Original articleUse of alcohol before suicide in the United States
Introduction
Suicide continues to be an urgent global public health problem [1]. In the United States, 38,364 people died by suicide in 2010, representing the 10th leading overall cause of death and fifth leading cause of years of potential life lost (YPLL). Men across the age span, but particularly in older age, have a higher suicide rate than do women at any age [2].
Alcohol plays a key role in suicide [3], [4], [5], [6]. According to the US Centers for Disease Control and Prevention (CDC), on average, 7,266 suicides (23%) and 243,516 YPLL (36%) were attributable to alcohol annually in 2001–2005 [7]. There have been several uncontrolled descriptive studies of the association of acute use of alcohol and suicide [6], including several reports of national US data by our investigative team [8], [9], [10]. This literature confirms that alcohol is commonly consumed before suicide; for example, our group recently reported that 37% of male and 29% of female suicide decedents in a US national sample had positive blood alcohol levels [8]. These data further showed that individuals who drank before suicide tended to consume high levels of alcohol; we recorded estimates of mean blood alcohol concentrations (BACs) of 0.15 g/dL and 0.13 g/dL in male and female suicide decedents, respectively, who used alcohol before suicide [10], levels that far exceed the 0.08 g/dL legal limit for drinking and driving in the United States.
What is missing from such data is the ability to compare drinking in suicide decedents with that in a nonsuicide comparison group, a procedure that would allow for estimation of the degree of risk for suicide associated with drinking occasions and heavy drinking occasions, respectively. Indeed, to our knowledge, there has been only one study that systematically compared acute use of alcohol in suicide decedents with that in a nonsuicide comparison group [11]. Using a case-control study of 149 firearm suicides, Branas et al. [11] found acute alcohol intoxication to increase firearm suicide risk. Although the report by Branas et al. is informative, its generalizability to suicides nationally or to suicides using other methods is unclear. Its small sample size also does not allow for estimates of risk in men versus women (i.e., n < 20 female suicides) or in specific age groups, a key limitation in light of dramatic differences in drinking (and heavy drinking) in the general population as a function of age and gender [12].
The primary purpose of the present study was to provide the first estimates based on US national data of relative risk of suicide associated with (a) drinking occasions and (b) heavy drinking occasions. We hypothesized that suicide decedents had higher drinking rates and levels before death than a living sample. This study addressed these issues using the National Violent Death Reporting System (NVDRS), a large well-characterized database with unrivaled toxicology information. The primary aim of the study was to compare acute alcohol use among suicide decedents with drinking patterns of a living population. The results can be used to facilitate the development of more effective clinical practices, treatment programs, and public policies to reduce the incidence of alcohol-associated suicides.
Section snippets
Methods
This study used restricted pooled data for decedents from the 2003–2011 NVDRS [13]. Supported by the CDC, the NVDRS is a state-based active surveillance system that provides a detailed account of violent deaths in the participating states. Although a smaller cohort of states participated in 2003 and 2004, in 2005–2011, 16 states (Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia,
Results
Among those tested for blood alcohol, 36% of male and 28% of female suicide decedents were BAC+ (i.e., BAC > 0.0 g/dL). Table 2 shows the prevalence of alcohol use before suicide among NVDRS decedents and before the interview among NESARC respondents by gender and age. Male and female suicide decedents younger than 60 years were more likely to drink than their living counterparts. As expected, among nonelderly decedents, men were significantly more likely to be BAC+ than women. In addition,
Discussion
Alcohol was detected in nearly 36% of male and 28% of female suicide decedents. There were noteworthy age differences in the relative likelihoods of drinking for suicide decedents versus survey respondents. Looking first at any alcohol ingestion, nonelderly male and female suicide decedents were two to four times more likely to use alcohol before suicide than the living sample was likely to drink in the 48 hours before the interview. Above age 65, the ratio was less than one, suggesting that
Acknowledgment
This study was supported by grant R01 AA020063 from the National Institute on Alcohol Abuse and Alcoholism. All analyses, interpretations, and conclusions based on the analysis of these data are solely the responsibility of the authors and do not represent the views of either the US Centers for Disease Control and Prevention or the states participating in the National Violent Death Reporting System.
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