Drinking and suicide: How alcohol use increases risks, and what can be done about it

Is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The data that support the findings of this study are held by NatCen Social Research and NHS Digital, and access is available on request through the UK Data Request Service. Concern from others about drinking was measured by a single AUDIT item asking if anyone, professional or personal, had expressed concerns about drinking. Participants were coded positive for ‘concern from others about drinking’ if they reported ever having received expressions of concern from others.

Alcohol-Related Risk of Suicidal Ideation, Suicide Attempt, and Completed Suicide: A Meta-Analysis

Additionally, acutely intoxicated individuals with suicidal urges appear to stabilize quickly in inpatient care 107. However, relapse and suicidal behavior following discharge remain significant concerns 108. Transfer to another inpatient setting following acute stabilization may decrease the risk of postdischarge suicide attempts 109, and longer treatment courses, whether inpatient or outpatient, may lower the posttreatment risk of suicidal behavior 110. Notably, impulsive suicide attempts may be a strong indicator of relapse risk after discharge.

1. There are well-established links between alcohol and cancer, heart disease and violence.
2. Cornelius et al. 240 found that the long-term clinical course for major depression in the comorbid adolescent population is surprisingly poor also including a higher mortality from suicide and higher treatment costs 241.
3. Studies of serotonin metabolites support this; for example, in high- and low-lethality attempters, trait aggression is related to lower concentrations of CSF 5hydroxyindolacetic acid (5HIAA; a major metabolite of serotonin), and high lethality attempters demonstrated lower CSF 5-HIAA 68.

Alcohol and depression

Knowledge about who is at risk of suicide is crucial, and a number of interventions show promising effects. Future research must focus on the development of suicide-prevention based on specific assessment and treatment protocols. 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.

Prevalence and predictors of suicidality among adults initiating office-based buprenorphine

Additionally, the gaps in intervention research on co-occurring suicidality and AUD/OUD are substantial, and pharmacological studies do not frequently account for the effects on suicidality, specifically, in addition to mood improvements in mood, in alcohol/opioid users. Given the high prevalence of alcohol/opioid use alongside escalating rates of suicide, there is a compelling need for attention to their cooccurrence. Although not specifically indicated for suicidal ideation or behavior, SSRIs have been used with some success in decreasing suicidal ideation alongside other depressive symptoms, and reducing alcohol misuse in depressed alcohol users 101, 117,118,119. SSRIs consistently produce a modest 15–20% reduction in alcohol consumption 120, however intra-individual reductions in alcohol intake range widely from 10 to 70% 120. In addition to SSRIs, tricyclic antidepressants are thought to mitigate depressive-like alcohol withdrawal symptoms 121 and may be effective for co-occurring depression and AUD 122, 123.

Neither gender nor age modified any of these associations (see Supplementary Tables 5 and 6, Supplementary Figs 1–3). Suicide, heart disease and cancer are consistently among the top 10 causes of death of Canadians, and alcohol increases the risk of all of these killers. While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide. Emotional reactions in survivors differ, with spouses and parents significantly more affected than adult children 224. Parents showed more sorrow, depression, feeling of powerlessness and guilt, while spouses felt more abandoned and angry 224.

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). Among people who die by suicide, alcoholism is the second-most common mental over the counter xanax alternative disorder, and is involved in roughly one in four deaths by suicide. As a psychologist and scientist, my research aims to understand whether alcohol actually increases the risk of dying by suicide. Assessments of the role of AUA in suicide attempts should begin with establishing if AUA occurred and estimating the amount of alcohol consumed. Thus, the relationship between alcohol abuse and depression in determining suicidality is complex and multifaced, and there are many factors which may impact on suicidality in depressed patients.

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. Clinical policy interventions targeting AUD also have the potential to affect suicide rates in health systems that have high rates of AUD and suicide. Singh et al. 24 reviewed autopsy and field reports for all paediatric suicide cases referred to the New Mexico Office of the Medical Investigator from 1979 to 2005.

We retrieved 8548 references until February 2015, including 6658 references through searching electronic databases, 1890 references through checking other sources, including reference lists, relevant web sites, or personal contact with authors of the included studies. We excluded 8380 duplicates and clearly irrelevant references through reading titles and abstracts. Of the 168 references considered potentially eligible after screening, 137 studies were excluded because they were not original article (i.e., letter, commentary, review) or did not meet the inclusion criteria (Fig 1). Eventually, 31 studies included in the meta-analysis, including 9 cohort studies 23–31 and 10 case-control studies 32–41 and 12 cross-sectional studies 42–53. Data were analyzed and the results were reported using a random effects model 22.