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Addict Sci Clin Pract. 2020 Feb 21;15(1):14. doi: 10.1186/s13722-020-0181-1.

Substance use disorders and risk of suicide in a general US population: a case control study.

Author information

Kaiser Permanente Northwest, Center for Health Research, 3800 N Interstate Ave., Portland, OR, 97227-1110, USA.
Public Health Sciences, Henry Ford Health System, Detroit, USA.
Department of Population Medicine, Harvard Medical School, Boston, USA.
Harvard Pilgrim Health Care Institute, Harvard Pilgrim Health System, Boston, USA.
Center for Health Policy and Health Services Research, Henry Ford Health System, 1 Ford Place, Suite 3A, Detroit, MI, 48116, USA.
HealthPartners, Institute for Education and Research, 8170 33rd Ave. South, PO Box 1524, MS 21111R, Bloomington, MN, 55425, USA.
Kaiser Permanente Hawaii, Center for Health Research, 501 Alakawa Street, Suite 201, Honolulu, HI, 96817, USA.
School of Public Health, Georgia State University, Urban Life Building, 140 Decatur St. Suite 434, Atlanta, GA, 30303, USA.
Kaiser Permanente Georgia, Center for Clinical and Outcomes Research, Portland, USA.
Department of Family Medicine, University of Colorado, Denver, 3055 Roslyn Street, #100, Denver, CO, 80238, USA.
Behavioral Health Services, Henry Ford Health System, Detroit, USA.
Department of Internal Medicine, Henry Ford Health System, Detroit, USA.
Kaiser Permanente Colorado, Institute for Health Research, 2550 S. Parker Rd, Suite 200, Aurora, CO, 80014, USA.
Kaiser Permanente Washington, Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101-1466, USA.



Prior research suggests that substance use disorders (SUDs) are associated with risk of suicide mortality, but most previous work has been conducted among Veterans Health Administration patients. Few studies have examined the relationship between SUDs and suicide mortality in general populations. Our study estimates the association of SUDs with suicide mortality in a general US population of men and women who receive care across eight integrated health systems.


We conducted a case-control study using electronic health records and claims data from eight integrated health systems of the Mental Health Research Network. Participants were 2674 men and women who died by suicide between 2000-2013 and 267,400 matched controls. The main outcome was suicide mortality, assessed using data from the health systems and confirmed by state death data systems. Demographic and diagnostic data on substance use disorders and other health conditions were obtained from each health system. First, we compared descriptive statistics for cases and controls, including age, gender, income, and education. Next, we compared the rate of each substance use disorder category for cases and controls. Finally, we used conditional logistic regression models to estimate unadjusted and adjusted odds of suicide associated with each substance use disorder category.


All categories of substance use disorders were associated with increased risk of suicide mortality. Adjusted odds ratios ranged from 2.0 (CI 1.7, 2.3) for patients with tobacco use disorder only to 11.2 (CI 8.0, 15.6) for patients with multiple alcohol, drug, and tobacco use disorders. Substance use disorders were associated with increased relative risk of suicide for both women and men across all categories, but the relative risk was more pronounced in women.


Substance use disorders are associated with significant risk of suicide mortality, especially for women, even after controlling for other important risk factors. Experiencing multiple substance use disorders is particularly risky. These findings suggest increased suicide risk screening and prevention efforts for individuals with substance use disorders are needed.


Alcohol use disorder; Drug use disorders; Substance use disorders; Suicide

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