Background: Psychological autopsy findings show that substance use disorder is the second most common psychiatric diagnosis among suicide decedents in Sweden and other Western countries. We sought to examine prevalence rates of different substance use disorders, as well as the broader category problematic substance use in a national cohort of suicide decedents, and to investigate clinical and suicide-specific characteristics in those with problematic substance use.
Methods: Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Included were those with accessible records from physician consultations in the final year of life (N = 956; 81% of all confirmed suicides in Sweden in 2015). Problematic substance use was defined as having a clinical diagnosis of alcohol or substance use disorder, and/or having received prescription of drugs that are solely used to treat substance use, and/or having physician-noted substance use issues.
Results: While relatively few had received a clinical diagnosis (alcohol use disorder, 8%; polysubstance use disorder, 4%), problematic substance use was identified in 21% of the cohort. Nearly 90% of the latter group had a comorbid psychiatric disorder. Over half were prescribed antidepressant treatment at the time of death. Two-thirds of those with problematic substance abuse were in contact with a physician at some point during the last 30 days of life; nearly half accessed somatic specialized care during this time period. One quarter had documentation of elevated suicide risk at some point during the last year of life, and this was more common in women.
Conclusions: The number of individuals who received a clinical diagnosis of alcohol/substance use disorder was relatively small compared to problematic substance use, which suggests that some individuals may not be getting specific support for their substance use issues. The high proportion with specialized somatic care contacts close in time to suicide highlights the need for broader awareness of mental health needs on the part of medical specialists. Intervention studies are needed to enhance collaborative care for persons with problematic substance use.