Suicide attempts in major affective disorder patients with comorbid substance use disorders

Background: The widely accepted impression that substance abuse and depende nce are associated with increased suicidal risk was evaluated by literature review and with new data. Method: Previous research on this association wa s reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affi liated with the Italian mental health system were analyzed. Results: The li terature supports associations of alcohol and drug use comorbidity with maj or affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) wit h suicidal behavior. Our new findings generally supported these Zway associ ations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressi ve disorders as well as substance abuse, with little effect of type of agen t. Substance abuse was more common in nonmixed bipolar disorders, men, and age below 30. Conclusion: The tendency for bipolar I, mainly nonmixed patie nts, to have a relatively high risk of substance abuse and low risk of suic ide attempts indicates that mainly depressive or dysphoric (bipolar II, non bipolar, and bipolar I, mainly mixed) mood disorders may be especially leth al. Differences in risks of substance abuse and suicidal behavior in men an d in bipolar I patients further suggest that substance abuse and mood disor ders may contribute to suicidal risk with at least partial independence or additivity.