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Sex‐Specific Risk Profiles for Suicide Among Persons with Substance Use Disorders in Denmark
Author(s) -
Adams Rachel Sayko,
Jiang Tammy,
Rosellini Anthony J.,
HorváthPuhó Erzsébet,
Street Amy E.,
Keyes Katherine M.,
Cerdá Magdalena,
Lash Timothy L.,
Sørensen Henrik Toft,
Gradus Jaimie L.
Publication year - 2021
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.15455
Subject(s) - medicine , suicide prevention , poison control , psychiatry , suicide attempt , injury prevention , suicide methods , substance abuse , cohort , medical emergency , suicide rates
Background and Aims Persons with substance use disorders (SUDs) are at elevated risk of suicide death. We identified novel risk factors and interactions that predict suicide among men and women with SUD using machine learning. Design Case–cohort study. Setting Denmark. Participants The sample was restricted to persons with their first SUD diagnosis during 1995 to 2015. Cases were persons who died by suicide in Denmark during 1995 to 2015 ( n = 2774) and the comparison subcohort was a 5% random sample of individuals in Denmark on 1 January 1995 ( n = 13 179). Measurements Suicide death was recorded in the Danish Cause of Death Registry. Predictors included social and demographic information, mental and physical health diagnoses, surgeries, medications, and poisonings. Findings Persons among the highest risk for suicide, as identified by the classification trees, were men prescribed antidepressants in the 4 years before suicide and had a poisoning diagnosis in the 4 years before suicide; and women who were 30+ years old and had a poisoning diagnosis 4 years before and 12 months before suicide. Among men with SUD, the random forest identified five variables that were most important in predicting suicide; reaction to severe stress and adjustment disorders, drugs used to treat addictive disorders, age 30+ years, antidepressant use, and poisoning in the 4 prior years. Among women with SUD, the random forest found that the most important predictors of suicide were prior poisonings and reaction to severe stress and adjustment disorders. Individuals in the top 5% of predicted risk accounted for 15% of all suicide deaths among men and 24% of all suicides among women. Conclusions In Denmark, prior poisoning and comorbid psychiatric disorders may be among the most important indicators of suicide risk among persons with substance use disorders, particularly among women.