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Published Online: 1 January 2012

Risk of Death From Accidental Overdose Associated With Psychiatric and Substance Use Disorders

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Abstract

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.

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Information & Authors

Information

Published In

Go to American Journal of Psychiatry
Go to American Journal of Psychiatry
American Journal of Psychiatry
Pages: 64 - 70
PubMed: 21955932

History

Received: 13 October 2010
Revision received: 19 April 2011
Revision received: 7 July 2011
Accepted: 15 July 2011
Published online: 1 January 2012
Published in print: January 2012

Authors

Details

Amy S.B. Bohnert, Ph.D.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.
Mark A. Ilgen, Ph.D.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.
Rosalinda V. Ignacio, M.S.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.
John F. McCarthy, Ph.D.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.
Marcia Valenstein, M.D.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.
Frederic C. Blow, Ph.D.
From the Serious Mental Illness Treatment Resource and Evaluation Center, Center for Clinical Management Research, Health Services Research and Development, VA, Ann Arbor, Mich.; and the Department of Psychiatry, University of Michigan, Ann Arbor.

Notes

Address correspondence to Dr. Bohnert ([email protected]).

Funding Information

Dr. Blow has received research support or consulting fees from JBS International, Flinn Family Foundation, and Hazelden Foundation. The other authors report no financial relationships with commercial interests.Supported by the VA Office of Mental Health Services Patient Care Services and by a Health Services Research and Development Service Career Development Award (CDA-09-204, principal investigator, Dr. Bohnert).

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