This causes a spiral effect of emotional decline and mental impairment that occurs with chronic alcohol and drug use and intoxication. In our research, it was found that a higher frequency and quantity of alcohol consumed plays a major role in death by suicide. The more heavily and habitually one drinks, the more vulnerable they are to these risks. Associations between specific SUDs (2001–2002) and risk of suicide death (2003–2016), Sweden. A total of 15,616 persons (0.2% of the cohort) died by suicide, compared with 3.0% of those with any DUD and 2.4% of those with AUD (Table 2).
Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population. This likely will concern two phases, development of research for acute intervention (e.g., crisis-line calls, hospital presentation) and then linkage to integrated interventions that address the specific role of AUA in suicidal risk for a particular patient, and target both behaviors. Assessments of the role of AUA in suicide attempts should begin with establishing if AUA occurred and estimating the amount of alcohol consumed. The information learned from a chain analysis can be used to develop a personalized distress safety plan that highlights high-risk periods and warning signs, and to devise strategies for avoiding alcohol.17 Overall, the goal of the plan is to prevent escalation of suicidal risk in the context of AUA. The new research examined the increase in suicide mortality among women in the context of data showing an increase in heavy alcohol use over time. The study included data from the National Violent Death Reporting System, in which 115,202 suicides—including 87,771 men and 27,431 women ages 18 and up—were reported between 2003 and 2018.
Sensitivity analyses
- Also, although rates of suicide and prevalence of AUD remain higher in men, they have increased more among women in recent decades.
- Concern from others about drinking was measured by a single AUDIT item asking if anyone, professional or personal, had expressed concerns about drinking.
- Shifting the research focus from binge drinking to other dimensions of alcohol use may be warranted, subject to the availability of sufficiently nuanced data.
Pairwise P values comparing magnitudes of association between specific SUDs and risk of suicide death. Co-sibling analyses were performed to assess for potential confounding by unmeasured shared familial (genetic and/or early-life environmental) factors. Relevant exposures that are shared among siblings may include parental psychosocial stress, substance use, or psychopathology.
Supplementary Material
It helps in reducing the patient’s sense of isolation contributing to decreasing future suicidal behaviors. They include deaths where the primary (or underlying) cause of death listed on the death certificate was one of 58 alcohol-related causes. The study looked at the risk of self-harm and suicide during the year before and after individuals reached the age of their deceased parent — typically about 24 years later. When people whose parents died by suicide reach that same age, their own risk often spikes, Danish researchers warn.
Links to NCBI Databases
To investigate the association between alcohol use and our three outcomes, we conducted multivariable logistic regressions. For our main analysis, we used total AUDIT score (continuous) to investigate whether there is a linear association between AUDIT score and outcomes. To investigate associations of our three outcomes with other domains of alcohol use, we ran models with categorical measures of drinking risk category (low-/moderate-/high-risk alcohol use) and of five specific domains of alcohol use.
Substance use disorders (SUDs) are among the strongest risk factors for suicide (Chesney et al., 2014; Crump et al., 2014; Fazel and Runeson, 2020; Harris and Barraclough, 1997; Wilcox et al., 2004). Men and women with SUDs have been reported to have more than 4-fold risks of suicide death compared with the general population, after adjusting for sociodemographic differences and comorbidities (Crump et al., 2014). Because of their high prevalence in most countries worldwide (Degenhardt et al., 2013; Rehm and Shield, 2019; Whiteford et al., 2013), SUDs are major contributors to the global burden of suicide (Ferrari et al., 2014). However, despite their importance for suicide risks, little is known about how risks vary by specific SUDs, because they seldom have been examined using the same data source to facilitate comparisons. A better understanding of comparative risks by specific SUDs is needed to improve risk stratification and help target interventions for the highest-risk subgroups. First, population-attributable fractions were calculated based on data including only persons who currently drank alcohol.
AUA is a potent proximal risk factor for suicidal behavior, and the risk increases with the amount of alcohol consumed, consistent with a dose-response relationship. Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. There is support for policies that serve to reduce alcohol availability in populations with high rates of AUD and suicide, that promote AUD treatment, and that defer suicide risk assessments in intoxicated patients to allow the blood alcohol concentration to decrease. The latest article from Alcohol Research Current Reviews explores links between alcohol use and suicidal behavior. Proximal risk factors for suicide in individuals with SUDs may include psychosocial dysfunction (Brook et al., 2009; Kendler et al., 2017), psychiatric symptoms (Kessler et al., 2005; Schuckit, 2006; Trivedi et al., 2015), and interpersonal stress (Conner and Ilgen, 2011). Further identification of the mechanisms by which specific SUDs are related to suicidal enabling behavior meaning behavior is needed to account for the risk gradient observed in the present study.
Patients are often unaware of the resources available to them and are more likely to use them if they know where to look. This strategy provides for participation in activities that exclude alcohol, tobacco, and other drug use. Constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol, tobacco, and other drug use, which ultimately reduces suicidal tendencies. “This is also an opportunity to reinforce that suicide is not inevitable after the suicide of a parent, with an absolute risk … estimated at less than 1%,” they added in a American Psychiatric Association news release.
Information on tobacco smoking and stressful life events was unavailable to assess for potential confounding by these factors. Lastly, this study was limited to one country and will need replication in other populations when feasible. The public health impacts may be even higher in countries that lack universal health care and have more restricted access to psychiatric and SUD treatment. Longitudinal research is needed to further support these findings empirically and ascertain potential causal associations, in addition to gaining insights into which groups of alcohol users in the general population would be most at risk for suicidal behaviours.
Our study found those who drink heavily and more frequently have increased risk of death by suicide, particularly over longer periods of time. This association was attenuated when sociodemographic and clinical covariates were added to the model, but strong evidence of an association remained (adjusted odds ratio 1.06, 95% CI 1.03–1.09). Similarly, there was evidence of a relationship between AUDIT score and suicidal thoughts in both the unadjusted (odds ratio 1.07, 95% CI 1.06–1.10) and fully adjusted model (adjusted odds ratio 1.05, 95% CI 1.03–1.07).
The most common SUDs in this cohort were alcohol, opioid, and sedative/hypnotic use disorders. Opioid and sedative/hypnotic use disorders also had the strongest associations with suicide mortality, which affected both men and women. Globally, opioid use disorder has the highest health burden among all DUDs because of its high worldwide prevalence and premature mortality (Degenhardt et al., 2013).