Substance Use Problems and Death of Despair in a 32-Year Follow-Up Study of Suicide Attempters Examined at a Medical Emergency Inpatient Unit

Deaths of despair (DoD), encompassing suicide, drug overdose, and alcohol-related mortality, are often linked to social and psychological distress. This study examined the long-term risk of DoD among individuals previously hospitalized for suicide attempts, with a focus on substance use problems and psychiatric disorders as potential risk factors. A prospective cohort of 1044 individuals admitted to inpatient care following a suicide attempt between 1987 and 1998 was followed for up to 32 years using national registers. Cox proportional hazards regression models were used to assess associations between psychiatric diagnoses and mortality outcomes. The results showed that substance use problems, compared to no such problems, were associated with an increased risk of all-cause mortality but not DoD. In secondary analyses, dysthymia was linked to an increased risk of suicide but not non-suicidal DoD, suggesting distinct underlying mechanisms. Notably, aside from gender, no control variables were significantly associated with non-suicidal DoD, indicating that other factors may play a more prominent role in this high-risk population. These findings challenge the traditional DoD framework and highlight the need for tailored prevention efforts that consider the distinct risk profiles of suicide and non-suicidal DoD. Future research should incorporate socioeconomic and demographic factors to enhance understanding and prevention strategies.