title: Associations of substance use patterns with attempted suicide among persons who inject drugs: can distinct use patterns play a role?
abstract: BACKGROUND
  While the elevated risk of suicide attempt among persons who inject drugs (PWID) is well documented, whether use of different substances is associated with varying degrees of risk remains unclear. We sought to examine the associations between substance use patterns and attempted suicide in a prospective cohort of PWID in Montreal, Canada.
  
  
  METHODS
  Between 2004 and 2011, participants completed an interviewer-administered questionnaire eliciting information on socio-demographics, substance use patterns, related behaviors, and mental health markers. Generalized estimating equations were used to model the relationship between self-reported use of six common substances (cocaine, amphetamine, opioids, sedative-hypnotics, cannabis and alcohol), associated patterns of use (chronic, occasional and none), and a recent (past six-month) suicide attempt.
  
  
  RESULTS
  At baseline, of 1240 participants (median age: 39.1, 83.7% male), 71 (5.7%) reported a recent suicide attempt. Among 5621 observations collected during follow-up, 221 attempts were reported by 143 (11.5%) participants. In multivariate analyses adjusting for socio-demographics and psychosocial stressors, among primary drugs of abuse, chronic [adjusted odds ratio (AOR): 1.97] and occasional (AOR: 1.92) cocaine use, and chronic amphetamine use (AOR: 1.96) were independently associated with attempted suicide. Among co-used substances, chronic sedative-hypnotic use was independently associated with an attempt (AOR: 2.29). No statistically significant association was found for the remaining substances.
  
  
  CONCLUSIONS
  Among PWID at high risk of attempted suicide, stimulant users appear to constitute a particularly vulnerable sub-group. While the mechanisms underlying these associations remain to be elucidated, findings suggest that stimulant-using PWID should constitute a prime focus of suicide prevention efforts.
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1.
authors.forename: Andreea Adelina
authors.initials: AA
authors.lastname: Artenie
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Family Medicine, Faculty of Medicine, McGill University, 5858 Chemin de la Côte-des-Neiges, Montréal, QC, Canada H3S 1Z1; Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, Canada H3C 3J7.
authors.forename: Julie
authors.initials: J
authors.lastname: Bruneau
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9.
authors.forename: Geng
authors.initials: G
authors.lastname: Zang
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, Canada H3C 3J7.
authors.forename: François
authors.initials: F
authors.lastname: Lespérance
authors.affiliation: Department of Psychiatry, Faculty of Medicine, McGill University, 1033 Pine Avenue West, Montréal, QC, Canada H3A 1A1.
authors.forename: Johanne
authors.initials: J
authors.lastname: Renaud
authors.affiliation: Department of Psychoeducation, Université du Québec à Trois-Rivières, C.P. 500, Trois-Rivières, QC, Canada G9A 5H7.
authors.forename: Joël
authors.initials: J
authors.lastname: Tremblay
authors.affiliation: Research Center, Centre Hospitalier de l'Université de Montréal (CHUM), 900 Saint-Denis, Montréal, QC, Canada H2X 0A9; Department of Psychiatry, Faculty of Medicine, Université de Montréal, C.P. 6128, succursale Centre-ville, Montréal, QC, Canada H3C 3J7. Electronic address: didier.jutras-aswad@umontreal.ca.
authors.forename: Didier
authors.initials: D
authors.lastname: Jutras-Aswad
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000150:complications / Q000523:psychology; D000697:Central Nervous System Stimulants; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000150:complications / Q000523:psychology; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D011792:Quebec; D057566:Self Report; D012931:Social Environment; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000523:psychology*; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires
chemical_list: D000697:Central Nervous System Stimulants
keywords: Drug use; Epidemiology; Injection; Risk factor; Stimulant; Suicide