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Suicide attempt among substance users

Do aggression and polysubstance use have an interaction effect on a suicide attempt.

Article in review: Gorgulu, T. (2020). Suicide attempt among substance users: Do aggression and polysubstance use have an interaction effect on a suicide attempt. Turkish Journal of Clinical Psychiatry. DOI:10.5505/kpd.2020.56887


Suicide is more common among substance users than among the general population, and there are several risk factors for suicide among substance users. This study has sought to determine how the interaction between polysubstance use and aggression are associated with suicide attempts. Researchers investigated the predictive variables of suicide attempt history and the effect of polysubstance use and aggression on suicide attempt history.


Only one significant correlation was found between aggression and the age of onset of drug use. This finding suggests that the younger the age when drug use begins, the greater the occurrence of aggression.

When considering other variables, it was also found that factors such as the age of onset of drug use, duration of drug use, having family who use the drug and polysubstance use. It was also indicated that as drug use duration increases, so too does the number of drugs used.


A total of 257 male participants aged 18 years and over were involved in this Turkish study. The fact that women were excluded from this study is a potential limitation. The mean age of participants was 30 and they had on average 8 years of education. A total of 58.5% were single.
More than half had begun using substances before the age of 18 years, and 70% stated they had used substances for more than three years. A total of 83% had friends who used the same substance and 37.4% had at least one family member who used the same drug.


A combination of methods was used to gather data for analysis.
• Sociodemographic data – collection of psychosocial data related to substance use, suicide attempt, risk factors and demographic questions inducing age, marital status and income
• Lifetime suicide attempt information – which was assessed through self-reported responses to the question “have you ever tried to kill yourself or have you ever attempted suicide?”
• Polysubstance use – which was assessed through self-reported responses to the question “how many drugs do you use?”
• Aggression was assessed by the Hospital Sacte, a subscale of Cull and Gill’s Suicide Probability Scale. The scale uses a Likert-type rating for responses to statements like “When I get mad I throw things” and “I tend to feel impulsive”.


A total of 67 participants (26.1%) had attempted one or more previous suicide attempts. A majority used only one drug (56.4%) with a total of 43.5% of participants were using more than one drug. Drug use rates were found to be:
• Cannabis 91.8%
• Ecstasy 38.9%
• Bonsai – 24.1%
• Crack- 20.2%
• Heroin- 18.3%
• Cocaine 18.3%

A total of 35.4% had suicidal ideation and 26.1% had suicide attempts. The methods used in these attempts were most commonly overdosing (40%) and self-cutting (38.5%) followed by hanging, jumping from height and firearms.


As a primary finding, this study found no interaction effect of aggression and polysubstance use on suicide attempt history. However, it was found that aggression and polysubstance use are separately important risks for suicide attempts. Anger may be a more dominant variable for suicide attempts. The use of more than one substance and aggression are stated as two important risk factors for suicide.

Previous studies in the field have focused on the effect of anger, hostility and suicide, and impulse control as variables. In this study, aggression was found to be an important variable, and was found to be an important risk factor for suicide amongst substance users and accordingly it is suggested that anger management therapies will be of use for substance users.

Polysubstance use was also found to be an important risk factor for suicide, another result consistent with other studies, which have found that the use of more than one substance increases suicide risk and that with every additional substance used, the suicide risk increase is doubled. Furthermore, most polysubstance users also have access to higher grade substances, which can increase the risk for hospitalisation for biopsychosocial conditions.

When friends or family are polysubstance users
This study has also found that the age of onset of using drugs and having friends who use substances during a person’s youth may mean increased risk. The importance of supporting young people who have begun to use substances or are surrounded by people who already use substances is stated. Researchers also noted a relationship between early onset of drug use and polysubstance use.

Substance use amongst families is also identified as a risk factor for suicide. Drug use in the family will undoubtedly adversely affect the functioning of the family, which could also increase the risk for individuals in the family, especially in the presence of other risk factors.

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