Psychiatric disorders in a population of deceased drug users

Figures & data

Table 1. ATC codes included from the LSR register

N05A	Antipsychotics
N06A	Antidepressants
N06B	Psychostimulants, agents used for ADHD and nootropics
N07BC01, N07BC51	Buprenorphine and combinations
N07BC02	Methadone

Table 2. Definition of groups prepared for analysis.

	No DUD treatment	DUD treatment and/or OAT
Psychiatric morbidity
A: Decedents without a registered psychiatric diagnosis or a dispensed prescription of psychotropic medication	Group 1 (only positive toxicology) Decedents with or without treatment for DUD and without psychiatric diagnosis or medication
B: Decedents with a registered psychiatric diagnosis or a dispensed prescription of psychotropic medication	Group 2 (psychiatric morbidity) Decedents with positive toxicology and psychiatric morbidity and no registered treatment for DUD	Group 3 (dual diagnosis) Decedents with positive toxicology and psychiatric morbidity and DUD treatment and/or OAT

Table 3. General characteristics of the population in the two observation periods.

	2001–2002	2011–2012	p value
Number	240	280
Mean age (years)	39.0	42.9	0.000*
Sex
Male	84.6% (203)	76.8% (215)	0.026*
Female	15.4% (37)	23.6% (65)
Psychiatric comorbidity and drug use treatment
Diagnosis within ICD-10 level^a:
F10–F19	25.8% (62)	19.6% (55)	0.092
F20–F29	16.3% (39)	11.8% (33)	0.142
F30–F39	2.9% (7)	7.0% (20)	0.030*
F40–F49	8.3% (20)	10.0% (28)	0.513
F60–F69	4.6% (11)	4.6% (13)	0.974
Other^b	3.7% (9)	10.7% (30)
Proportion of the population with psychiatric diagnoses, excl. F10–F19	26.7% (64)	28.9% (81)	0.566
Dispensed prescription medication^c:
Antipsychotics	10.4% (25)	19.3% (54)	0.005*
Antidepressants	11.3% (27)	17.9% (50)	0.034*
Psychostimulants	–	2.5% (7)	0.014*
OAT^d	22.1% (53)	19.3% (54)	0.431
Registered in SIB register for DUD treatment/contact up to 2 years prior to autopsy	30.8% (74)	24.3% (68)	0.095
Group 1: Only positive toxicology Decedents with or without treatment for DUD and without psychiatric diagnosis or medication	63.3% (152)	56.4% (158)	0.110
Group 2: Psychiatric morbidity Decedents with positive toxicology and psychiatric morbidity and no registered treatment for DUD	22.5% (54)	26.1% (73)	0.345
Group 3: Dual diagnosis Decedents with positive toxicology and psychiatric morbidity and DUD treatment and/or OAT	14.2% (34)	17.5% (49)	0.301

*Indicates significant difference.

^a Persons may have more than one psychiatric diagnosis.

^b F00–F09, F50–F59, F70–89, F99.

^c Dispensed prescriptions ≤8 weeks prior to the date of autopsy.

^d Includes methadone, buprenorphine and combinations.

Table 4. Temporal changes in toxicological findings in relation to the presence of psychiatric comorbidity or dual diagnosis.

	2001–2002	2011–2012	p value
Group 1: Positive toxicology
N	152 (63.3 %)	158 (56.4 %)
Age, years (mean)	39.5	44.4	0.000*
Toxicological screening:
Antipsychotics	5.9% (9)	13.3% (21)	0.028*
Antidepressants	3.3% (5)	8.2% (13)	0.063
Anti-epileptics	2.6% (4)	7.6% (12)	0.048*
Psychostimulants	–	<2.6% (<4)	0.164
Benzodiazepines	42.8% (65)	63.9% (101)	0.000*
Methadone	52.6% (80)	72.8% (115)	0.000*
Buprenorphine	<2.6% (<4)	<2.6% (<4)	0.539
Other opioids	30.9% (47)	11.4% (140)	0.000*
Morphine^a	42.8% (65)	17.1% (27)	0.000*
Group 2: Psychiatric morbidity
N	54 (22.5 %)	73 (26.1%)
Age, years (mean)	36.9	40.4	0.411
Toxicological screening:
Antipsychotics	33.3% (18)	42.5% (31)	0.296
Antidepressants	25.9% (14)	39.7% (29)	0.104
Anti-epileptics	7.4% (4)	17.8% (13)	0.089
Psychostimulants	–	6.8% (5)	0.050*
Benzodiazepines	42.6% (23)	68.5% (50)	0.004*
Methadone	46.3% (25)	67.1% (49)	0.019*
Buprenorphine	–	–	–
Other opioids	38.9% (21)	12.3% (9)	0.000*
Morphine	42.6% (23)	19.2% (14)	0.004*
Group 3: Dual diagnosis
N	34 (14.2 %)	49 (17.5%)
Age, years (mean)	40.4	41.5	0.997
Toxicological screening:
Antipsychotics	32.4% (11)	34.7% (17)	0.824
Antidepressants	32.4% (11)	40.8% (20)	0.433
Anti-epileptics	17.6% (6)	12.2% (6)	0.491
Psychostimulants	–	< 8.2% (< 4)	0.142
Benzodiazepines	38.2% (13)	77.6% (38)	0.000*
Methadone	76.5% (26)	77.6% (38)	0.908
Buprenorphine	–	8.2% (4)	0.088
Other opioids	29.4% (10)	10.2% (5)	0.025*
Morphine	32.4% (11)	18.4% (9)	0.143

* Indicates significant difference.

^a Morphine (N02AA01) is grouped separately from other opioids, as heroin quickly degrades into morphine after intake and most often appears as morphine in toxicology screening.

Table 5. Cause of death in relation to the presence of psychiatric morbidity or dual diagnosis in the two observation periods.

	2001–2002
	Group 1 Only positive toxicology N = 152	Group 2 Psychiatric morbidity N = 54	Group 3 Dual diagnosis N = 34	p value
Mean age (years)	39.45	36.94	40.44	Group 1–3: 0.995 Group 1–2: 0.621 Group 2–3: 0.609
Sex				0.479
Male	86.8% (132)	81.5% (44)	79.4% (27)
Female	13.2% (20)	18.5% (10)	20.6% (7)
Cause of death
Somatic causes	13.2% (20)	7.4% (4)	< 11.8% (<4)	0.306
Drug-induced deaths	69.1% (105)	72.2% (39)	76.5% (26)	0.670
Trauma	11.8% (18)	7.4% (4)	11.8% (4)	0.655
Unknown	5.9% (9)	13.0% (7)	< 11.8% (<4)	0.223
	2011–2012
	Group 1 Only positive toxicology N = 158	Group 2 Psychiatric morbidity N = 73	Group 3 Dual diagnosis N = 49	p value
Mean age (years)	44.42	40.37	41.53	Group 1–3: 0.502 Group 1–2: 0.055 Group 2–3: 0.989
Sex
Male	81.0% (128)	74.0% (54)	67.3% (33)	0.113
Female	19.0% (30)	26.0% (19)	32.7% (16)
Cause of death
Somatic causes	12.0% (19)	13.7% (10)	12.2% (6)	0.936
Drug-induced deaths	73.4% (116)	69.9% (51)	79.6% (39)	0.489
Trauma	10.8% (17)	16.4% (12)	<8.1% (<4)	0.198
Unknown	3.8 (6)	–	<8.1% (<4)	0.223