Using the psychological steve harwell alcoholic autopsy method, Heilä et al. 254 investigated schizophrenic subjects in whom active illness and depressive symptoms were highly prevalent immediately before suicide and a history of suicide attempts was common. Women were more likely to have committed suicide during an acute exacerbation of the illness. Alcoholism was most common among middle-aged men (45%), whereas middle-aged women had a high rate of depressive symptoms (88%).
The main bibliographic databases, including PubMed, Scopus, and Web of Science, were searched until February 2015. The reference lists of all included studies were scanned and the authors of the identified studies were contacted for additional eligible studies. We reported descriptive statistics, and presented associations between covariates and the primary exposures explored with chi-squared and t-tests, as appropriate. For main analyses, we conducted univariable analyses followed by multivariable analyses to adjust for the effects of ten specific potential confounders. Participants were asked ‘Have you ever made an attempt to take your life, by taking an overdose of tablets or in some other way? ’, ‘Have you ever thought of taking your life, even though you would not actually do it?
Data availability
Sociological interpretations include the hypothesis that acute alcohol use leads to increased social deterioration and anomie 177, unemployment, debts, and social isolation 188–190. Biological interpretations of the association include impaired physical and mental functioning 191 and interactions with other psychotropic drugs 192. Disinhibition, in which alcohol acts to remove psychological and even physiological barriers to self-harm, has also been proposed as a relevant factor 193. Part of preventing suicide is raising awareness around the topic and bringing it into conversations. The topic of suicide is surrounded by secrecy, which is one of the barriers to getting treatment for people who need it.
Treatment Interventions for Co-occurring Suicidality and OUD
- The spouses of suicides who misused alcohol were significantly more likely to react with anger than the spouses of those who did not.
- The studies reporting suicide as a general term without distinguishing between suicidal ideation, suicide attempt, or completed suicide were excluded.
- Adolescents are exposed to a lot of misinformation and skewed perceptions of drug culture through social media and society in general.
- In almost all industrialized countries, the highest suicide rate is found among men aged 75 years and older 207.
Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population. Our study indicates these combine to produce a 282 per cent increased risk of death by suicide. Attitudes toward and drinking and help-seeking behavior are culturally determined, but genetic factors play an important role in the predisposition to both suicidal behavior 271 and alcohol abuse 272,273. Intervention should help people find a motivation to stop drinking, identify the circumstances that motivate them to drink, identify the factors that engender this conduct, and evaluate the possible risk of suicide. Psychotherapy can help individuals learn new methods of coping with stressors and develop social relationship in the community. Particularly for adolescents, family therapy may play a crucial role both in the resolution of the problems and in the recovery of the patient.
Reviewing the literature for the period 1991–2001, Cherpitel, Borges, and Wilcox 88 found a wide range of alcohol-positive cases for both completed suicide (10–69%) and suicide attempts (10–73%). Several case-control studies at the individual level have shown a high prevalence of alcohol abuse and dependence among suicide victims 89,90. Kolves et al. in a psychological autopsy study reported that 68% of males and 29% of females who committed suicide met the criteria for alcohol abuse or dependence 89. Strong support for a direct link between alcohol and suicide comes from aggregate-level data. Both longitudinal and cross-sectional aggregate-level studies usually report a significant and positive association between alcohol consumption and suicide 91–93.
Association between total AUDIT score and suicidal behaviour
Social and environmental disadvantages, such as lack of family support, unemployment, and homelessness 144, 156,157,158 are highly prevalent among persons with OUD, as well as suicidal individuals. Childhood trauma (e.g., physical or sexual abuse) is a particularly significant early risk factor for suicide 159 and is highly prevalent in OUD 160,161,162. Indeed, a history of childhood abuse significantly increase the risk for suicidal behavior in individuals OUD 144, 149, 157. Individuals with AUD share a number of neurobiological characteristics with suicidal individuals. Evidence of impaired serotonin (5-hydroxytryptamine; 5-HT) transmission has been found postmortem in the brains of suicide decedents 62, as well as in the cerebrospinal fluid (CSF) of nonfatal attempters 63, 64.
In contrast, only middle-aged men had a significant yearly increase in alcohol-involved suicides. Public policies should be looking to increase awareness of the link between alcohol and suicide and to assess and treat problematic alcohol use as a way to prevent suicide. The results of our research highlight just how needed these measures are in our society, but prevention requires change at both the individual and systemic level. 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. Bartels et al. 255 reported that alcohol use was also correlated with depression and suicidal behavior, and depression alone accounted for over 80% of the explained variance in suicidal behavior.