Childhood trauma and the severity of past suicide attempts in outpatients with cocaine use disorders

Abstract

Introduction: Suicide attempts have been associated with both cocaine use disorder (CocUD) and childhood trauma. We investigated how childhood trauma is an independent risk factor for serious and recurrent suicide attempts in CocUD. Method: 298 outpatients (23% women) with CocUD underwent standardized assessments of substance dependence (Diagnostic and Statistical Manual—mental disorders, fourth edition, text revised), impulsiveness, resilience, and childhood trauma, using validated tools. Suicide attempts history was categorized as single vs. recurrent or non-serious vs. serious depending on the lifetime number of suicide attempts and the potential or actual lethality of the worst attempt reported, respectively. Bivariate and multinomial regression analyses were used to characterize which childhood trauma patterns were associated with the suicide attempts groups. Results: 58% of CocUD patients reported childhood trauma. Recurrent and serious suicide attempts clustered together and were thus combined into “severe SA.” Severe suicide attempt risk increased proportionally to the number of childhood traumas (test for trend, p = 9 × 10⁻⁷). Non-severe suicide attempt risk increased with impulsiveness and decreased with resilience. In multinomial regression models, a higher number of traumas and emotional abuse were independently and only associated with severe vs. non-severe suicide attempts (effect size = 0.82, AUC = 0.7). The study was limited by its cross-sectional design. Conclusion: These preferential associations between childhood trauma and severe suicide attempts warrant specific monitoring of suicide attempts risk in CocUD, regardless of the severity of addiction profiles.

Keywords:

• Cocaine
• addiction
• suicide
• childhood trauma
• recurrent suicide attempt
• substance use disorder
• serious suicide attempt
• impulsiveness
• resilience

Acknowledgments

The authors would like to thank the investigators that were involved in building the present cohort. Clara Brichant (INSERM U1144, Paris F-75006), Didier Touzeau (CSAPA Clinique liberté, Bagneux F-92220), Cyrille Orizet (Assistance Publique—Hôpitaux de Paris, CSAPA Montecristo, Hôpital Européen Georges Pompidou, Paris F-75015), Philippe Coeuru (CSAPA Espoir Goutte d’Or – Aurore, Paris F-75018), Pierre Polomeni (Assistance Publique—Hôpitaux de Paris, Service d’addictologie, Hôpital René Muret- Bigottini, Sevran F-93270), Xavier Laqueille (Centre Hospitalier Sainte- Anne, CSAPA Moreau de Tours, Paris F-75014), Elisabeth Avril (CSAPA, Gaia association, Paris F-75011), El Hadi Zerdazi, Kristel Piani & Marine Jarroir (INSERM U1144, Paris F-75006), Pr. Olivier Cottencin (Service d’Addictologie, Hôpital Fontan 2 − CHRU Lille, Lille F-59037), Cyrille Orizet (Assistance Publique—Hôpitaux de Paris, CSAPA Montecristo, Hôpital Européen Georges Pompidou, Paris F- 75015), Aurélia Gay (CHU Saint-Etienne, Pôle Psychiatrie Adultes et Infanto-Juvénile, Saint-Etienne F-42055), Philippe Lack (CSAPA Hôpital de la Croix-Rousse, Lyon F-69317), Philippe Coeuru (CSAPA Espoir Goutte d’Or – Aurore, Paris, F-75018), Arnaud Plat (Assistance Publique—Hôpitaux de Paris, Unité de Traitement Ambulatoire des Maladies Addictives, Hôpital Beaujon, Clichy F-92110), Philippe Batel (Clinique Montevideo, Boulogne F-92100).

Disclosure statement

None of the authors report a conflict of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or any of its academic affiliates. This study was designed and conducted as partial fulfillment of Dr Romain Icick’s PhD thesis and of Mrs. Clara Chretienneau’s MSc thesis (Université de Paris).

Additional information

Funding

Investissements d’Avenir program managed by the “Agence Nationale de la Recherche” (ANR) under reference ANR-11-IDEX-0004-02 and Labex BIO-PSY; DRCI [OST07013] and French Ministry of Health [2010 AOM10165] for patients recruitment; ANR [ANR-13-SAMA-0005-01], ERA-net Neuron Synapse and Mental Disorders 2013 (COCACE, R14026KK) and 2017 (ADIKHUMICE, ANR-17-NEU3-0002-05) for analyses related to the combined sample.