同時使用古柯鹼和酒精與自殺傾向有關


  【24drs.com】根據針對急診就醫之自殺患者進行的一篇大型研究,同時使用古柯鹼和酒精是企圖自殺的高風險警告。
  
  研究者發現,個別檢視時,喝酒和自殺傾向沒有顯著關聯,使用古柯鹼則是有臨界顯著關聯,但是,同時有酒精濫用與使用古柯鹼時,與企圖自殺的風險顯著相關。
  
  第一研究者、羅德島普洛威頓斯布朗大學Alpert醫學院精神病學和人類行為助理教授Sarah Arias博士表示,研究結果強調,物質濫用對於後來的殺行為的影響並不清楚。
  
  Arias博士指出,當我們考量其他因素如性別或種族時,有不同程度的風險。研究結果顯示,並非所有物質或使用這些物質的所有人的自殺行為風險都有相同的影響。當照護者評估有風險的患者時,這些研究結果可能是有用的。
  
  研究結果線上發表於4月4日Crisis期刊。
  
  這篇研究包括了在2010-2012年間於該國8處急診之一就診的874名男性與女性、主動自殺意念和行為陽性之患者,這些患者來自「Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE)」這項研究。
  
  研究團隊收集了所有患者的人口統計學資料與物質使用情況,之後追蹤他們12個月,在追蹤期間,874名患者中有195人(22%)再度企圖自殺至少一次,再度企圖自殺者中,59%年齡小於40歲、59%是女性(59%)且76%為非西班牙裔白人。
  
  研究對象濫用的各種物質包括大麻、處方止痛藥、鎮靜劑、興奮劑,但是,只有同時使用古柯鹼與酒精者被發現與企圖自殺有顯著關聯。
  
  所有研究對象中,298人(34%)濫用酒精、72人(8%)使用古柯鹼、41人(5%)兩種都有使用。有酒精濫用且有使用古柯鹼者,企圖自殺的比率(39%)顯著高於沒有同時酒精濫用且有使用古柯鹼者(21%, P = .008)。
  
  研究者也發現,在白人與女性,物質濫用不太可能是自殺風險指標,在年長者中,物質濫用和自殺之間關聯的可能性更大。女性比男性更可能曾經企圖自殺,但是資料顯示,女性比較不可能有物質濫用。
  
  研究者寫道,這些不同的結果強調,性別、物質使用、自殺企圖之間的複雜相互影響。他們也認為,女性可能有不同的風險,取決於她們是否有物質濫用或曾企圖自殺。
  
  Arias博士表示,她希望這些資料有助於闡明,在特定患者中、某些特定物質如何濫用,對於自殺風險有何影響。
  
  她在新聞稿中表示,這不是一個明確的、簡單的關聯。儘管物質使用常常被視為自殺意向和行為一個非常強有力的預測因素,當我們探討個別物質時,我們發現,與行為的未來關聯性並不一致。
  
  辨別可以預測或預防自殺企圖的因素,對於發展有效的自殺預防和介入計畫是很重要的。
  
  Arias博士表示,我們正致力於確認可以用來更佳地評估與辨識哪些人有自殺風險的因素,最終,我認為,這是朝向獲得更佳結果的正確方向。可能同時有使用酒精和古柯鹼的患者,風險可能比較高,這類研究結果對於通報自殺風險評估是有幫助的。
  
  她指出,還不清楚為何同時有使用酒精和古柯鹼會增加自殺風險。這可能是與之前研究提出的,同時使用酒精和古柯鹼引起的快感有關,可能比單用古柯鹼時持續3-5倍之久,遺憾的是,我們無法用現有的資料進一步調查。
  
  資料來源:http://www.24drs.com/
  
  Native link:Concurrent Cocaine, Alcohol Use Linked to Suicidality

Concurrent Cocaine, Alcohol Use Linked to Suicidality

By Megan Brooks
Medscape Medical News

The concurrent use of cocaine and alcohol may flag individuals at high risk of attempting suicide, according to a large study of suicidal emergency department patients.

When examined independently, alcohol use had no significant association with suicidality, and cocaine use had a borderline significant association. But alcohol misuse and cocaine use combined was significantly associated with a future suicide attempt, investigators found.

"The findings highlight that the impact of substance use on future suicide behavior is not clear-cut," lead investigator Sarah Arias, PhD, assistant professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University, Providence, Rhode Island, told Medscape Medical News.

"There are differential levels of risk when we consider other factors, such as sex or race. The findings show that not all substances or substance users are impacted equally when we look at risk for future suicide behaviors. These findings may be useful for providers when assessing at-risk patients," Dr Arias added.

The findings were published online April 4 in Crisis.

Useful for Risk Assessment

The study included 874 men and women who presented at one of eight emergency departments around the country between 2010 and 2012 and who screened positive for active suicidal ideation or behavior. The patients were part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study.

The study team gathered demographic and substance use information from all participants and then followed them for 12 months. During follow-up, 195 (22%) of the 874 participants attempted suicide again at least once. Of those who again attempted suicide, 59% were younger than 40 years, 59% were women, (59%) and 76% were non-Hispanic whites.

Participants in the study reported misusing many different substances, including marijuana, prescription painkillers, tranquilizers, and stimulants, but only the combined use of cocaine and alcohol was found have a significant association with suicide attempt.

Among all participants, 298 (34%) misused alcohol, 72 (8%) used cocaine, and 41 (5%) used both. Those reporting both alcohol misuse and cocaine use had a significantly higher proportion of suicide attempts (39%) compared with those without comorbid alcohol misuse and cocaine use (21%, P = .008).

The researchers also found that substance misuse was less likely an indicator of suicide risk among whites and women, whereas in older adults, the association between substance misuse and suicide was more likely. Women were more likely than men to have a history of suicide attempt, but the data showed that women were less likely to engage in substance abuse.

"These disparate findings emphasize the complex interaction of sex, substance use, and suicide attempts," the investigators write. They also suggest that women may be differentially at risk, depending on whether they report substance use or past suicide attempts.

Dr Arias said she hopes the data help shed light on how misuse of particular substances, among particular patients, may affect their risk for suicide.

"It's not a clear-cut, straightforward association," she said in a news release. "Even though substance use is often touted as a very strong predictor of suicidal intentions and behaviors, when we look at individual substances, we're seeing that there's not that consistency in the future association with behavior."

Identifying factors that predict and protect against attempted suicide are important for the development of effective suicide prevention and intervention programs.

"We're on our way to trying to identify factors that can be used to better assess and identify people who are at risk for suicide, and ultimately, I think this is a step in the right direction to get a better picture," Dr Arias said. "Patients who have potentially comorbid alcohol and cocaine use may be at a higher risk. Findings like these can be useful for informing suicide risk assessment."

She also said it is unclear why combined alcohol and cocaine use might raise the risk for suicide. "This may be related to previous research indicating that concurrent use of alcohol and cocaine elicit an amplified high that can last three to five times longer than a high from cocaine use alone. Unfortunately, we weren't able to investigate this further with the data we had available," she said.

The study was funded by the National Institute of Mental Health. The authors report no relevant financial relationships.

Crisis. Published online April 4, 2016.

    
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