A meta-analysis of acute use of alcohol and the risk of suicide attempt

Global burden and trend of substance use disorders, self-harm, and interpersonal violence from 1990 to 2021, with projection to 2040

BACKGROUND

Alcohol use disorders (AUD), drug use disorders (DUD), interpersonal violence, and self-harm are a major public health concern globally, with high rates of disability, morbidity, and mortality associated with this. This study aims to estimate the disease burden, trends, projections, and disparities of AUD, DUD, interpersonal violence, and self-harm among all ages and sexes from 1990 to 2021.

METHODS

This study is a secondary analysis utilizing data from the Global Burden of Disease (GBD) 2021 in 204 countries and territories. The incidence, deaths, and disability-adjusted life years (DALYs), projection, and the inequality were estimated for AUD, DUD, interpersonal violence, and self-harm among all age and sex.

RESULTS

In 2021, there were 55.78 (46.56-64.31) million new cases of AUD, 13.61 (11.63-15.67) million new cases of DUD, 29.40 (26.17-32.65) million new cases of interpersonal violence, 5.49 (4.6-6.5) million new cases of self-harm globally. By 2040, AUD is forecasted to be 51.98 (29-74.97) million, DUD will be 13.81 (9.23-18.39) million, 36.01 (15.25-56.78) million for interpersonal violence, and 10.55 (3.16-17.94) million for self-harm. In terms of gender and age distribution, males had higher incidence, mortality, and DALYs for AUD, DUD, and interpersonal violence compared to females. Females had higher incidence of self-harm, while males had higher mortality. By age group, individuals aged 15-49 bore the highest burden of DUD, interpersonal violence, and self-harm, while those aged 50-74 had the highest burden of AUD. The burden of these conditions is closely related to the socio-demographic index (SDI). High- and middle-high SDI regions had a heavier burden of AUD, DUD, and self-harm, while low- and middle-low SDI regions had a heavier burden of interpersonal violence. Additionally, from 1990 to 2021, health inequalities for AUD and self-harm decreased, while those for DUD and interpersonal violence increased.

CONCLUSIONS

From 1990 to 2021, the disease burden of AUD, DUD, interpersonal violence, and self-harm exhibited specific patterns across different genders, age groups, and regions. Multilevel interventions should be initiated, with a focus on reducing inequalities through resource allocation and policy support.

An integrated alcohol and suicide intervention for adolescents in inpatient psychiatric treatment

BACKGROUND

Despite the bidirectional relationship between alcohol use and STB, the two issues are often treated separately in adolescent inpatient psychiatric hospitals, highlighting the need for brief interventions that address both alcohol use and STB in an integrated fashion.

AIMS

This study tested the feasibility, acceptability, and preliminary effectiveness of a brief integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST) with a post-discharge mHealth booster for adolescents in inpatient psychiatric treatment.

METHODS

We conducted an RCT of iASIST relative to an attention-matched comparison condition with adolescents hospitalized following STB (N = 40).

RESULTS

iASIST demonstrated feasibility and acceptability and mixed models indicated that both groups had significant decreases in substance use over the 3-month follow-up, but post-intervention group differences were not significant. In terms of cannabis use, however, iASIST participants significantly improved over time. Intervention group participants showed a significant decrease in suicide plans from baseline to follow-up, which was not the case for control group participants.

DISCUSSION

Study findings suggest a larger RCT is warranted to test the effectiveness of the iASIST intervention.

CONCLUSION

iASIST shows promise in its ability to target the public health problems of alcohol use and STB in an integrated fashion with a high-risk adolescent population receiving acute psychiatric care.

Understanding Suicidal Thoughts and Behaviors Among LGBTQ + Youth: Differential Associations Between Bullying and Substance Use

Rates of suicidal thoughts and behaviors (STB, i.e., suicidal thoughts, plans, and attempts), substance use, and bullying victimization are higher among lesbian, gay, bisexual, transgender, and/or queer (LGBTQ +) youth compared to their heterosexual peers. However, research examining the interactive and potentially compounding associations of concurrent bullying and substance use (alcohol, cannabis, hallucinogens, and opioids) with STB is sparse, especially among LGBTQ + youth. Thus, the current study aims to understand how these substances moderate the association between bullying victimization and STB by utilizing data (N = 96,482) from the combined 2003-2019 Youth Risk Behavior Survey (YRBS). Using a cross-sectional design and hierarchical logistic regression, we found that, on average, LGBTQ + youth who were bullied were more likely to report planning to attempt suicide (O.R. = 2.71, p < .01). Similarly, youth who reported using opioids/prescription drugs (O.R. = 4.60, p < .05) or hallucinogens (O.R. = 8.89, p < .01) were more likely to attempt suicide. No significant associations between alcohol use and STB were found. Lastly, cannabis emerged as a significant moderator of the associations between bullying victimization and suicidal ideation and plans, such that adolescents who were bullied and used cannabis were less likely to report suicidal ideation and planning compared to those who were bullied but did not use cannabis. These findings highlight that different substances are distinctively associated with STB among LGBTQ + youth, providing a better understanding of how individuals who are being bullied may cope and to develop prevention programs to combat suicidal thoughts, planning, and attempts.

Association of substance use with suicide mortality: An updated systematic review and meta-analysis

Background

Rates of suicide mortality and substance use have increased globally. We updated and extended existing systematic reviews of the association between substance use and suicide.

Methods

This systematic review and meta-analysis explored the association between substance use and suicide mortality in peer reviewed, longitudinal cohort studies published from 2003 through 2024. Risk of bias was assessed using the Newcastle-Ottawa Scale. Pooled data were analyzed using a quality effects model. Meta-regression was used to assess the effect of moderation by study quality. Asymmetry in funnel plots and Doi plots were used to detect reporting bias.

Findings

The analysis involved 47 studies from 12 countries. Substance misuse (SMR: 5.58, 95 % CI: 3.63-8.57, I2: 99 %) was significantly associated with risk for suicide. Alcohol (SMR: 65.39, 95 % CI: 3.02-19.62, I2: 99 %), tobacco (SMR: 1.83, 95 % CI: 1.20-2.79, I2: 83 %), opioid (SMR: 5.46, 95 % CI: 3.66-8.15, I2: 96 %), cannabis (SMR 3.31, 95 % CI: 1.42-7.70, I2: 95 %), and amphetamine (SMR 11.97, 95 % CI: 3.13-45.74, I2: 99 %) misuse were each linked to higher rates of suicide mortality. The association between substance misuse and suicide was stronger for females (SMR: 12.37, 95 % CI: 7.07-21.63, I2: 98 %) than males (SMR: 5.21, 95 % CI: 3.09-8.78, I2: 99 %) overall and in analyses of specific substances. Further disaggregated data were not available to sufficiently explore for potential health inequities across social factors.

Conclusions

This meta-analysis highlights that substance misuse remains a significant suicide risk factor. It underscores the need for universal and targeted prevention and equitable access to effective interventions.

Suicide Risk in Alcohol Use Disorders: Literature Review and Study Protocol with Preliminary Data for a Study in Treatment-Seeking Inpatients

Background/Objectives: Individuals with substance use disorders are at risk of displaying suicidal behavior with suicide occurring more frequently compared to the general population. This article gives an overview of the existing literature on the association of substance use disorders, especially alcohol use disorder (AUD), with suicidal behavior. Studies indicate that individuals with AUD report a lifetime prevalence of 40% for at least one instance of attempted suicide. They also have a 10 to 14 times higher risk of suicidal behavior compared to the general population. Methods: The protocol and preliminary data from an ongoing study focused on the prevalence and clinical correlations of suicidal ideation and attempts in treatment-seeking inpatients with AUD are presented. The objective of this study is to address open questions regarding the clinical factors and psychiatric comorbidities associated with suicidality in patients with AUD. In a pilot and feasibility study in an inpatient rehabilitation facility for the treatment of substance use disorders, 150 patients with AUD were examined. For assessment, the Beck Depression Inventory (BDI-II), the Symptom Check-list-90 (SCL-90), and the Scale Suicidal Experience and Behavior (SSEV) were used as standardized questionnaires. In addition, psychosocial and sociodemographic variables were recorded. A total of 257 items were surveyed for each respondent. The statistical analysis was carried out using IBM SPSS. Results: The initial evaluation indicates the feasibility of the study with a high number of responders (90% response rate). Of the participants surveyed, 50.7% (N = 76) were at risk of suicide and 40.7% (N = 61) had already made at least one suicide attempt. Even with a small sample size, a significant, moderate-to-large correlation between alcohol use disorder and suicidality could be demonstrated. Conclusions: This confirms that suicidality is a risk factor for patients with AUD. The role of psychiatric comorbidity, clinical correlations and consequences of AUD, Gender and treatment outcome will be studied in a larger sample of 700 patients.

Comparing substance-involved suicide and unintentional deaths from 2011 to 2021 in Missouri, United States

Background: Substance-involved suicide and unintentional overdose deaths share risk factors, yet our understanding of how these deaths overlap and differ remains limited. Direct comparisons of substance-involved suicide and unintentional deaths are lacking.Objective: To guide effective prevention and intervention efforts regarding substance-involved suicide, we examined risk factors, demographic and substance-related, of substance-involved suicide and unintentional deaths.Methods: Using logistic and multinomial regression, we used medical examiner records obtained annually (N = 6,467, 72% male) to examine characteristics associated with suicide and unintentional substance-involved deaths in St. Louis, Missouri between 2011 and 2021.Results: Between 2011 and 2021, age-standardized suicide rates slightly decreased (3.55 to 3.33), while unintentional deaths nearly tripled (23.2 to 68.2). Many deaths involved both alcohol and traumatic injury, and almost a fifth of suicides involved prescription opioids. In the logistic model (combining data across 11 years), the following factors were associated with increased odds of suicide, relative to unintentional deaths: White race (OR = 5.42, 95%CI[3.95,7.56]), greater age (OR = 1.01, 95%CI[1.00,1.02]), traumatic injury (OR = 4.40, 95%CI[3.17,6.13]), and presence of not otherwise classified substances (including prescription medications; OR = 4.36, 95%CI[3.11,6.10]). The following were associated with decreased odds of suicide: presence of medical condition (OR = 0.32, 95%CI[0.23,0.45]), fentanyl (OR = 0.04, 95%CI[0.02,0.06]), ethanol (OR = 0.64, 95%CI[0.46,0.88]), cocaine (OR = 0.40, 95%CI[0.24,0.63]), heroin (OR = 0.05, 95%CI[0.03,0.09]), and other stimulants (OR = 0.32, 95%CI[0.20,0.50]).Conclusions: Results suggest a divergence over time in the rates of classified substance-involved suicide and unintentional deaths. A distinctive set of demographic and substance use characteristics differentiated the two manners of death, highlighting potential risk factors to inform further research and targeted interventions.

Acute Alcohol Use and Suicide

Importance

While acute alcohol use (AAU) is known to increase the risk of suicide significantly, the underlying mechanisms of this association are still understudied.

Objective

To examine the association between AAU and the risk factors for suicide, focusing on the association between AAU and choice of suicide methods.

Design, Setting, and Participants

This cross-sectional study included data from the Korean National Investigations of Suicide Victims Study (KNIGHTS). The KNIGHTS dataset comprises nationally representative data encompassing nearly all suicide deaths in South Korea from January 1, 2013, to December 31, 2020. The study was analyzed from November 2 to 10, 2023.

Main Outcomes and Measures

The main outcome was whether decedents who died by suicide had consumed alcohol before their death. Trained investigators conducted psychological autopsies by reviewing police reports of suicide deaths. Whether the decedent who died by suicide had consumed alcohol before death was determined from 3 sources: (1) confirmation by informants, (2) autopsy reports indicating a positive blood alcohol concentration, and (3) observations from police officers. Demographic characteristics, premortem psychiatric symptoms, and suicide characteristics, including method of suicide and presumed reasons for suicide, were examined. Hierarchical logistic regression models were used to examine the association between the contributing factors and AAU.

Results

This study included 55 226 decedents who died by suicide (65.5% male), of whom 21 998 (39.8%) were under the influence of alcohol at the time of death. AAU was associated with being male (odds ratio [OR], 1.37 [95% CI, 1.31-1.44]); being middle aged (eg, from age 30 to 39 years: OR, 1.20 [95% CI, 1.06-1.35]); and having alcohol use disorder symptoms (OR, 13.28 [95% CI, 12.38-14.24]). Among suicide methods, gas, drug, and pesticide poisoning showed a positive association with AAU, with gas poisoning showing the highest OR (OR, 1.88 [95% CI, 1.61-2.20]). An interaction was found between age and suicide method, with older adults (eg, aged 80 years or older) having higher odds of AAU when using methods such as drug (OR, 6.28 [95% CI, 3.53-11.17]), pesticide (OR, 6.56 [95% CI, 3.86-11.13]), and gas (OR, 2.48 [95% CI, 1.52-4.04]) poisoning.

Conclusions and Relevance

The findings of this cross-sectional study suggest that AAU was associated with gas poisoning, as indicated by the ORs. Given that charcoal burning involves substantial preparation time, alcohol may have been deliberately used to facilitate planned suicide attempts. Furthermore, the deaths of older adults who consumed alcohol prior to suicide, even when using less lethal methods, highlight the critical need for monitoring and effectively managing alcohol use within this population.

Alcohol use prior to episodes of nonsuicidal self-injury in women with borderline personality disorder participating in a randomized clinical trial of dialectical behavior therapy

OBJECTIVE

Alcohol use is an important, but understudied, risk factor for nonsuicidal self-injury (NSSI), defined as deliberate physical harm to oneself without intent to die. Alcohol use may facilitate engagement in NSSI by increasing impulsivity and physical pain tolerance. Limited data also suggest that people engage in more medically severe NSSI under the influence of alcohol.

METHOD

This secondary analysis study examined the use of alcohol prior to NSSI in a sample of 79 female patients with borderline personality disorder who were enrolled in a randomized clinical trial of dialectical behavior therapy. We used multilevel modeling (MLM) to examine preregistered hypotheses that alcohol use prior to NSSI would be related to the impulsivity of NSSI, physical pain experienced during NSSI, and the medical severity of injuries from NSSI.

RESULTS

Participants endorsed alcohol use prior to 21.96% (47/221) of NSSI episodes, and roughly one third of participants (n = 27) reported at least one episode of NSSI preceded by alcohol use. For NSSI episodes preceded by alcohol use, more than half (52.38%) of participants reported using alcohol up to the moment of initiating NSSI. Alcohol use was significantly associated with higher impulsivity of NSSI episodes (b = 1.16, p = .041), but not physical pain from NSSI or medical severity of NSSI.

CONCLUSIONS

Findings need to be replicated but indicate that alcohol use occurs frequently prior to NSSI and could be a target for reducing impulsive episodes of NSSI. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Momentary Fluctuations in Impulsivity Predicts Suicidal Ideation Among Those With Problematic Alcohol Use

BACKGROUND

Problematic alcohol use is a recognized risk factor for suicidal thoughts and behaviors. Individuals who misuse alcohol and those experiencing suicidal ideation (SI) often exhibit elevated impulsivity, suggesting that impulsivity may be an underlying mechanism. Impulsivity fluctuates considerably within individuals over short periods, particularly among those engaged in episodic heavy drinking, college students, and those with SI. While impulsivity is associated with suicidal thinking at a trait level, its relationship with SI on a momentary level remains relatively unexplored. This study aimed to (a) replicate cross-sectional findings linking impulsivity and SI in those with problematic alcohol use, and (b) extend these findings to examine the momentary associations between impulsivity and SI within this population.

METHOD

Two independent undergraduate samples were utilized: the first cross-sectional (n = 653) and the second employing ecological momentary assessment (n = 56). All participants screened for problematic alcohol or substance use.

RESULTS

Our results show a unique association between the impulsivity facet of negative urgency and SI. Results also demonstrate an interactive effect of negative affect and "spur of the moment decisions" in predicting concurrent SI, as well as an interaction between negative affect and "saying things without thinking" in prospectively predicting SI.

CONCLUSIONS

Findings highlight the saliency of negative urgency, both at the trait and state level in the prediction of SI. Although in need of replication, results indicate that specific aspects of momentary impulsivity may be uniquely linked with SI, and that this relationship may be context dependent.

Alcohol restrictions and suicide rates in South Africa during the COVID-19 pandemic: results of a natural experiment

BACKGROUND

Alcohol use is a well-established potentially modifiable risk factor for suicide, yet few studies have investigated the impact of alcohol restrictions on suicide rates, particularly in low- and middle-income countries.

METHODS

We used data from nationally representative annual surveys of postmortem investigations in 2017 (n=6117) and 2020/21 (n=6586) to estimate changes in suicide rates associated with the COVID-19 pandemic and related alcohol restrictions.

FINDINGS

Age standardised suicide mortality rates per 100 000 were 10.91 (10.64, 11.18) in 2017 and 10.82 (10.56, 11.08) in 2020/2021, with approximately 4.4 times more deaths among males than females in both periods. No significant differences were observed between overall suicide rates during the 2020/2021 pandemic period compared with 2017 (risk ratio=1.04 (1.00, 1.07)), but in the 15-24-year age group, suicide rates were 11% higher among males and 31% higher among females than in 2017. Partial alcohol restrictions during the pandemic were not associated with lower suicide risk. However, the shift from partial to full restriction on the sale of alcohol was associated with an 18% (95% CI 10% to 25%) reduction in suicides for both sexes combined and a 22% (95% CI 13% to 30%) reduction in suicides among men, but no significant reduction among women.

INTERPRETATION

Our findings offer some support for the hypothesis that restricting access to alcohol at a population level is associated with a reduction in suicide rates and suggests that restricted access to alcohol may have been one of the reasons global suicide rates did not increase during the pandemic in some countries.

Assessing Links Between Alcohol Exposure and Firearm Violence: A Scoping Review Update

BACKGROUND

Firearm violence remains a leading cause of death and injury in the United States. Prior research supports that alcohol exposures, including individual-level alcohol use and alcohol control policies, are modifiable risk factors for firearm violence, yet additional research is needed to support prevention efforts.

OBJECTIVES

This scoping review aims to update a prior 2016 systematic review on the links between alcohol exposure and firearm violence to examine whether current studies indicate causal links between alcohol use, alcohol interventions, and firearm violence-related outcomes.

ELIGIBILITY CRITERIA

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines, a comprehensive search of published studies was conducted, replicating the search strategy of the prior review but focusing on studies published since 2015. The review included published studies of humans, conducted in general populations of any age, gender, or racial/ethnic group, that examined the relationship between an alcohol-related exposure and an outcome involving firearm violence or risks for firearm violence. Excluded were small studies restricted to special populations, forensic or other technical studies, non-original research articles such as reviews, and studies that relied solely on descriptive statistics or did not adjust for confounders.

SOURCES OF EVIDENCE

The review included published studies indexed in PubMed, Web of Science, and Scopus. Eligible articles were published on or after January 1, 2015. The latest search was conducted on December 15, 2023.

CHARTING METHODS

Using a structured data collection instrument, data were extracted on the characteristics of each study, including the dimension of alcohol exposure, the dimension of firearm violence, study population, study design, statistical analysis, source of funding, main findings, and whether effect measure modification was assessed and, if so, along what dimensions. Two authors independently conducted title/abstract screening, full-text screening, and data extraction until achieving 95% agreement, with discrepancies resolved through discussion.

RESULTS

The search yielded 797 studies. Of these, 754 were excluded and 43 met the final inclusion criteria. Studies addressed a range of alcohol exposures and firearm violence-related outcomes, primarily with cross-sectional study designs; 40% considered effect measure modification by any population characteristic. Findings from the 21 studies examining the relationship of individual-level alcohol use or alcohol use disorder (AUD) with firearm ownership, access, unsafe storage, or carrying indicated a strong and consistent positive association. Seven studies examined associations of individual-level alcohol use or AUD with firearm injury or death; these also indicated a pattern of positive associations, but the magnitude and precision of the estimates varied. Eight studies examined the impact of neighborhood proximity or density of alcohol outlets and found mixed results that were context- and study design-dependent. Two studies linked prior alcohol-related offenses to increased risk of firearm suicide and perpetration of violent firearm crimes among a large cohort of people who purchased handguns, and two studies linked policies prohibiting firearm access among individuals with a history of alcohol-related offenses to reductions in firearm homicide and suicide. Finally, four studies examined alcohol control policies and found that greater restrictiveness was generally associated with reductions in firearm homicide or firearm suicide.

CONCLUSIONS

Findings from this scoping review continue to support a causal relationship between alcohol exposures and firearm violence that extends beyond acute alcohol use to include AUD and alcohol-related policies. Policies controlling the availability of alcohol and prohibiting firearm access among individuals with alcohol-related offense histories show promise for the prevention of firearm violence. Additional research examining differential impacts by population subgroup, alcohol use among perpetrators of firearm violence, policies restricting alcohol outlet density, and randomized or quasi-experimental study designs with longitudinal follow-up would further support inferences to inform prevention efforts.

The Clinical Sequelae of the COVID-19 Pandemic: Loneliness, Depression, Excessive Alcohol Use, Social Media Addiction, and Risk for Suicide Ideation

BACKGROUND

Depression, loneliness, and alcohol use disorder are associated with suicide ideation. The ongoing COVID-19 pandemic has challenged our social structures with social distancing and isolation policies implemented worldwide, severely restricting social interactions. Studies regarding the effects of the pandemic are starting to shed light on the harmful psychological effects of these policies.

AIMS

This study aims to identify whether the increase in suicidal ideation among college students (mostly young adults) during the pandemic was due to the known risk factors of loneliness, depression, alcohol use disorder, social media addiction, and other background variables.

METHOD

Nine hundred and eleven college students completed self-report questionnaires assessing suicidal risk, depressive symptoms, loneliness, excessive alcohol use, and social media use.

RESULTS

During the pandemic suicidal ideation was associated with loneliness (χ2 = 54.65, p < 0.001), depressive symptoms (χ2 = 110.82, p < 0.001), alcohol use disorder (χ2 = 10.02, P < 0.01) and social media addiction (χ2 = 13.73, P < 0.001). Being single [OR = 2.55; p < 0.01], and self-identifying as a non-heterosexual [OR = 2.55; p < 0.01] were found to constitute additional risk factors.

LIMITATIONS

The structural nature of quantitative self-report scales does not offer the flexibility of gaining a deeper understanding of causes, specific to particular circumstances that may lead participants to ideate on suicide, even briefly.

CONCLUSIONS

Social distancing and isolation policies during the COVID-19 pandemic constitute an additional factor in the risk for suicide ideation.

Changes in meteorological conditions as near-term risk factors for suicide attempts

To evaluate the impact of acute meteorological changes (i.e., maximum temperature, humidity, wind speed, atmospheric pressure, cloud coverage, visibility, precipitation) as situational risk factors proximal (i.e., present in the hours directly preceding) to suicide attempts. Participants were 578 adult patients who were hospitalized within 24 h of a suicide attempt at the only Level 1 trauma hospital in the state of Mississippi. Participants completed a semi-structured interview to determine home address and exact timing of their suicide attempt. A within-person, case-crossover design was used with each patient serving as their own control. Meteorological variables were generated for the 6-hours preceding each patient's suicide attempt (case period) and corresponding hours the day prior (control period). Conditional logistic regression analyses were used to examine predictors of suicide attempts, and biological sex and season were evaluated as potential moderators. The presence of precipitation was associated with reduced odds of suicide attempts. Wind speed was marginally positively associated with suicide attempts among males, and visibility was positively associated with suicide attempts among females. Maximum temperature was positively associated with suicide attempts in the spring. Wind speed, visibility, maximum temperature, and precipitation (absence of) may represent situational risk factors for suicide attempts. Future studies should evaluate additional near-term situational risk factors and determine how to leverage this information to improve suicide risk management efforts to ultimately ameliorate the burden of suicide.

Risk of Suicide Across Medical Conditions and the Role of Prior Mental Disorder

Importance

According to the World Health Organization, more than 700 000 individuals worldwide die by suicide each year. Medical conditions likely increase the risk of suicide.

Objective

To (1) provide age- and sex-specific pairwise estimates of the risk of suicide across a comprehensive range of medical conditions, (2) investigate whether there is a dose-response-like relationship at play (ie, the higher the disability burden due to medical morbidity, the higher the risk of suicide), and (3) determine if the risk of suicide with medical conditions is particularly pronounced among those who had mental disorder preceding the medical conditions.

Design, Setting, and Participants

This cohort study was an observational study of population-based data for all individuals living in Denmark at some point between 2000 and 2020. The data analysis took place from September 2023 to May 2024.

Exposures

Thirty-one specific medical conditions as well as prior mental disorder.

Main Outcomes and Measures

The main outcome was suicide. Associations between the 31 specific medical conditions, nested within 9 categories, and suicide were examined via Poisson regression, yielding incidence rate ratios (IRRs). Subsequent analyses included an interaction term to assess whether a previous hospital-treated mental disorder modified the associations. Finally, the association between the disability burden of medical conditions and suicide was examined for those with and without prior mental disorder, respectively.

Results

A total of 6 635 857 individuals (3 337 613 females and 3 298 244 males) were included in the analyses of the associations between medical conditions and suicide. Except for endocrine disorders, all categories of medical conditions were associated with a statistically significant increased risk of suicide (which was most pronounced for gastrointestinal conditions [IRR, 1.7; 95% CI,1.5-1.8], cancer [IRR, 1.5; 95% CI, 1.4-1.6], and hematological conditions [IRR, 1.5; 95% CI, 1.3-1.6]). Interaction between mental disorder and individual medical conditions did not seem to play a major role for suicide risk. For those without but not for those with mental disorder, there was a dose-response-like relationship between the disability burden of medical conditions and suicide.

Conclusions and Relevance

Medical conditions are generally associated with increased risk of suicide in a dose-response-like manner. Individuals with hospital-treated mental disorder appear to be at such elevated risk of suicide that additional disability associated with medical conditions has little impact in this regard.

Suicide attempts in Martinique and Reunion Island and appointments no-show

OBJECTIVES

Studies on suicidal behaviors in the French overseas territories remain rare. Although mental health resources are limited, some patients identified as being at risk of suicide do not attend the specialist consultations scheduled after identification or screening. Thus, the objective of our study was, firstly to provide a descriptive profile of patients followed up for a suicide attempt in Martinique and Reunion Island, and secondly to explore the risk factors associated with appointments no-show during follow-up.

METHODS

We conducted an ancillary retrospective cross-sectional study using data from the APSOM study. Data were collected on 255 patients aged at least 16, admitted to hospital emergency departments after a suicide attempt and followed up in ambulatory care, including 137 in Martinique and 118 in Reunion Island. The characteristics of the sample were described by means [min, max] and proportions [95% confidence intervals]. Differences according to the presence of appointments no-show or not were analyzed using comparison tests of means and percentages (Chi2, Fisher and Wilcoxon). Factors associated with appointments no-show were analyzed using a bootstrapped multivariate logistic regression model.

RESULTS

The mean age of patients was 35 years [16-84 years]. Women were predominant with a sex ratio of 2.4:1 (71% women). Unemployment affected 37% [28%, 46%] of patients in Martinique and 49% [40%, 59%] in Reunion Island. Psychoactive substances consumption at the time of the suicidal act was observed in 36% [27%, 45%] of patients in Martinique and 34% [26%, 44%] in Reunion Island. The average number of suicide attempts was two per patient [1-20]. Finally, we found no significant association with appointments no-show except for center. Patients from Reunion Island were associated with better compliance than patients from Martinique (OR: 0.20 [0.05-0.65], P<0.012).

CONCLUSION

Our study provides a description of suicide attempts admitted to hospital and followed up in ambulatory care in two French overseas territories and suggests interesting approaches for adapting prevention strategies to the socioeconomic context and cultural realities of these territories, particularly outreach interventions for the most vulnerable patients.

Potential role of glucagon-like peptide-1 (GLP-1) receptor agonists in substance use disorder: A systematic review of randomized trials

BACKGROUND

Increasing evidence suggests that GLP-1 receptor agonists (GLP-1RA) have a potential use in addiction treatment. Few studies have assessed the impact of GLP-1RA on substance use disorder (SUD), particularly in humans. The study aimed to do systematic review of clinical trials to assess GLP-1RA's effect on reducing SUD in patients.

METHODS

The scientific literature was reviewed using the MEDLINE, Scopus and Cochrane Library databases, following PRISMA guidelines. Studies including patients with a diagnosis of SU who were treated with GLP-1RA were selected. The primary outcome was GLP-1RA's therapeutic effect on SUD, and the secondary outcomes were therapeutic effects of GLP-1RA on weight, BMI and HbA1c.

RESULTS

1218 studies were retrieved, resulting in 507 papers after title and abstract screening. Following full-text review, only 5 articles met inclusion criteria. We incorporated a total of 630 participants utilizing Exenatide (n=3) and Dulaglutide (n=2) as GLP-1RAs. Therapeutic effect of GLP-1RA on SUD was assessed in 5 studies, with 3 demonstrating a significant decrease in SUD (alcohol and nicotine). GLP-1RA's impact on body weight, BMI, and HbA1c, was reported in 3 studies. These revealed a notable reduction in these parameters among the GLP-1RA treated group.

CONCLUSION

This review will give an overview of current new findings in human studies; we suggest that the effects of GLP-1RA in SUD is a possible new option of therapy in addiction medicine.

Reciprocal relations between acute interpersonal negative life events and acute alcohol use: An examination of the 24 h preceding suicide attempts among hospitalized patients

OBJECTIVE

To examine the within-person relations between acute alcohol use and interpersonal negative life events (INLEs) in the 24 h preceding suicide attempts.

METHOD

Participants were 151 adult patients (67.55 % female; M age = 36.00) who were hospitalized within 24 h of a suicide attempt. Participants completed the Timeline Follow-back for Suicide Attempts interview to gather information about hourly events for the 24 h preceding their suicide attempt. Hierarchical logistic models were estimated to examine the influence of acute INLEs on next-hour alcohol use and acute alcohol use on next-hour INLEs. Biological sex and chronic alcohol use (past year) were evaluated as potential moderators.

RESULTS

Overall, acute alcohol use was associated with increased odds of next-hour INLEs and acute INLEs were associated with increased odds of next-hour alcohol use. Moderator analyses indicated that the influence of alcohol use on INLEs increased as participants' level of chronic alcohol use decreased, and relations did not vary by biological sex.

CONCLUSIONS

There is a bidirectional relation between INLEs and alcohol use in the hours preceding suicide attempts. Understanding that these within-person interrelations may differ in strength depending on one's level of chronic alcohol use has practical utility for providers tasked with clinical decision making.

Ethyl alcohol consumption characteristics of deceased individuals in Lithuania

The number of alcohol-related deaths in Lithuania has fallen by almost one-third in the last decade; however, the number of deaths has been on the rise since 2019. Data on the postmortem investigation of victims between 2018 and 2022 were obtained from the Lithuanian State Forensic Medicine Service database. This study analyzed data from 1200 autopsies. The deceased victims were categorized based on their cause of death and blood alcohol concentration (sober, legally intoxicated, mild, medium, or heavy). The causes of death were diseases (54.17 %, n = 650), suicides (12.08 %, n = 145), homicides (2.5 %, n = 30), and accidents (31.25 %, n = 375). Toxicological tests for alcohol were performed in all cases. Alcohol levels in the blood and urine were measured using gas chromatography. A significant correlation was observed between blood alcohol concentration and age (r = -0.13, p = 0.007). A statistically significant difference was observed in the proportions of men and women who were intoxicated. Among the causes of death, the group of individuals who died because of accidents exhibited the highest average blood alcohol concentration. Alcohol intoxication is undoubtedly a contributing factor to fatalities resulting from accidents and homicides. These findings assist in determining the intoxication level of victims and in assessing any potential links that may contribute to or predispose victims to lethal outcomes in cases of disease, suicide, homicide, or accident.

Prevalence of suicide ideation and its associated risk factors among undergraduate students of the university for development studies, Tamale

BACKGROUND

Suicide and its associated risk factors are of public health importance across the globe. The affected persons are mostly the youth. Empirical research in this crucial area of public health is generally lacking, especially among undergraduate university students in Ghana. This study sought to determine the prevalence of suicide ideation, and its associated risk factors that statistically predict suicide ideation among undergraduate students.

METHODS

A descriptive cross-sectional quantitative survey was conducted. A structured online questionnaire was used to elicit information on the prevalence of suicide ideation and its correlates. A systematic sampling technique was used to sample 400 respondents. Of this number, 53.25% were male and 46.75% were female. Data were analyzed using SPSS v26. Results were presented in charts, tables, and cross-tabulations. A regression analysis was also done to model suicide ideation with socio-demographic variables.

RESULTS

The prevalence of suicide ideation among participants was 24.5%. Significant risk factors for suicide ideation found in the study were academic stress and victimization. Suicide ideation was predicted with statistical significance by the presence of victimization (OR = 3), and academic stress (OR = 2).

CONCLUSION

The prevalence of suicide ideation among participants is real and will need combined efforts of university management and, the counseling unit to put in place interventions that will help avert suicide ideation and its dreaded squeal of completed suicide.

The prevalence of alcohol-related deaths in autopsies performed in Lithuania between 2017 and 2020: a cross-sectional study

BACKGROUND

Consumption of alcohol is a risk factor for non-communicable and infectious diseases, mental health problems, and can lead injuries and violence. The aim of this study was to evaluate the prevalence of alcohol-involved deaths among decedents who died of external causes and underwent autopsy in Lithuania.

METHODS

Study includes age persons of any age (from 0 to 110 years) who died and were autopsied in Lithuania from 1 January 2017 to 31 December 2020. Data were obtained from the Lithuanian State Register of Deaths and Their Causes.

RESULTS

Among external causes of death, the presence of alcohol was detected in 55.0% of cases. Male decedents had a significantly higher number of positive BAC level recorded, at 46.6%, compared with female decedents (32.1%; P < 0.001). The highest incidence of deaths where the alcohol was detected in the deceased's blood was found when the decedent was listed as being in the victims of assault group (71.5%, 95% CI 65.4-77.2). However, the highest median BAC score was found for those in the accidents group (59.7%, 95% CI: 58.2-61.2, BAC 2.42 ‰, IQR 1.86).

CONCLUSIONS

The findings of this study suggest that alcohol use may be a contributing factor in a wide range of fatal incidents, including accidents, injuries, and cases of violent intent. Inequalities between males and females were identified, with a higher proportion of males with alcohol detected in blood at the time of death.

Commercial determinants of mental ill health: An umbrella review

Mental ill health has complex and interrelated underlying causes, with wider determinants of health often overlooked as risk factors. The 'commercial determinants of health' are gradually receiving more attention and recognition but there is a relative lack of awareness of the commercial determinants of mental health. This aim of this umbrella review was to synthesise systematic review level evidence for the association between commercial determinants and mental health outcomes. This umbrella review included evidence from high, middle, and low-income countries. We included terms related to broader commercial activities and terms focused on six key unhealthy commodities (tobacco, alcohol, ultra-processed foods, gambling, social media, fossil fuels) and the impacts of fossil fuel consumption (climate change, air pollution, wider pollution). We included 65 reviews and found evidence from high quality reviews for associations between alcohol, tobacco, gambling, social media, ultra-processed foods and air pollution and depression; alcohol, tobacco, gambling, social media, climate change and air pollution with suicide; climate change and air pollution with anxiety; and social media with self-harm. There was a lack of evidence examining wider practices of commercial industries. Our umbrella review demonstrates that by broadening the focus on commercial determinants, the influence of commercial products and activities on mental ill health can be better understood. The lack of research examining broader commercial practices on mental ill health is an area that should be addressed. Our review highlights the existing base of high-quality evidence for many of these unhealthy commodities' impacts on mental ill health and indicates that commercial determinants is a valuable framework for understanding the drivers of mental ill health.

Rural suicide in Newfoundland and Labrador: A qualitative exploration of health care providers' perspectives

INTRODUCTION

Residents of rural regions may have higher and unique suicide risks. Newfoundland and Labrador (NL) is a Canadian province replete with rural regions. Despite an abundance of rural suicide research, heterogeneity in rural regions may preclude amalgamating findings to inform prevention efforts. Thus, exploring the unique needs of NL is needed. Importantly, health care providers (HCP) may afford unique perspectives on the suicide-related needs or concerns of rural life. We asked HCPs of residents of rural NL their perceived suicide risk factors, concerns, and needs for rural NL.

METHOD

Twelve HCPs of rural residents of NL completed virtual semi-structured interviews. Interviews were analysed using reflexive thematic analysis [13,14].

RESULTS

HCPs noted individual, psychological, social, and practical factors linked to rural-suicide risk and subsequent needs. Findings highlight the unique challenges of residing and providing health care in rural NL and inform prevention and intervention efforts.

Sleep measures as a predictor of suicidal ideation among high-risk adolescents

Suicide is the second leading cause of death among youth aged 15-24 years. Identifying modifiable risk factors relevant to adolescents is crucial for suicide prevention. Sleep patterns have been linked to suicidality in adults, but lack sufficient study in youth. This ecological momentary assessment (EMA) study aimed to explore the relationship between objectively and subjectively measured sleep characteristics and next-day suicidal ideation in high-risk youth. We included 29 adolescents (12-18 years old) admitted to the inpatient psychiatric ward post-suicide attempt or due to suicidal intent within the previous month. We conducted objective (actigraphy) and subjective (sleep diary) sleep pattern assessments over ten consecutive days. Daily suicidal ideation was evaluated using a questionnaire based on the validated C-SSRS interview. A significant positive association was observed between sleep onset latency (SOL) and expressing a "death wish" the following day (OR = 1.06, 95% CI [1-1.11], p = .04), with each minute of longer SOL increased the risk for a death wish the following day by 6%. In addition, a marginally significant negative association was observed between total sleep time (TST) and expressing a "death wish" the following day (OR = 0.57, 95% CI [0.3-1.11], p = 0.1), with each one-hour decrease in objectively measured TST increasing the odds of a death wish by 43%. Our study highlights the interplay between sleep patterns and suicidal ideation, with SOL and TST playing a significant role that may function as proximal risk factors for suicidality and as a target for intervention while treating suicidal youth.

Can profiles of behaviors occurring within 48 h of a suicide attempt predict future severity of suicidal thoughts and reattempt?: An examination of hospitalized patients 12 Months post-discharge

Behavioral warning signs (WS) are near-term changes within individuals, which aid in determining imminent risk for suicide attempts. However, those who attempt suicide differ in their engagement of WS, and it is unclear if these differences relate to future risk of suicidal behavior. Using a sample of 132 adults presenting to a hospital following a suicide attempt, the current study sought to determine if differences in engagement in WS for the index attempt prospectively predicted suicide attempt, frequency of ideation, and intensity of suicide ideation 12 months post discharge. Latent class analyses (LCAs) conducted on 6 behaviors (i.e., alcohol use, nightmares, interpersonal negative life events, suicide communication, risky behavior, low sleep, and high sleep) found a 5-class solution optimally fit the data. One identified class, characterized by engagement in risky behaviors the hours before an attempt differed from other identified classes in terms of risk for future suicidal ideation and behaviors. More specifically, participants in "High Risky Behavior" class had higher rates of 12-month suicide reattempt, significantly more frequent suicide ideation, and significantly worse intensity of suicide ideation during the 12 months following their index attempt compared to participants endorsing typical patterns of WS. These results held when adjusting for various traditional baseline covariates (e.g., depressive symptoms). The current study demonstrates that patterns of behavioral WS may be utilized as their own prognostic indicator of future suicidal ideation and behaviors among high-risk individuals reporting a recent suicide attempt, which can inform post-discharge clinical intervention and prevention efforts.

Evaluation of the risk relationship between average alcohol volume consumed and suicide in the USA: an analysis of mortality linked cohort data

OBJECTIVE

Alcohol use disorder is an established risk factor for suicide; however, it is largely unknown whether subclinical levels of drinking may also contribute to the risk of suicide. The objective was to evaluate the relationship between average alcohol volume consumed per day and suicide.

METHODS

Data from the annual, cross-sectional National Health Interview Survey, 1997-2018 in the USA, was obtained and linked to the 2019 National Death Index. The association between average alcohol volume consumed in grams per day (g/day) and suicide was quantified using Cox proportional hazards model (multiplicative) and Aalen's additive hazard model. All analyses were stratified by sex, and adjusted for education, marital status, psychological distress, race and ethnicity, and survey year.

RESULTS

On the multiplicative scale, for males, former drinkers and those who consumed on average >40-60 g/day had about 43% (HR=1.43, 95% CI 1.03, 2.01) and 72% (HR=1.72, 95% CI 1.14, 2.60) greater risk of dying by suicide, compared with lifetime abstainers, respectively. There was no significant association found for former or current drinkers among females, on the multiplicative scale. On the additive scale, for males, drinking >40-60 g/day on average was associated with 22.7 (95% CI 6.0, 39.4) additional deaths per 100 000 person-years, while for females, being a former drinker and drinking >0-20 g/day on average was associated with 5.5 (95% CI 0.7, 10.4) and 1.9 (95% CI 0.2, 3.5) additional deaths per 100 000 person-years, compared with lifetime abstainers. The level of education was not found to modify the focal relationship for males or females.

CONCLUSIONS

The findings suggest that the relationship between average alcohol volume consumed per day and suicide is nuanced. Additional research on the respective relationship is needed, including repeated measures of average alcohol consumption over time.

A dose-response meta-analysis on the relationship between average amount of alcohol consumed and death by suicide

BACKGROUND

To determine whether sub-clinical levels of drinking may contribute to suicide risk, and whether the risk differs by sex, we aimed to evaluate the relationship between average amount of alcohol consumed per day and death by suicide.

METHODS

A systematic literature search was performed in Embase, Medline, PsycINFO, PubMed, and Web of Science from database inception up to April 27, 2022. The search strategies incorporated a combination of medical subject headings and keywords for "alcohol use" and "suicide". One-stage dose-response meta-analyses using a restricted maximum likelihood random-effect estimator were conducted to explore the relationship between average alcohol volume consumed and suicide, by sex. Three different shapes of the dose-response relationship-linear (on the log-scale), quadratic, and restrictive cubic splines-were tested.

RESULTS

A total of eight studies were included (three studies for females (n=781,205), and eight studies for males (n=1,215,772)). A linear dose-response relationship between average alcohol volume consumed and the log-risk of suicide was identified for both males and females. For males and females, a relative risk (RR) of 1.11 (95% CI: 1.05, 1.18) and 1.64 (95% CI: 1.07, 2.51) for suicide when consuming an average of 10 g of pure alcohol per day compared to lifetime abstention, 1.38 (95% CI: 1.14, 1.66) and 4.39 (95% CI: 1.21, 15.88) for 30g/day, and 1.71 (95% CI: 1.25, 2.33) and 11.75 (95% CI: 1.38, 100.33) for 50g/day, respectively.

CONCLUSIONS

As consumption increases, the risk of suicide increases proportionally. The risk of suicide associated with average daily alcohol consumption may be elevated for females, compared with males. Albeit, more research is needed, particularly among females.

Literary Prescriptions: Applying Bibliotherapy in a Psychotherapeutic Context

Bibliotherapy, a relatively underutilized lifestyle intervention in psychotherapy, is a unique cost-effective avenue of treatment that empowers patients by integrating therapeutic reading into their treatment plan. This approach strategically uses empirically validated cognitive-behavioral and self-help literature to facilitate the application of therapeutic topics outside of psychotherapy sessions. Bibliotherapy's range of administration styles highlights its potential as an adjunct to medication, psychotherapy, and/or healthy lifestyle interventions in a comprehensive treatment plan. Most meta-analyses conducted so far regarding bibliotherapy in a clinical setting consist of studies that use minimal patient interaction via short phone calls or emails. Despite this, meta-analyses show medium-to-large effect sizes that are comparable to traditional psychotherapy modalities for common disorders, most notably depression. This article explores the practical implementation of bibliotherapy research via an example psychotherapy session with a patient who has a diagnosis of major depressive disorder (MDD). An evidence-based reading list is proposed alongside a decision tree and actionable clinical insights for the effective implementation of bibliotherapy.

Group based metacognitive therapy for alcohol use disorder: a pilot study

Introduction

Alcohol use disorder (AUD) is a severe clinical disorder, which has been associated with 5.3% of death worldwide. Although several treatments have been developed to improve AUD symptomatology, treatment effects were moderate, with a certain amount of patients displaying symptom deterioration after treatment termination. Moreover, outpatient treatment placements become increasingly scarce, thus necessitating more efficient treatment options. Therefore, the aim of the present study was to investigate the efficacy, feasibility, and acceptability of a newly invented, short, group based metacognitive therapy (MCT) for patients diagnosed with AUD.

Method

Seven patients were treated with eight sessions of group based MCT using a single case series design with an A-B replication across patients. Patients were assessed one month and one week before treatment, as well as one week and three months after treatment termination.

Results

Patients improved significantly and with large effect sizes regarding dysfunctional metacognitive beliefs, desire thinking/craving and depressive symptoms up to three months after treatment termination. AUD symptomatology as well as positive and negative metacognitive beliefs improved at post-treatment, but improvements could not be maintained at follow-up. All included patients completed the treatment and were highly satisfied.

Conclusion

The presented findings show preliminary evidence for the efficacy, feasibility, and acceptability of the implemented group based MCT treatment. Large scale randomized controlled trials (RCTs) are needed to confirm the effectiveness of the developed program for patients diagnosed with AUD.

Alcohol use disorder as a moderator of the relationship between posttraumatic stress disorder and suicidality among military personnel

BACKGROUND

Alcohol use disorder (AUD), posttraumatic stress disorder (PTSD), and suicide are substantial public health concerns among military service members, yet the nature of their relationships is not well understood. Here, we tested the hypothesis that AUD moderates the relationship between PTSD symptom severity and suicidal ideation.

METHODS

This secondary analysis uses data collected at baseline for a randomized clinical trial. The sample consists of 160 active-duty service members from three service branches (Army, Air Force, and Navy). All participants met diagnostic criteria for PTSD and were not engaged in evidence-based PTSD treatment at the time of enrollment. Zero-inflated Poisson generalized linear regression models were used to test the associations of PTSD and AUD symptom severity with the presence and severity of suicidal ideation.

RESULTS

Findings suggest that AUD symptom severity moderates (i.e., amplifies) the relationship between PTSD symptoms and severity of suicidal ideation among military personnel with untreated PTSD. Among service members with mild or absent AUD, we found no significant association between PTSD symptoms and the severity of suicidal ideation. However, when AUD severity was average (i.e., sample mean) or high (mean + 1SD), PTSD symptoms were significantly positively associated with the severity of suicidal ideation.

CONCLUSIONS

This study highlights the importance of assessing AUD and PTSD as a part of suicide risk evaluations of veterans. The results also provide strong support for the maintenance and further development in the military health system of treatment programs that simultaneously address AUD and PTSD comorbidity.

Investigating Associations of Substance Use and Dependence With Planned Versus Unplanned Suicide Attempt

OBJECTIVE

The present analyses investigated substance use and dependence as correlates of past-year suicide attempt and of unplanned versus planned suicide attempt in a nationally representative sample.

METHOD

Participants were 214,505 adults (52% female; 64% White, 12% Black, <1% Native American, <1% Pacific Islander, 6% Asian, 16% Hispanic, 2% multiracial) from the 2015-2019 National Surveys on Drug Use and Health. Four logistic regression models were constructed. Models 1 and 2 examined substance use and dependence, respectively, as correlates of suicide attempt. Models 3 and 4 evaluated whether substance use and dependence were related to suicide attempt in the absence of a plan.

RESULTS

In Models 1 and 2, higher cigarette smoking and marijuana use; any use of opioids, sedatives, and hallucinogens; and greater dependence on nicotine, alcohol, marijuana, and any illicit or prescription drug were associated with elevated risk for suicide attempt. Associations with cigarette smoking, sedative use, and dependence on nicotine, alcohol, and any illicit or prescription drug remained statistically significant in sensitivity analyses limited to individuals with suicidal ideation. In Models 3 and 4, substance use and dependence were unrelated to risk for unplanned (vs. planned) suicide attempt.

CONCLUSIONS

Although substance-related outcomes are consistently associated with suicide attempt, there was little evidence that substance use and dependence are related to risk for unplanned versus planned suicidal behavior.

Screening student drinking behaviors: examining AUDIT criterion validity using CIDI-based alcohol use disorder as the 'gold standard'

Introduction

High levels of alcohol consumption among college students have been observed across countries. Heavy drinking episodes are particularly prevalent in this population, making early identification of potentially harmful drinking critical from a public health perspective. Short screening instruments such as the Alcohol Use Disorders Identification Test (AUDIT) are serviceable in this regard. However, there is a need for studies investigating the criterion validity of AUDIT in the student population. The aim was to examine the criterion validity of the full AUDIT and AUDIT-C (the first three items directly gauging consumption patterns) in a sample of college and university students using 12-month prevalence of alcohol use disorder derived from an electronic, self-administered version of the World Health Organization (WHO) Composite International Diagnostic Interview, fifth version (CIDI 5.0), which serves as the 'gold standard'.

Methods

The study population of the current study is derived from the SHoT study (Students' Health and Wellbeing Study), which is a large national survey of students enrolled in higher education in Norway. In a follow-up study of mental disorders among participants of the SHoT2022 study, students were invited to complete a self-administered electronic version of the CIDI. A random sample of 4,642 participants in the nested CIDI-sample was asked to fill out a set of screening instruments, including AUDIT, before starting CIDI. Based on Youden Index maximization, we estimated the sex-specific optimal cut-offs for AUDIT and AUDIT-C in relation to alcohol use disorder, as determined by CIDI.

Results

For the full AUDIT, the optimal cut-offs were 9 for males and 10 for females. The corresponding cut-offs for AUDIT-C were 6 for males and 5 for females. The same optimal cut-offs for both the full AUDIT and AUDIT-C were replicated in bootstrapped analyses with 1,000 runs.

Conclusion

The full AUDIT demonstrated acceptable criterion validity with a balance between sensitivity and specificity. However, for AUDIT-C, caution should be exercised when interpreting screening results among college and university students. In conclusion, the full AUDIT is a reliable screening instrument for college and university students, while further modification may be needed for AUDIT-C in this setting.

Reasons for contacting a crisis line and the initiation of emergency dispatches

OBJECTIVE

To better understand processes of mental health crisis line utilization by examining associations between reasons for contacting a crisis line with the initiation of emergency dispatches (i.e., activation of 911 or local emergency services) in a national sample.

METHODS

Contacts (i.e., calls, texts, email, and chats) to the Veterans Crisis Line (VCL) across 2017-2020 were used to examine associations among stated reasons for the contact and the use of an emergency dispatch. Hierarchical logistic regression models were used to determine the odds of an emergency dispatch by reason for the contact.

RESULTS

Suicidal thoughts/crisis were present in 61.5% of contacts that ended in emergency dispatches and were associated with the largest adjusted odds of a dispatch, (Adjusted Odds Ratio [AOR] [95% CI] = 9.34 [9.21, 9.48]), followed by homicidal thoughts/crisis (AOR [95% CI] = 3.84 [3.73, 3.95]), and third-party concerns (AOR [95% CI] = 2.42 [2.37, 2.47]). Substance use/ addiction (AOR [95% CI] = 2.14 [2.10, 2.18]), abuse and violence (AOR [95% CI] = 1.89 [1.82, 1.96]), and physical health (AOR [95% CI] = 1.87 [1.84, 1.91]) were also associated with increased odds of a dispatch.

CONCLUSIONS

Emergency dispatches are primarily used in response to imminent suicide risk but are also used in other potentially violent or lethal circumstances such as homicides, violence or abuse, and other crises. These findings highlight the role that crisis lines play in emergency service delivery, and the need to better understand how they are utilized under real world circumstances.

High Risk or Risky Highs: Understanding the Links Between Alcohol and Cannabis Use on the Transition From Suicidal Ideation to Attempts in Australian Men

Alcohol and cannabis use are consistently associated with greater risk of suicide, particularly among men and in higher-income countries (e.g., Australia). Adult data (n = 7,464) from waves 1 and 2 of Ten to Men: The Australian Longitudinal Study on Male Health were used to explore whether alcohol and/or cannabis use increased the longitudinal risk of a suicide attempt among suicidal ideators. Cannabis use was associated with increased risk of transitioning from suicidal ideation to making a suicide attempt; no association was found for alcohol. Broadly, these findings indicate that greater cannabis but not alcohol use may increase risk of transitioning to making a suicide attempt among those who are thinking about suicide.

Protocol for creating a dataset of U.S. state alcohol-related firearm laws 2000-2022

Firearms are a major source of preventable morbidity and mortality in the United States, contributing to over 48,000 deaths in 2022 and generating societal costs in excess of $500 billion. A body of work has examined the relationship between US state level firearm laws and health outcomes, generally finding that some firearm regulations are associated with lower firearm-related mortality. Alcohol has been identified as an additional risk factor for both homicides and suicide and stronger state alcohol laws have been associated with lower rates of suicide. To date, there are no empirical studies that have investigated the impact of laws over a long period of time that target the intersection of alcohol and firearm. One reason for this may be because there is no existing dataset that includes the range of these state laws over time. This study describes the protocol for collecting, coding and operationalizing these legal data.

Analyzing 14-years of suicide rates in Chile: Impact of alcohol policy, domestic violence, and a suicide prevention program

Suicide is a major public health problem worldwide with far-reaching effects on families, communities, and societies. Influencing factors range from macro-level interventions like alcohol control policies and suicide prevention programs to individual contributors such as alcohol abuse and domestic violence. This study aimed to examine the relationship between Chile's suicide rate changes from 2002 to 2015 and the Alcohol Act of 2004, a national suicide prevention program implemented in 2007, alcohol abuse, and domestic violence. Assembling a unique longitudinal dataset from Chilean public institutions, the study employed an instrumental variable time-series cross-regional design. Results indicated that the Alcohol Act was not associated with suicide rates, domestic violence exhibited a significant association with increased suicide rates, and the national suicide prevention program was linked to reductions in suicide rates, especially among males. These findings align with research from neighbouring countries, showcasing the efficacy of suicide prevention programs in decreasing suicide rates in Chile. Results highlight the importance of integrating protocols to early-detect domestic violence in suicide prevention programs, as well as the need to further improving alcohol control policies to complement suicide prevention programs.

Differentiating the association between age of alcohol use initiation and conditional suicidal behaviors among adolescents

INTRODUCTION

Suicide and early alcohol use initiation are public health concerns. Previous studies have explored the associations between age of alcohol use initiation and suicidal behaviors, which progresses from ideation to action. Distinguishing between the various associations can help gain a deeper understanding of suicidal behaviors and aid in developing social suicide prevention strategies.

METHODS

The study utilized the Youth Risk Behavior Survey to investigate this association. A total of 17 209 students were finally included in the study. Conditional suicidal behaviors included no suicidal behavior (NS), suicidal ideation without a plan or attempt (SINPA), suicide plan without an attempt (SPNA) and suicide attempt (SA).

RESULTS

Among 17 209 students, the prevalence of suicidal ideation, suicide plan, and suicide attempt were 21.4%, 17.3%, and 11.1%, respectively. Moreover, 15.2% of the students used alcohol before age 13, whereas 31.7% of students used alcohol at age 13 or older. Compared to NS, students using alcohol showed significant associations with SA (OR = 2.34, p < .001; OR = 1.29, p < .01), SPNA (OR = 1.68, p < .001; OR = 1.19, p < .05) and SINPA (OR = 1.55, p < .001; OR = 1.40, p < .001). Comparing with SINPA and SNPA, students using alcohol before age 13 were associated with SA (OR = 1.61, p < .001; OR = 1.46, p < .001), whereas those using alcohol at or after the age 13 were not associated with SA (OR = 0.98, p > .05; OR = 1.09, p > .05).

DISCUSSION

This study demonstrated that early alcohol use initiation was significantly associated with suicide attempts among students with suicidal ideations or plans.

Understanding complex causes of suicidal behaviour among graduates in Bangladesh

This study utilizes both fieldwork and desk-based discourse analysis of newspaper reports to investigate the concerning number of suicides among graduates in Bangladesh. According to some reports, a majority of suicide cases involve young adults who are either currently studying at university or have recently completed their degree (between the ages of 20 and 32). This research contends that patriarchal social expectations in Bangladesh place significant pressure on young adults to secure well-paying jobs to support their families and uphold their family's status, which can have a negative impact on their mental health. Furthermore, this article identifies additional risk factors that contribute to the high suicide rates among graduates in Bangladesh. These factors include unemployment, poverty, relationship problems, drug addiction, political marginalization, and the stigma of shame, all of which can cause low self-esteem and suicidal thoughts. Moreover, the research suggests that families in Bangladesh have not been providing adequate support to their young members when facing challenges in life. On the contrary, families have added to the pressure on young adults, which can be attributed to joiner's theory of the effect of industrialization on family norms and values.

Early closing of hotels: Impacts on alcohol consumption, drunkenness, liver disease and injury mortality

INTRODUCTION

Early (six o'clock) closing of hotels was introduced in 1916 in Australia to curb heavy drinking. It lasted between 21 and 51 years in four Australian states. The aim of this study is to assess the impact of early closing on alcohol consumption, liver disease mortality rates, drunkenness and various forms of injury.

METHODS

Time series analysis was undertaken using an Autoregressive Integrated Moving Averages modelling technique. Relevant data were derived from annual publications of the Australian Bureau of Statistics and its predecessor organisations.

RESULTS

Early closing had a substantial downward effect on alcohol consumption across 1901-2006. It had a substantial and beneficial effect on liver disease mortality. Drunkenness rates declined pre-World War II (WWII), though they increased post-WWII. Rates for homicide decreased substantially, and close to substantially for suicide and female homicide. Early closing impacts were more beneficial pre-WWII than post-WWII.

DISCUSSION AND CONCLUSIONS

Early closing has not been favourably remembered in Australia in recent years. However, all pre-WWII impacts of early closing were beneficial including public drunkenness rates. Post-WWII, beneficial effects were less clear-cut and drunkenness increased. Resistance to early closing may also have arisen in the 1950s as families had more disposable income and ability to consume alcohol. While universal six o'clock closing is no longer feasible or desirable, opening hours and days for hotels are still part of the policy discussion in Australia. The experience of early closing pre-WWII gives confidence that the impacts of these can be beneficial.

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure

OBJECTIVES

There is a well-established association between alcohol use, misuse, intoxication and self-harm, the latter of which is associated with suicide. This study aimed to better understand the association between proximity to alcohol outlets and the likelihood of young people presenting to hospital following self-harm.

METHODS

This was a nationwide retrospective geospatial study using data from the New Zealand Integrated Data Infrastructure using population-level data for 10-29-year-olds for the 2018 and 2017 calendar years. Presentations to hospital following self-harm were identified using the national minimum data set. Proximity to alcohol outlets was defined in road network distance (in kilometres) and ascertained using Integrated Data Infrastructure geospatial data. Alternative measures of proximity were employed in sensitivity analyses. Complete-case two-level random intercept logistic regression models were used to estimate the relationship between alcohol outlet proximity and hospital presentation for self-harm. Adjusted models included sex, age, ethnicity, area-level deprivation, urbanicity and distance to nearest medical facility. Analyses were also stratified by urbanicity.

RESULTS

Of the 1,285,368 individuals (mean [standard deviation] age 20.0 [5.9] years), 7944 (0.6%) were admitted to hospital for self-harm. Overall, the odds of presenting to hospital for self-harm significantly decreased as the distance from the nearest alcohol outlet increased, including in adjusted models (adjusted odds ratio 0.980; 95% confidence interval = [0.969-0.992]); the association was robust to changes in the measure of alcohol proximity. The effect direction was consistent across all categorisations of urbanicity, but only statistically significant in large urban areas and rural areas.

CONCLUSIONS

The findings of this study show a clear association between young people's access to alcohol outlets and presentation to hospital for self-harm and may provide a mandate for government policies and universal interventions to reduce young people's access to alcohol outlets. Further research regarding causative mechanisms is needed.

The role of alcohol use in pesticide suicide and self-harm: a scoping review

PURPOSE

Suicide and self-harm by pesticide self-poisoning is common in low- and middle-income countries (LMICs). Alcohol is an important risk factor for self-harm; however, little is known about its role in pesticide self-poisoning. This scoping review explores the role that alcohol plays in pesticide self-harm and suicide.

METHODS

The review followed the Joanna Briggs Institute scoping review guidance. Searches were undertaken in 14 databases, Google Scholar, and relevant websites. Articles were included if they focussed on pesticide self-harm and/or suicide and involvement of alcohol.

RESULTS

Following screening of 1281 articles, 52 were included. Almost half were case reports (n = 24) and 16 focussed on Sri Lanka. Just over half described the acute impact of alcohol (n = 286), followed by acute and chronic alcohol use (n = 9), chronic use, (n = 4,) and only two articles addressed harm to others. One systematic review/meta-analysis showed increased risk of intubation and death in patients with co-ingested alcohol and pesticides. Most individuals who consumed alcohol before self-harming with pesticides were men, but alcohol use among this group also led to pesticide self-harm among family members. Individual interventions were recognised as reducing or moderating alcohol use, but no study discussed population-level alcohol interventions as a strategy for pesticide suicide and self-harm prevention.

CONCLUSION

Research on alcohol's role in pesticide self-harm and suicide is limited. Future studies are needed to: further assess the toxicological effects of combined alcohol and pesticide ingestion, explore harm to others from alcohol including pesticide self-harm, and to integrate efforts to prevent harmful alcohol use and self-harm.

A psychometric evaluation of the Life Attitudes Schedule-Short Form

The Life Attitudes Schedule-Short Form (LAS-SF) is a measure of suicide proneness featuring various conceptual models. We tested four competing LAS-SF factor structures, as well as construct validity with mental health and suicide metrics. Community dwelling adults (N = 488) completed an online cross-sectional survey. Results supported a four factor (i.e., death-related, health-related, injury-related, and self-related subscales) LAS-SF structure with one higher order factor. Death-related, injury-related, and self-related subscales demonstrated moderate positive associations with mental health and suicidal ideation. Death-related and self-related subscales showed links with suicidal ideation, as well as suicide and depression risk (controlling for other factors). This study is important in highlighting suicide proneness theory may need to be refined. LAS-SF uses include possible risk screening in clinical settings and future focus on the psychological death aspects of the LAS-SF in prospective research. Study limitations include lack of sample diversity and cross-sectional design.

Implementing Suicide Risk Screening in a Virtual Addiction Clinic

The purpose of this study was to describe the feasibility of implementing suicide risk screening in a virtual addiction clinic. Suicide risk screening was implemented in a virtual addiction clinic serving individuals with substance use disorders (SUD) using a quality improvement framework. One-hundred percent (252/252) of eligible patients enrolled in the clinic were screened for suicide risk (44% female; M[SD] age = 45.0[11.0] years, range = 21-68 years). Nineteen patients (8%) screened positive for suicide risk. After screening, no patients required emergency suicide interventions (100% non-acute positive). Notably, 74% (14/19) of those who screened positive did so by endorsing at least one past suicide attempt with no recent ideation. Suicide risk screening in virtual addiction clinics yields important clinical information for high-risk SUD populations without overburdening workflow with emergency services. Given the high proportion of non-acute positive screens based on suicide attempt histories with no recent ideation, clinicians may utilize information on suicide attempt history to facilitate further mental healthcare.

Characteristics of Attempted and Completed Suicides During the COVID-19 Pandemic

BACKGROUND

This study aimed to describe patients admitted for attempted or completed suicide during the COVID-19 pandemic.

METHODS

A 1-year retrospective review was performed of adult patients admitted for attempted or completed suicide.

RESULTS

Of the 30 patients included, most injuries involved firearms (37%) and cutting/piercing (30%). Sixty-three percent of patients presented with an Injury Severity Score ≥16, and 37% of injuries involved the head. Upon admission, an alcohol test was completed for 83% of patients, 56% of whom tested positive. Thirty percent of patients died from their injuries, with all but one involving a firearm. Most of those who survived to discharge (62%) were discharged to an inpatient behavioral health facility.

DISCUSSION

The current study indicated a large proportion of suicides during the COVID-19 pandemic involved firearms and alcohol use. These findings point to the need for interventions aimed at preventing suicide and substance abuse during pandemic situations.

Suicidality by Sexual Identity and Correlates Among American Indian and Alaska Native High School Students

PURPOSE

This study aims to determine the prevalence of suicidality among American Indian and Alaskan Native (AI/AN) adolescents. Additionally, we measured suicidality, stratified by sex, and its association with sexual identity, sexual violence, and binge drinking.

METHODS

We pooled data from the Youth Risk Behavior Survey from 2005 to 2019 to analyze the prevalence of sexual minorities, forced sex, and binge drinking, and their association with suicidality using basic descriptive statistics followed by adjusted odds ratios stratified by sex among AI/AN youth.

RESULTS

19% of AI/AN participants reported having suicidal thoughts and 14% reported having a previous suicide attempt. More than 17% of AI/AN participants identified as sexual minority youth (SMY). Compared to AI/AN heterosexual youth, AI/AN bisexual youth had significantly higher odds of reporting suicidal thoughts (aOR = 16.01), planning (aOR = 12.4), and previous attempts (aOR = 7.73). This pattern was also significantly demonstrated for AI/AN gay/lesbian youth. 43% of all AI/AN participants reported being forced into sexual intercourse. The presence of binge drinking was associated with higher odds of suicidal thoughts for both females and males compared to those who did not binge drink.

DISCUSSION

At the intersection of multiple marginalization, AI/AN SMY have a high mental health burden, demonstrating the need for culturally informed, community-led, and targeted mental health support focused on SMY AI/AN. Though this study fails to capture the heterogeneity within the AI/AN community, as nuances exist at the tribal level, these results demonstrate work needs to be done to support the health burden that AI/AN youth carry.

Evaluation of the risk relationship between average alcohol volume consumed and suicide: An analysis of mortality linked cohort data

Objective

To evaluate the relationship between average alcohol volume consumed per day and suicide.

Methods

Data from the annual, cross-sectional US National Health Interview Survey, 1997-2018, was obtained, and linked to the 2019 National Death Index. The association between average alcohol volume consumed in grams per day (g/day) and suicide was quantified using Cox proportional hazards model (multiplicative) and Aalen's additive hazard model. All analyses were stratified by sex, and adjusted for education, marital status, race/ethnicity, and survey year.

Results

On the multiplicative scale, for males, former drinkers and those who consumed on average (40, 60] g/day had about 53% (HR=1.53, 95% CI: 1.10, 2.13) and 77% (HR=1.77, 95% CI: 1.17, 2.66) greater risk of dying by suicide, compared to lifetime abstainers, respectively. There was no significant association found for former or current drinkers among females, on the multiplicative scale. On the additive scale, for males and females, being a former drinker was associated with 11.4 (95% CI: 2.3, 20.4) and 5.6 (95% CI: 0.8, 10.4) additional deaths per 100,000 person years, compared to lifetime abstainers. For males only, drinking (40, 60] g/day on average was associated with 23.2 (95% CI: 6.7, 39.7) additional deaths per 100,000 person years. Level of education was not found to modify the focal relationship for males or females.

Conclusions

The findings suggest that the relationship between average alcohol volume consumed per day and suicide is nuanced. Additional research on the respective relationship is needed, including repeated measures of average alcohol consumption over time.

Purpose in life protects against the development of suicidal thoughts and behaviors in U.S. veterans without a history of suicidality: A 10-year, nationally representative, longitudinal study

OBJECTIVES

To determine the incidence of suicidal ideation and suicide attempts (STBs) in veterans without an endorsed history of STBs and identify baseline predictors of these outcomes over a 10-year period.

METHODS

Population-based prospective cohort study of 2307 US military veterans using five waves of the 2011-2021 National Health and Resilience in Veterans Study. Baseline data were collected in 2011, with follow-up assessments conducted 2-(2013), 4-(2015), 7-(2018), and 10-years (2021) later.

RESULTS

In total, 10.1 % (N = 203) of veterans endorsed incident suicidal ideation (SI) over the 10-year period and 3.0 % (N = 55) endorsed an incident suicide attempt (SA). Multivariable regression analyses revealed the following baseline predictors of incident SI: lower annual household income, current posttraumatic stress disorder, current alcohol use disorder (AUD), disability with activities of daily living (i.e., ADLs) or instrumental activities of daily living (i.e., IADLs), lower perceived social support, lower community integration, and lower purpose in life. Current AUD, greater cumulative trauma burden, and lower purpose in life at baseline were predictive of incident SA. Relative importance analyses revealed that lower purpose in life was the strongest predictor of both incident SI and SA.

CONCLUSIONS

Psychosocial determinants of health, such as purpose in life, may be more reliable predictors of incident suicidal thoughts and behaviors than traditional risk factors (e.g., psychiatric distress; history of SA) in those without a history of STBs. Evidence-based interventions that facilitate purpose in life and feelings of connectedness and belonging should be examined as possible treatments for STBs.

Suicidality and mood disorders in psychiatric emergency patients: Results from SBQ-R

Patients with mood disorders are at high risk of suicidality, and emergency departments (ED) are essential in the management of this risk. This study aims to (1) describe the suicidal thoughts and behaviours of patients with mood disorders who come to ED; (2) assess the psychometric properties of the Suicidal Behaviours Questionnaire-Revised (SBQ-R) in a psychiatric ED; and (3) determine the best predictors of suicidality for these patients. A total of 300 participants with mood disorders recruited for the Signature Bank of the Institut universitaire en santé mentale de Montréal (IUSMM) were retained. Suicidality was assessed using the SBQ-R. Other clinical and demographic details were recorded. Bivariate analyses, correlations and multivariate regression analyses were conducted. SBQ-R's internal consistency, construct and convergent validities were also tested. In the Patient Health Questionnaire-9 (PHQ-9), 53.3% of the sample stated they had suicidal or self-harm thoughts in the last 2 weeks. The mean score obtained at the SBQ-R was 8.3. Multivariate analysis found that SBQ-R scores were associated with depressive symptoms and substance use, especially alcohol, accounting for 44.3% of the model variance. Cronbach's alpha was 0.81 [0.78, 0.84] and factor loadings for items 1-4 were 0.68, 0.88, 0.54, and 0.85, respectively. The confirmatory factor analysis indicated that the model fit the data well. The SBQ-R is a brief and valid instrument that can easily be used in busy emergency departments to assess suicide risk. Depressive symptoms and alcohol use shall also be assessed, as they are determinants of increased risk of suicidality.

C-L Case Conference: The Case of a 34-Year-Old Male Veteran with Suicidal Ideation in the Context of Alcohol Intoxication

We describe the case of a 34-year-old male veteran who presents to the emergency department with suicidal ideation while intoxicated on alcohol. From his progression from intoxication through sobriety, this case details changes in his suicide risk during the sobering process. Consultation-liaison psychiatrists present guidance for this clinical scenario based on their experiences and a review of the available literature. The following important concepts for managing suicide risk among patients with alcohol intoxication are considered: evaluating for medical risk, timing the suicide risk assessment, anticipating withdrawal, diagnosing other disorders, and achieving a safe disposition.