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Cited by 14Substance Abuse Treatment and OutcomesSuicide and Self-Harm StudiesPsychiatric care and mental health services

In-patient psychiatric care and non-substance-related psychiatric diagnoses among individuals seeking treatment for alcohol and substance use disorders: associations with all-cause mortality and suicide

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Levola, Jonna, Laine, Riku, Pitkänen, Tuuli·2022·The British Journal of Psychiatry
DOI 10.1192/bjp.2022.20
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Abstract

Background: The largest excess mortality risk has been reported for combinations of psychiatric disorders that included substance use disorders. Aims: To study the associations of different non-substance-related in-patient psychiatric diagnoses with all-cause mortality and suicide up to 28 years of age after entering substance use treatment. Method: National register data on psychiatric hospital admissions and death were combined with the treatment records of over 10 000 individuals in substance use treatment between 1990 and 2009. Cox regression was used to calculate hazard ratios (HRs) with 95% CIs for all-cause and suicide-specific mortality from the time of entering substance use treatment. Results: Nearly one-third (31.4%; n = 3330) of the study population had died during follow-up or by their 65th birthday, with more than one in ten (n = 385) from suicide. Over half of the study population (53.2%) had undergone psychiatric in-patient care and 14.1% involuntary psychiatric care during the study period. Bipolar disorder and unipolar depression were associated with a 57% (HR 1.57, 95% CI 1.18–2.10) and 132% (HR 2.32, 95% CI 1.21–4.46) increase in risk of suicide, respectively. Involuntary psychiatric care was associated with a 40% increase in risk of suicide (HR 1.42, 95% CI 1.05–1.94). Conclusion: Severe psychiatric morbidity is common among individuals seeking treatment for alcohol and/or substance use and specifically mood disorders appear to increase the risk of suicide. Treatment service planning needs to focus on integrated care for concomitant substance use and psychiatric disorders to address this risk.

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  • Five studies found an increased risk of suicide for people admitted involuntarily.

    “However, five studies found an increased risk of suicide for people admitted involuntarily (98–102), and one study found that involuntary admission was associated with a greater risk of all-cause mortality (with no deaths attributable to suicide in either group) (103).”

    From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [101]

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Authors
Levola, J., Laine, R., & Pitkänen, T.
Affiliations
  • University of Helsinki (FI)
  • Finnish Youth Research Society (FI)
Corresponding author
Levola, Jonna
ORCID
Venue
The British Journal of Psychiatry
Publisher
Royal College of Psychiatrists
Published
2022-02-15
Volume
221
Issue
1
Pages
386-393
ISSN
  • 0007-1250 (ISSN-L)
  • 1472-1465
DOI
10.1192/bjp.2022.20
OpenAlex
W4213067327
Cited by
14
References
20
Citations by year
2026: 4 · 2025: 3 · 2024: 4 · 2023: 1 · 2022: 2
FWCI
1.81
Type
journal article
Language
en
Open access
Licence
www.cambridge.org/core/terms (unspecified)
Locations
  • The British Journal of Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
  • Työväentutkimus Vuosikirja (submittedVersion)
Funders
Alkoholitutkimussäätiö
Topics
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
Keywords
all-cause mortality, suicide, substance use disorders, alcoholism, bipolar disorder, major depressive disorder, involuntary psychiatric treatment, mood disorders, integrated care, psychiatric hospital admissions
MeSH terms
Mental Disorders, Bipolar Disorder, Patient Care, Humans, Risk Factors, Suicide, Substance-Related Disorders

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