Risk of Death From Accidental Overdose Associated With Psychiatric and Substance Use Disorders
Risk of Death From Accidental Overdose Associated With Psychiatric and Substance Use Disorders
复制标题
DOI：
10.1176/appi.ajp.2011.10101476
复制
发表时间：
2012-01-01
影响因子：
17.7
通讯作者：
Blow, Frederic C.
中科院分区：
文献类型：
--
作者：
Bohnert, Amy S. B.;Igen, Mark A.;Blow, Frederic C.
目的：尽管近年来致死性意外用药过量的发生率急剧增加，但对该结果的风险因素仍知之甚少，特别是在临床人群中。作者研究了精神病和物质使用诊断与意外药物过量死亡的关系。方法：该研究随访了2000年至2006年的一组患者。该队列包括1999财政年度期间在退伍军人健康管理机构接受治疗的所有患者，这些患者在2000财政年度开始时仍然存活（N= 3，291，891）。使用国家死亡指数记录确定意外过量死亡，并将其定义为潜在死因编码为ICD-10代码X40-X45的死亡（N= 4，485）。诊断确定患者的医疗records.Results：调整人口统计学和临床特征，与以前的精神和物质使用障碍诊断的意外过量死亡的风险比范围从1.8到8.8。在对物质使用障碍进行额外校正后，非物质相关精神疾病与意外过量死亡风险的显著相关性持续存在（风险比为1.2至1.8）。除创伤后应激障碍外，抑郁症和焦虑症与药物过量死亡的风险有更强的关联（风险比分别为3.02和3.07），而不是与酒精或非法药物有关的过量死亡风险（风险比分别为1.89和1.23）。在接受退伍军人健康管理局护理的患者中，意外过量死亡被发现与精神病和物质使用障碍有关。研究结果表明，风险评估和过量预防对脆弱的临床亚群的重要性。
Objective: Despite dramatic increases in the rate of fatal accidental overdose in recent years, risk factors for this outcome remain poorly understood, particularly in clinical populations. The authors examined the association of psychiatric and substance use diagnoses with death from accidental overdose.Method: The study followed a cohort of patients from 2000 to 2006. The cohort included all patients treated in Veterans Health Administration facilities during fiscal year 1999 who were alive at the start of fiscal year 2000 (N=3,291,891). Death by accidental overdose was determined using National Death Index records and defined as a death with underlying cause of death coded to ICD-10 codes X40-X45 (N=4,485). Diagnoses were determined by patient medical records.Results: Adjusting for demographic and clinical characteristics, hazard ratios of death by accidental overdose associated with prior psychiatric and substance use disorder diagnoses ranged from 1.8 to 8.8. Significant associations of non-substance-related psychiatric disorders with risk of death by accidental overdose persisted after additional adjustment for substance use disorders (hazard ratios from 1.2 to 1.8). Depressive disorders and anxiety disorders other than posttraumatic stress disorder had stronger associations with risk of medication-related overdose death (hazard ratios, 3.02 and 3.07, respectively) than with risk of overdose death related to alcohol or illegal drugs (hazard ratios, 1.89 and 1.23, respectively).Conclusions: Among patients receiving care from the Veterans Health Administration, death from accidental overdose was found to be associated with psychiatric and substance use disorders. The study findings suggest the importance of risk assessment and overdose prevention for vulnerable clinical subpopulations.