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Original Investigation
May 11, 2022

Suicide Attempt and Risk of Substance Use Disorders Among Female Youths

Author Affiliations
  • 1University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
  • 2Institut national de santé publique du Québec, Montreal, Quebec, Canada
  • 3Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
  • 4Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
  • 5Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
  • 6Department of Psychiatry, McGill University, Montreal, Quebec, Canada
JAMA Psychiatry. 2022;79(7):710-717. doi:10.1001/jamapsychiatry.2022.1025
Key Points

Question  Do female youths who attempt suicide have an increased risk of substance use disorders later in life?

Findings  In this cohort study of 122 234 females aged 8 to 19 years followed up for 31 years, suicide attempts before 20 years of age were associated with greater risk of developing a substance use disorder later in life compared with no suicide attempt. Female youths with repeated suicide attempts or who attempted suicide by hanging or suffocation were at greatest risk of subsequent substance use disorders.

Meaning  The findings suggest that female youths who attempt suicide may require better monitoring for substance use disorders after the initial suicide attempt.


Importance  Suicide attempts are prevalent among female youths, yet little is known about the subsequent development of substance use disorders.

Objective  To assess the association between suicide attempts among females before 20 years of age and future risk of substance use disorders.

Design, Setting, and Participants  In this longitudinal cohort study, females aged 8 to 19 years (hereafter referred to as youths) who attempted suicide were matched with female youths with no attempt between April 1, 1989, and March 31, 2019, in Quebec, Canada. The cohort was followed up for 31 years, for a total of 2 409 396 person-years, to identify subsequent substance use disorders.

Exposures  Confirmed suicide attempts among females 8 to 19 years of age.

Main Outcomes and Measures  The main outcome measure was hospitalization for a substance use disorder later in life. Hazard ratios (HRs) and 95% CIs for the association of suicide attempt with substance use disorders were estimated using Cox proportional hazards regression models adjusted for baseline age, mental illness, resource-limited socioeconomic status, and year at start of follow-up.

Results  Among 122 234 female youths (mean [SD] age, 15.6 [1.9] years), 5840 (4.8%) attempted suicide and 4341 (3.6%) developed a substance use disorder. Compared with the 116 394 matched female youths who did not attempt suicide (95.2%), those who attempted suicide had a greater risk of hospitalization for any substance use disorder during the follow-up period (HR, 6.03; 95% CI, 5.39-6.77), especially sedative or hypnotic use disorders (HR, 32.24; 95% CI, 23.29-44.64). Suicide attempt was associated with the development of sedative or hypnotic use disorders up to 5 years (HR, 66.69; 95% CI, 34.72-128.09), although risks remained elevated up to 3 decades later for all substances. Compared with those without suicide attempt, female youths with 3 or more suicide attempts had 21.20 (95% CI, 13.53-32.90) times the risk of substance use disorders, whereas female youths with 1 attempt had 5.70 (95% CI, 5.08-6.41) times the risk of these disorders.

Conclusions and Relevance  In this cohort study, female youths who attempted suicide had increased risk of subsequent substance use disorders compared with female youths who did not attempt suicide. These findings suggest that closer management and prevention of substance use among female youths who attempt suicide may be beneficial.

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