Suicide attempts prior to fatal drug overdose in Luxembourg from 1994 to 2011

Educational Objectives: This study may help participants to recognize factors influencing suicidal behavior that should be assessed or monitored in the context of substance use.
Purpose: To assess the prevalence of lifetime suicide attempts in opiate and cocaine related (FOD) cases. To analyze associations between suicide attempts and socio-demographic, life and substance use profiles of FOD victims . Methods: A triangulation approach allowed to cross-examining data from national law enforcement sources, the national drug use surveillance system (RELIS) and of forensic and toxicological evidence. Bivariate statistical analysis was performed by means of Chi-square χ² tests as well as logistic regression analysis of the association between suicide attempts and selected variables. Results: Prior to death, 16.8% of FOD victims reported a single suicide attempt, 37% multiple attempts and 46.2% declared none. No associations were found between suicide attempts and the following variables: sex, age, nationality, penal past (including prison stays), educational, occupational status and income of victims, occupational status of parents and detection of psychotropic prescription drugs in post mortem toxicological analysis. After adjustment for sex and age, FOD victims who showed one or more lifetime suicide attempts were more likely to have experienced non-fatal overdoses [AOR = 5.755 (95% CI 1.633 – 20.278), and (licit or illicit) substance abuse of one or both parents [AOR = 2.859 (95% CI 1.250 – 6.539), p=0.013]. The greater likelihood of unmarried FOD victims to witness suicide attempts (χ²:4.573; p=0.032), compared with married decedents, was no longer observed after sex-age adjustment. Conclusion: Suicide attempts are frequent in fatal drug overdose victims and a strong association has been observed between the former and the frequency of non-fatal overdoses experienced by decedents included in our sample. Family contexts may be at stake when it comes to explain the likelihood of suicide attempts in victims of fatal drug overdose. The fact that substance abuse in parents was positively linked to suicide attempts in FOD victims suggest that increased attention should be paid to family histories in the prevention of drug overdoses and suicide, and the link between both. Our findings could inspire further research, building upon bigger study samples and prospective cohort designs, allowing to collecting more in-depth data on the social and family support experienced by FOD victims.