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Peer-reviewedCC BY-NCEuropean addiction research

Psychiatric Comorbidities and Risks of Death, Nonfatal Overdose, and Self-Harm in Opioid Agonist Therapy: A Retrospective Cohort Study.

  • Yangyang Li1
  • Alexander Denissoff1,2
  • Margareeta Häkkinen1,3,4
  • Lauri Sillanmäki1
  • Solja Niemelä5,6
6 affiliations
  1. 1Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland.
  2. 2Family and Social Services, Psychiatry, Wellbeing Services County of Päijät-Häme, Lahti, Finland.
  3. 3Department of Safety, Finnish Institute for Health and Welfare, Forensic Chemistry Unit, Helsinki, Finland.
  4. 4Western Uusimaa Wellbeing Services County, Mental Health and Substance Abuse Services, Lohja, Finland.
  5. 5Department of Psychiatry, University of Turku and Turku University Hospital, Turku, Finland, [email protected].
  6. 6Mental Health and Addiction Services, Wellbeing County of Southwest Finland, Turku, Finland, [email protected].
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Abstract

Introduction

Psychiatric disorders are common among patients with opioid use disorder (OUD). Opioid agonist therapy (OAT) is an effective treatment for OUD, but outcomes for patients with psychiatric comorbidities remain understudied. This study aimed to examine the connections between psychiatric comorbidities and outcomes in individuals undergoing OAT.Methods

We retrospectively collected data from the Wellbeing Services County of Southwest Finland clinical registry. The cohort included 1,235 patients receiving OAT from January 1, 2004, to April 15, 2021. Patients attending OAT, psychiatric diagnoses, overdoses, and self-harm were identified from the registry data using ICD-10 codes. In cases of death, the register also included the date of death. We analyzed associations between psychiatric comorbidities and outcomes using Cox regression for death and logistic regression for nonfatal overdose and self-harm.Results

We identified the prevalence of the following psychiatric comorbidities: non-substance use disorder (non-SUD) psychiatric disorders (39.0%), psychosis (17.0%), mood disorders (29.1%), anxiety disorders (26.2%), personality disorders (20.7%), and other SUDs not related to opioids (other SUDs) (61.4%). After adjusting for all covariates, we found an association between alcohol use disorder (AUD) (hazard ratio = 1.54, 95% confidence interval = 1.06-2.22) and a higher risk of death during OAT. Additionally, non-SUD psychiatric disorders (overdose: odds ratio [OR] = 1.64, 1.14-2.36; self-harm: OR = 1.50, 1.03-2.18), psychosis (overdose: OR = 1.89, 1.29-2.79; self-harm: OR = 1.87, 1.26-2.78), and other SUDs (overdose: OR = 2.61, 1.81-3.83; self-harm: OR = 2.56, 1.74-3.82) were associated with higher odds of both overdose and self-harm.Conclusion

The study emphasizes the need for screening and secondary preventive measures for psychosis and other SUDs (particularly AUD) in OAT settings.

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Cite

BibTeXRIS
BibTeX
@article{li2026psychiatric,
  title = {{Psychiatric Comorbidities and Risks of Death, Nonfatal Overdose, and Self-Harm in Opioid Agonist Therapy: A Retrospective Cohort Study.}},
  author = {Yangyang Li and Alexander Denissoff and Margareeta Häkkinen and Lauri Sillanmäki and Solja Niemelä},
  journal = {European addiction research},
  year = {2026},
  month = oct,
  doi = {10.1159/ear/acrag001},
  url = {https://europepmc.org/article/MED/42895930},
  note = {CC BY-NC},
}
RIS
TY  - JOUR
TI  - Psychiatric Comorbidities and Risks of Death, Nonfatal Overdose, and Self-Harm in Opioid Agonist Therapy: A Retrospective Cohort Study.
AU  - Yangyang Li
AU  - Alexander Denissoff
AU  - Margareeta Häkkinen
AU  - Lauri Sillanmäki
AU  - Solja Niemelä
PY  - 2026
DA  - 2026/10/19
JO  - European addiction research
DO  - 10.1159/ear/acrag001
UR  - https://europepmc.org/article/MED/42895930
AB  - Introduction  Psychiatric disorders are common among patients with opioid use disorder (OUD). Opioid agonist therapy (OAT) is an effective treatment for OUD, but outcomes for patients with psychiatric comorbidities remain understudied. This study aimed to examine the connections between psychiatric comorbidities and outcomes in individuals undergoing OAT.Methods  We retrospectively collected data from the Wellbeing Services County of Southwest Finland clinical registry. The cohort included 1,235 patients receiving OAT from January 1, 2004, to April 15, 2021. Patients attending OAT, psychiatric diagnoses, overdoses, and self-harm were identified from the registry data using ICD-10 codes. In cases of death, the register also included the date of death. We analyzed associations between psychiatric comorbidities and outcomes using Cox regression for death and logistic regression for nonfatal overdose and self-harm.Results  We identified the prevalence of the following psychiatric comorbidities: non-substance use disorder (non-SUD) psychiatric disorders (39.0%), psychosis (17.0%), mood disorders (29.1%), anxiety disorders (26.2%), personality disorders (20.7%), and other SUDs not related to opioids (other SUDs) (61.4%). After adjusting for all covariates, we found an association between alcohol use disorder (AUD) (hazard ratio = 1.54, 95% confidence interval = 1.06-2.22) and a higher risk of death during OAT. Additionally, non-SUD psychiatric disorders (overdose: odds ratio [OR] = 1.64, 1.14-2.36; self-harm: OR = 1.50, 1.03-2.18), psychosis (overdose: OR = 1.89, 1.29-2.79; self-harm: OR = 1.87, 1.26-2.78), and other SUDs (overdose: OR = 2.61, 1.81-3.83; self-harm: OR = 2.56, 1.74-3.82) were associated with higher odds of both overdose and self-harm.Conclusion  The study emphasizes the need for screening and secondary preventive measures for psychosis and other SUDs (particularly AUD) in OAT settings.
SN  - 1022-6877
SN  - 1421-9891
ER  -