The Etiology of Risk: Alcohol and Drug Use Disorders and Suicidal Behavior

项目摘要 目前的建议旨在澄清观察到的酒精与酒精之间联系的机制， 药物使用障碍（分别为AUD和DUD; SUD统称）和自杀行为（SB），包括自杀 尝试和完成。该研究团队有着广泛的富有成效的合作历史，包括， 特别是精神病和药物使用紊乱研究。我们可以进入瑞典国家登记处 包括近1100万人的医疗、犯罪、人口普查、家庭和社会经济数据; 资源将被链接，以创建详细的数据集，包括个人， 家庭和环境层面。我们将利用这些资源，通过我们的追求， 四个具体目标。第一个目的是澄清AUD/DUD与自杀行为风险的相关程度， 考虑到关键的混杂因素，如精神共病。使用遗传流行病学方法 结合其他旨在促进因果推理的信息设计，我们将讨论 观察到的关联可归因于混杂因素、因果过程或两者。第二，我们将研究如何 家族性AUD、DUD和SB影响个体风险，将遗传风险与环境风险分开 通过我们正在进行的合作开发的新研究设计。并行分析将检查 在非家庭环境中暴露于AUD、DUD和SB的作用。第三，我们将解剖医疗保健 在AUD/DUD患者中使用，以确定潜在的SB风险指标，有两个主要焦点：i） 和就诊原因，以及ii）精神病/SUD药物使用与结局之间的关联。 最后，我们将把前三个具体目标的发现纳入风险的综合病因学模型， 自杀未遂和自杀完成的数据这些模型将以一种发展性的 信息的方式，使我们能够确定两种结果的风险因素之间的中介过程。 重要的是，瑞典和美国的自杀行为率高度相似，并且有许多共同的特征， 包括种族和社会经济多样化的人口;然而，美国缺乏注册资源 与瑞典的同类产品相当。我们希望这些登记处的统计能力， 凭借研究团队在精神病和药物滥用研究、社会和遗传方面的广泛专业知识， 流行病学和因果模型，将产生实质性的结果之间的关系AUD/DUD和 SB，对改善我们在SB预防和干预方面的努力具有重要意义。

Project Summary The current proposal seeks to clarify the mechanisms underlying observed associations between alcohol and drug use disorders (AUD and DUD, respectively; SUD collectively) and suicidal behaviors (SB), including suicide attempts and completions. The research team has an extensive history of productive collaborations, including, in particular, psychiatric and substance use disorder research. We have access to Swedish national registries including medical, criminal, census, family, and socioeconomic data for nearly 11 million individuals; these resources will be linked to create detailed datasets encompassing a wide range of risk factors at personal, familial, and environmental levels. We will utilize these resources to extend our prior research through our pursuit of four specific aims. The first aim is to clarify the extent to which AUD/DUD is related to risk of suicidal behavior, accounting for critical confounding factors such as psychiatric comorbidity. Using genetic epidemiologic methods in conjunction with other informative designs aimed at facilitating causal inference, we will address whether the observed association is attributable to confounders, causal processes, or both. Second, we will examine how familial AUD, DUD, and SB impact individual risk, disentangling genetic from environmental components of risk through novel study designs developed through our ongoing collaboration. Parallel analyses will examine the role of exposure to AUD, DUD, and SB in the non-familial environment. Third, we will dissect health care utilization among those with AUD/DUD to identify potential SB risk indicators, with two primary foci: i) timing of and reason for doctor visits, and ii) associations between psychiatric/SUD medication usage and outcomes. Finally, we will incorporate our findings from the first three specific aims into integrative etiologic models of risk, separately for suicide attempts and completions. These models will be structured in a developmentally informative manner and enable us to identify mediational processes among risk factors for both outcomes. Critically, Sweden and the US have highly comparable rates of suicidal behavior and share many characteristics, including an ethnically and socioeconomically diverse population; however, the US lacks registry resources comparable to those available in Sweden. We expect that the statistical power of these registries, in conjunction with the research team's extensive expertise in psychiatric and substance abuse research, social and genetic epidemiology, and causal modeling, will yield substantive findings on the relationship between AUD/DUD and SB, with important implications for improving our efforts at SB prevention and intervention.