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Abstract
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A study of specific drugs as risk factors for suicide and self-harm can be linked to the bigger issue of the relative harm of various substances. The role and impact of the interplay between psychiatric co-morbidity and impulsivity can be related more widely to the link between substance use and self-harm and suicide.
Chai et al. [1] have made an important contribution to the literature on substance use and self-harm and suicide (SHS) by linking specific types of substance use disorders recorded at presentation to accident and emergency departments to subsequent SHS, using a population-based cohort in Hong Kong.
Chai et al. [1] used an epidemiological framework with control for multiple factors to assess the contribution of each drug to SHS and adjusted their analyses for psychiatric co-morbidity, which is an extremely important confounder, because psychiatric co-morbidity is the single strongest predictor of SHS and is closely related to substance use [2].
Compared with other patients, patients with drug use disorders, regardless of type of drug, were at elevated risk for SHS. The authors concluded that all types of drug use disorders pose a risk of SHS and underlined the importance of approaches that seek to prevent and regulate drug use, including supply-oriented approaches. It is notable that some drugs, such as ketamine and opioids, were associated with very high risk of SHS, whereas other drugs, such as hallucinogens or cannabis, were associated with somewhat lower risk of SHS. Similarly, in some previous studies, psycho-depressants, such as opioids or alcohol, were associated with completed suicide, whereas cannabis and stimulants were not [2]. Further, Chai et al. [1] found that previous drug use disorders and psychiatric disorders were significantly associated with increased risk of SHS, but noted that this link is complicated and that the potential contribution of state impulsivity to SHS because of drug use disorders should be considered.
Language: en |