Response to Aubin et al. (2017)

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138910/1/add13937.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138910/2/add13937_am.pd

Associations between body mass index and suicide in the veterans affairs health system

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/102714/1/oby20422.pd

Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration

Background and AimsLimited information is available regarding links between specific substance use disorders (SUDs) and suicide mortality; however, the preliminary evidence that is available suggests that suicide risk associated with SUDs may differ for men and women. This study aimed to estimate associations between SUDs and suicide for men and women receiving Veterans Health Administration (VHA) care.DesignA cohort study using national administrative health records.SettingNational VHA system, USA.ParticipantsAll VHA users in fiscal year (FY) 2005 who were alive at the beginning of FY 2006 (n = 4 863 086).MeasurementsThe primary outcome of suicide mortality was assessed via FY 2006–2011 National Death Index (NDI) records. Current SUD diagnoses were the primary predictors of interest, and were assessed via FY 2004–2005 VHA National Patient Care Database (NPCD) records.FindingsIn unadjusted analyses, a diagnosis of any current SUD and the specific current diagnoses of alcohol, cocaine, cannabis, opioid, amphetamine and sedative use disorders were all associated significantly with increased risk of suicide for both males and females [hazard ratios (HRs)] ranging from 1.35 for cocaine use disorder to 4.74 for sedative use disorder for men, and 3.89 for cannabis use disorder to 11.36 for sedative use disorder for women]. Further, the HR estimates for the relations between any SUD, alcohol, cocaine and opioid use disorders and suicide were significantly stronger for women than men (P < 0.05). After adjustment for other factors, most notably comorbid psychiatric diagnoses, associations linking SUDs with suicide were attenuated markedly and the greater suicide risk among females was observed for only any SUD and opioid use disorder (P < 0.05).ConclusionsCurrent substance use disorders (SUDs) signal increased suicide risk, especially among women, and may be important markers to consider including in suicide risk assessment strategies. None the less, other co‐occurring psychiatric disorders may partially explain associations between SUDs and suicide, as well as the observed excess suicide risk associated with SUDs among women.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/137620/1/add13774.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/137620/2/add13774_am.pd

Use of non‐pharmacological strategies for pain relief in addiction treatment patients with chronic pain

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/138296/1/ajad12600_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/138296/2/ajad12600.pd

Predictors of injury-related and non-injury-related mortality among veterans with alcohol use disorders

To describe the association between alcohol use disorders (AUDs) and mortality and to examine risk factors for and all-cause, injury-related and non-injury-related mortality among those diagnosed with an AUD.Department of Veterans Affairs, Veterans Health Administration (VHA).A cohort of individuals who received health care in VHA during the fiscal year (FY) 2001 ( n  = 3 944 778), followed from the beginning of FY02 through the end of FY06.Demographics and medical diagnoses were obtained from VHA records. Data on mortality were obtained from the National Death Index.Controlling for age, gender and race and compared to those without AUDs, individuals with AUDs were more likely to die by all causes [hazard ratio (HR) = 2.30], by injury-related (HR = 3.29) and by non-injury-related causes (HR = 2.21). Patients with AUDs died 15 years earlier than individuals without AUDs on average. Among those with AUDs, Caucasian ethnicity and all mental illness diagnoses that were assessed were associated more strongly with injury-related than non-injury-related mortality. Also among those with AUDs, individuals with medical comorbidity and older age were at higher risk for non-injury related compared to injury-related mortality.In users of a large health-care system, a diagnosis of an AUD is associated significantly with increased likelihood of dying by injury and non-injury causes. Patients with a diagnosis of an AUD who die from injury differ significantly from those who die from other medical conditions. Prevention and intervention programs could focus separately upon selected groups with increased risk for injury or non-injury-related death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79146/1/j.1360-0443.2010.03024.x.pd

Opioid dose and risk of suicide

Chronic pain is associated with increased risk of suicide, and opioids are commonly used to treat moderate to severe pain. However, the association between opioid dose and suicide mortality has not been examined closely. This retrospective data analysis described the risk of suicide associated with differing prescribed opioid doses. Data were from Veterans Affairs health care system treatment records and the National Death Index. Records analyzed were those of Veterans Affairs patients with chronic pain receiving opioids in fiscal years 2004 to 2005 (N = 123,946). Primary predictors were maximum prescribed morphine-equivalent daily opioid dose and opioid fill type. The main outcome measured was suicide death, by any mechanism, and intentional overdose death during 2004 to 2009. Controlling for demographic and clinical characteristics, higher prescribed opioid doses were associated with elevated suicide risk. Compared with those receiving ≤20 milligrams/day (mg/d), hazard ratios were 1.48 (95% confidence intervals [CI], 1.25-1.75) for 20 to <50 mg/d, 1.69 (95% CI, 1.33-2.14) for 50 to <100 mg/d, and 2.15 (95% CI, 1.64-2.81) for 100+ mg/d. The magnitude of association between opioid dose and suicide by intentional overdose was not substantially different from that observed for the overall measure of suicide mortality. Risk of suicide mortality was greater among individuals receiving higher doses of opioids, and treatment providers may want to view high opioid dose as a marker of elevated risk for suicide. Additional research is needed on opioid use, pain treatment, and suicide

Self‐Efficacy to Avoid Suicidal Action: Factor Structure and Convergent Validity among Adults in Substance Use Disorder Treatment

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/109886/1/sltb12101.pd

Specialty substance use disorder services following brief alcohol intervention: a meta‐analysis of randomized controlled trials

Background and aimsBrief alcohol interventions in medical settings are efficacious in improving self‐reported alcohol consumption among those with low‐severity alcohol problems. Screening, Brief Intervention and Referral to Treatment initiatives presume that brief interventions are efficacious in linking patients to higher levels of care, but pertinent evidence has not been evaluated. We estimated main and subgroup effects of brief alcohol interventions, regardless of their inclusion of a referral‐specific component, in increasing the utilization of alcohol‐related care.MethodsA systematic review of English language papers published in electronic databases to 2013. We included randomized controlled trials (RCTs) of brief alcohol interventions in general health‐care settings with adult and adolescent samples. We excluded studies that lacked alcohol services utilization data. Extractions of study characteristics and outcomes were standardized and conducted independently. The primary outcome was post‐treatment alcohol services utilization assessed by self‐report or administrative data, which we compared across intervention and control groups.ResultsThirteen RCTs met inclusion criteria and nine were meta‐analyzed (n = 993 and n = 937 intervention and control group participants, respectively). In our main analyses the pooled risk ratio (RR) was = 1.08, 95% confidence interval (CI) = 0.92–1.28. Five studies compared referral‐specific interventions with a control condition without such interventions (pooled RR = 1.08, 95% CI = 0.81–1.43). Other subgroup analyses of studies with common characteristics (e.g. age, setting, severity, risk of bias) yielded non‐statistically significant results.ConclusionsThere is a lack of evidence that brief alcohol interventions have any efficacy for increasing the receipt of alcohol‐related services.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/112279/1/add12950.pd