/S0376871617304787