Substance use disorder (SUD) is associated with elevated suicide risk. The aim was to compare health care contacts as well as clinical and suicide-specific characteristics in individuals with and without substance use issues who died by suicide. Data were derived from a nationwide medical record review of confirmed suicides in Sweden. In the current study we included individuals with at least one physician contact in the last year of life (N = 956). Substance use issues were defined as either a SUD diagnosis, physician notations of ongoing substance use, or a prescription for SUD medication. Substance use issues were found in 21 % of the total cohort. Individuals with substance use issues were more likely to have notations of social stressors. Depressive disorders were recorded in 23 % of the total cohort with no differences between those with and without substance use issues. Anxiety disorders were more common in individuals with substance use issues, as were notations of depressive symptoms and anxiety. In the final month of life, 66 % in the substance use group saw a psychiatrist, but fewer consulted GPs (29 %). Suicide risk was noted in 25 % of individuals with substance use issues, and in 15 % of those without. Many individuals with substance use issues were not identified as suicidal despite frequent healthcare contact, underscoring gaps in risk recognition. Improving risk management requires better training for professionals and enhanced collaboration between healthcare providers to address these complex needs.

Expected positive and negative outcomes of smoking have been suggested to predict nicotine involvement. The present meta-analysis integrated research on the associations between smoking outcome expectancies and smoking. A systematic search in the electronic databases PsycInfo, Medline, Psyndex, Google Scholar, and Web of Science identified 215 studies, which were included in a multi-level meta-analysis. Positive smoking outcome expectancies were associated with higher smoking levels, with expectancies that smoking reduces negative affect showing the strongest correlation (r = .29) and expectancies that smoking helps with appetite/weight reduction showing the weakest correlation with smoking (r = .14). Associations of expected negative outcomes of smoking tended to be weaker than associations with positive outcome expectancies and were, in part, inconsistent. There were moderating effects of child age, percentage of individuals who smoke, sampling (clinical versus nonclinical), outcome measure (quantity of smoking versus nicotine dependence; use of conventional cigarettes versus e-cigarettes), publication status, and validity of the outcome expectancy measure. Expectancies about the reduction of negative affect via smoking are a particularly relevant target for prevention and intervention. Our results indicate that decreasing positive expectancies may be more promising than increasing negative expectancies. Tobacco control advocates should draw attention to perceived consequences of smoking in designing measures aimed at preventing smoking initiation and reducing smoking involvement.

Depression has been cited as a possible confounder, moderator, and mediator of the relationship between cannabis use and suicidal behaviours. We aimed to assess the role of depression in the relationship between cannabis use and suicidal behaviours by systematically reviewing existing literature in the general population. We systematically searched PubMed, Science Direct and PsycArticles from database inception to May 20th 2024, for quantitative observational studies investigating the role of depression in the association between cannabis use and suicidal behaviours. We conducted a meta-analysis to examine the confounding role of depression and search for qualitative arguments in favour of moderating and/or mediating roles of depression. We screened 1081 articles, selected 43 for full-text screening and finally included 25. Among adolescents, cannabis use was associated with suicidal ideation (OR = 1.46 [1.17, 1.83]) and suicide attempts (OR = 2.17 [1.56, 3.03]) in studies adjusting for depression. Among adults, cannabis use was associated with suicidal ideation (OR = 1.78 [1.28, 2.46]) in studies adjusting for depression. 12 out of 25 studies found no association between cannabis use and suicidality after adjustment for depression. Six studies investigated a potential moderating role of depression, with four reporting significant but conflicting results. No article investigated the mediating role of depression. There is a clear relationship between cannabis use and suicidal behaviours, which is partly confounded by depression. Studies investigating a moderating role of depression did not agree about the direction of moderation. Further research using methodologies that consider the chronology of events is needed.