Alcohol use and death by suicide: A meta-analysis of 33 studies

Various classical studies found an excess of suicide among alcoholics [73–80]. Beck and Steer [81] and Beck et al. [82] found that alcoholism was the strongest single predictor of subsequent completed suicide in a sample of attempted suicides. Recent findings from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) [32] indicate that the 12-month prevalence of DSM-IV-TR alcohol dependence in the adult population in USA is 3.8% and that of alcohol abuse 4.7% [33]. This means that, every year, 8.5% of the adult US population in USA has an alcohol use disorder [33].

Study sample

This issue requires greater amounts of relevant qualitative and quantitative data that can be used to develop policy and implement actionable change. Improved efforts by healthcare providers and the public at large to understand mental health and SUD can reduce stigma and empower individuals to seek treatment. Critically, continued national attention to this issue will enable lasting change for pregnant and parenting people with mental health conditions and SUD. Negative and stigmatizing attitudes create a barrier to mental health and SUD treatment. Perceptions of gender and parenthood for individuals who are pregnant and may need services further exacerbate stigma. Stigma against people with these health conditions can also lead to healthcare providers’ refusal to undergo the training needed to treat pregnant and parenting people with mental health conditions, SUD, and co-occurring disorders.

Data availability

The well-established heritability of alcohol consumption and the interaction of genes with social and environmental factors [274] should also be taken into account when dealing with alcohol use as related to suicidal behavior. Failure to identify specific alcohol-related disorders can delay the initiation of readily available therapies and increase the morbidity and alcohol and the etiology of depression american journal of psychiatry mortality of patients. The goal of intervention is to treat acute, modifiable risk factors and to continuously ensure the patient’s safety (19). Patients at high risk for suicide should be hospitalized as a precaution, and detoxification treatment should be started immediately. Subsequently, it is crucial to make the patient aware of the process of rehabilitation.

Association between total AUDIT score and suicidal behaviour

Suicide deaths involving heavy alcohol use have increased significantly among women in recent years, according to a new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Previous research has shown that alcohol is a risk factor for suicidal behavior and that women have a higher risk than men do for suicide adderall’s effects on the brain: short-term and long-term symptoms while intoxicated. And in the two decades leading up to 2018, suicide death rates in the United States increased, with the rate among women increasing faster than the rate among men. Results for the univariable and multivariable analyses assessing the relationship between grouped AUDIT score and suicidal behaviour are shown in Table 3.

  1. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account.Find out more about saving content to Google Drive.
  2. However, co-morbid psychopathology is neither sufficient nor necessary for this association [14].
  3. If it means saving a loved one, warning labels on beer cans seem like a pretty low price to pay.
  4. Moreover, students participating in a national survey in 2001–2002 were 1.25× more likely to meet DSM-IV criteria for an alcohol use disorder relative to an age-matched cohort not attending college (Blanco et al., 2008).
  5. They noted that younger male subjects most often used violent suicide methods.

Alcohol and Suicidal Behavior

Indeed, it would be a coup to prioritize the inclusion of AUD patients with suicidal ideation, insofar as suicidal thoughts and behavior has so often served as exclusion criteria in clinical trials research. 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.

Murphy et al. studied 50 suicides and found that an alcohol use disorder was the primary diagnosis in 23% and a co-occurring diagnosis in 37% [86]. Conwell et al. performed a study in New York City and reported that alcohol misuse was present in the history of 56% of individuals who completed suicide [43]. Several reviews have discussed the relationship between alcohol use disorder (AUD) and suicidal thoughts and behavior, but none has given a pooled effect estimate [9–11]. An old meta-analysis was conducted by Smith et al [12] based on studies published before 1999.

The diagnosis of depression is crucial for suicide prevention because treatment of unipolar depression is different from that of bipolar depression, the latter increasing the likelihood of suicide if treated only with antidepressant drugs [228–232]. Incomplete symptomatology, impulsive actions, periodic alcohol abuse, compulsive buying behaviors, acute delusional episodes, medicolegal actions and comorbidities can hide or modify bipolar symptomatology. Bipolarity should be systematically screened for in cases of substance abuse (present in 40–60% of bipolar disorder patients), particularly in cases of alcohol abuse [233]. Regulatory agencies have issued warnings that the use of selective serotonin-reuptake inhibitors poses a small but significantly increased risk of suicidal ideation or nonfatal suicide attempts for children and adolescents [232,234].

The guidelines recommend making sure that suicide prevention programs are strongly linked with the mental health resources in the community. A good prevention program should adopt a broad spectrum approach since suicide cannot be explained with linear cause-and-effect logic, but rather as a complex and multidimensional phenomenon. The guidelines also recommend incorporating promising, but underused, strategies into current programs where possible, expanding suicide prevention efforts for adolescents and young adults, introducing screening programs, and evaluating the prevention programs. Aharonovich et al. [258] found that all subtypes of depression increased the risk for making a suicide attempt in patients with substance dependence abuse. Major depression occurring before the patient became substance dependent predicted the severity of suicidal intent, while major depression during abstinence predicted the number of attempts. Because patients with substance use disorders are prone to suicidal ideation and attempts, clinicians need to screen such patients for suicidal thoughts and behaviors routinely and continuously throughout treatment.

Brief motivational enhancement techniques to increase patients’ willingness to pursue treatment and overcome obstacles may also be an effective engagement approach. Motivational interviewing is focused on helping people work through their ambivalence about changing their behavior and explores patients’ concerns and beliefs about change. Once a decision has been made to attempt suicide, alcohol use may serve several functions. Alcohol may also serve as a “means to an end” as the suicide method itself [182–184]. Whether they suffer from anxiety or other mental illness, some kind of mood or personality disorder, or are trying to cope with a trauma, many people turn to alcohol in an attempt to forget their problems.

Safety planning is frequently included as an element in cognitive behavioral interventions for suicide prevention and can also be used as a brief standalone intervention, typically paired with a referral for mental health 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. Shifting the research focus from binge drinking to other dimensions of alcohol use may be warranted, subject to the availability of sufficiently nuanced data. Qualitative research exploring drinking motives and contexts for alcohol consumption may further enhance our understanding of the role of alcohol use behaviours and links with suicidal and self-harming behaviour.

OR is the relative odds of outcome in the exposed group versus the non-exposed group occurring at any given point in time. Wherever reported, we used full adjusted forms of RR and OR controlled for at least one or more potential confounding factors such as age, gender, race, mental disorder, drug abuse, smoking, marital status, body mass index, educational level, employment status, income, and living alone. We conducted the most comprehensive meta-analysis on the link between alcohol (ab)use and death by suicide to date.

Reduced serotonin input in the prefrontal cortex may underlie decreased behavioral inhibition in individuals with alcoholism and a greater probability of acting on suicidal feelings. Higher suicidality in depressed patients with alcohol dependence compared to depressed persons without comorbid alcohol dependence may also be related to the differences in dopaminergic regulation between the two groups. It has been observed that depressed subjects with a history of alcohol i drink every night am i an alcoholic dependence had lower CSF HVA levels, compared with depressed subjects without a history of alcoholism [159]. In this prospective analysis of 2296 college students deemed at increased risk for suicide, the degree of alcohol problems, but not consumption level, significantly predicted the likelihood of suicide attempts. Other baseline features predictive of suicide attempts included wishes for death, suicidal ideation, suicide attempts and degree of global impairment.

Several reports13–15 have examined risk factors for suicide attempts and suicide among individuals with AUD. Department of Health and Human Services formed the Task Force on Maternal Mental Health as a subcommittee of SAMHSA’s Advisory Committee for Women’s Health. The purpose of the Task Force is to identify, evaluate, and make recommendations to the Advisory Committee for Women’s Health to coordinate and improve federal activities related to addressing maternal mental health conditions, substance misuse, and SUD.

Clearly, the link between drinking alcohol and thoughts or attempts of suicide is stronger than we might have previously thought. Here is a discussion of why this connection exists, and why it’s so important to get help with your mental health struggles or addiction. Another theory of suicide suggests the severity of depressive symptoms, such as a hopeless sense of not belonging, is directly proportional to the likelihood of a lethal suicide attempt. Raising awareness in these age groups about the severe consequences of substance abuse and chemical dependence requires a clinical approach to young, impressionable minds that are still developing.

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