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

项目摘要 目前的提案试图澄清所观察到的酒精和酒精之间联系的机制 药物使用障碍(分别为AUD和DUD；统称为SUD)和自杀行为(SB)，包括自杀 尝试和完成。研究团队有着广泛的富有成效的合作历史，包括， 特别是精神病学和物质使用障碍的研究。我们有权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；这些 将链接资源以创建详细的数据集，其中包含个人、 家族性和环境性。我们将利用这些资源，通过我们的追求来扩展我们之前的研究 四个具体目标。第一个目的是澄清AUD/DUD与自杀行为风险的关系程度， 考虑到严重的混杂因素，如精神共病。使用遗传流行病学方法 与其他旨在促进因果推理的信息性设计一起，我们将讨论 观察到的关联可归因于混杂因素、因果过程或两者兼而有之。第二，我们将研究如何 家族性AUD、DUD和SB影响个体风险，将遗传因素与风险的环境成分分开 通过我们持续的合作开发的新颖的研究设计。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，我们将剖析医疗保健 AUD/DUD患者利用这些指标来确定潜在的SB风险指标，主要关注两个方面：i)时间安排 和去看医生的原因，以及ii)精神科/sud药物使用与结果之间的联系。 最后，我们将把我们来自前三个具体目标的发现纳入风险的综合病因学模型， 单独对自杀未遂和自杀未遂进行处罚。这些模型将以发展的方式构建 这是一种提供信息的方式，使我们能够确定影响这两种结果的风险因素之间的调解过程。 重要的是，瑞典和美国的自杀行为比率非常接近，并且有许多共同的特征， 包括种族和社会经济多元化的人口；然而，美国缺乏登记资源 可与瑞典的同类产品相媲美。我们期望这些登记处的统计能力与 凭借研究团队在精神病学和药物滥用研究、社会和遗传学方面的广泛专业知识 流行病学和因果模型将对AUD/DUD和AUD/DUD和 SB，对改进我们预防和干预SB的努力具有重要影响。

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.