Suicide
attempts in Alcoholics
Ulrich
W Preuss, M.D.
July,
2001
Silde 1: A. Completed suicide is
high in alcohol dependent individuals
1. 25% of
completed suicides are conducted by alcoholics (Murphy &
Wetzel, 1990)
2. Lifetime
prevalence of completed suicide in alcoholics is 7%-15% of alcoholics complete
suicide (Inskip et al., 1998, Murphy et al., 1992, 1979)
3. Attempted
suicide is a more frequent phenomenon than completed suicide (Schmidtke, 1997,
Ostamo et al. 1991) and attempted suicide is one of the strongest predictor of
completed suicides (Dhossche et al., 2000, Isometsa & Lonnqvist, 1998).
Slide 2: B. There are several
predictors/risk factors of suicide attempts in general
1. Psychiatric diagnoses: Mood disorders
(Kessler et al., 1999, Brent et al., 1988), Personality disorders (Beautrais,
1996), particularly borderline antisocial personality disorder (Suominen et al.
2000) and
substance/alcohol use disorders (Dhossche et al., 2000, Dieserud et al., 2000).
These put individuals at a 4 to 5 times increased risk for suicide attempts
(Moscicki, 1994, Beautrais, 2000).
2. Additional
demographic risk factors: Being
a. Female
(Welch et al., 2000, Schmidtke et al., 1996),
b. Separated or divorced (Kessler et al., 1999,
Dieserud et al.,
2000, Hawton et al., 1994),
c. Unemployed
(Platt,1985),
d. Fewer
years of education (Petronis et al., 1990, Sorenson
and Golding, 1988).
Slide 3 C. A number of studies reported about Predictors/risk factors of suicide attempts in alcohol-dependent individuals
1. Risk factors for suicide attempts reported in
alcoholic samples are the same as in other samples
2.
Additional risk factors refer to characteristics of
alcohol dependence
including:
a. Family
history of alcoholism, (Schuckit, 1986)
b. Early
onset of drinking and alcohol dependence (Hesselbrock et al., 1988, Roy, 1993)
c. Previous
treatment for alcohol dependence (Black et al., 1986, Schuckit, 1986).
Slide 4 D. Problems with
previous research
1. Most studies use imprecise terminology.
2. Study samples are mainly small (Hewitt et al., 1998: n=39,
Suominen et
al., 1997: n = 118)
3. Studies do not differentiate between
independent and induced
psychiatric disorders
1. Identify and confirm risk factors for
suicide attempts in a large,
family based sample of alcoholics using the COGA dataset.
2. Test the robustness of these predictors
in a multivariate design
(logistic regression)
3. Look at suicide attempts in families of
alcoholics with and without a
history of suicide attempts.
Slide 6: F. Hypotheses: Alcoholics with a history of suicide
attempts:
1.
Show different sociodemographic characteristics by being more
a.
female
b.
younger
c.
unemployed
d.
separated
divorced
e.
uneducated
2.
They show a more severe course of alcoholism
3.
Higher psychiatric comorbidity
4.
More suicide attempts, psychiatric comorbidity and
substance use disorders
in first-degree relatives
II. Methods:
Slide
7: A The Collaborative
Study on the Genetics of Alcoholism (COGA) sample:
1. 3,190
alcohol-dependent individuals were included in this analysis
2. Included probands,
selected controls and family members
3. Semistructured interviews (SSAGA) were used to obtain
information on
a. Suicidal behavior
b. Socioeconomic characteristics
c. Psychiatric comorbidity,
d. Substance use disorders
e.
Characteristics of alcohol dependence
4. Univariate and multivariate statistics were used to test
hypotheses
Slide 8 B. Sample: These alcohol dependent individuals were assigned
into two
groups:
1. Group 1: alcohol-dependent individuals with a history suicide
attempts
2. Group 2: alcohol-dependent individuals without a
history suicide attempts
Slide 9: A. First hypothesis: There are differences in sociodemographic characteristics between Groups 1 and 2
1. Group
1 is younger and had less years of education
2. They
have a significant higher proportion of females, are more often
unemployed and divorced or
separated.
3. Additional
factors: They were less likely to have a college degree and were more often
unemployed. No differences regarding ethnicity were found.
Slide 10: B. Second hypothesis:
Group 1 subjects show a more severe course of alcohol dependence showing
1. An
earlier onset of alcohol dependence
2. A
higher number of DSM III R alcohol dependence criteria endorsed
3. More
alcohol-related violence
4. A
higher number of alcohol related physical problems.
5. Additional
factor: they received more treatment because of their alcohol dependence
Slide 11: C. Third hypothesis: Group 1 individuals have more substance
use disorders and higher psychiatric comorbidity by showing
1. A
significantly higher number of substances dependent on including marihuana,
amphetamine and opiates.
2. A
higher number of psychiatric disorders including independent and induced
depression, mania, panic disorders, and social phobia.
Slide 12: D. Fourth hypothesis: First-degree relatives of Group 1 had
a significantly higher frequency of suicide attempts than relatives of Group
2. This is due to higher rates of
suicide attempts in fathers and siblings of suicidal alcoholics.
E. No differences
were found regarding frequency of alcohol dependence,
psychiatric and other drug dependence.
Slide 13: F. Regression
analysis: A number of suicide attempt
risk factors remained
significant in a
multivariate approach.
1.
In the equation:
-
Older age
-
Being unemployed
-
Induced and independent depression,
-
Number of DSMIIIR alcohol dependence criteria,
-
Number of alcohol-related physical problems,
-
Separated/ divorced,
-
Number of alcohol-related violence
2.
Not in the equation:
-
Alcohol dependence age of onset
-
Being married
3. Slight differences in the profile of risk
factors between males and females.
IV Conclusion:
Slide 14 A.
Alcohol-dependent individuals with a history of suicide attempts:
1. Are more
severely impaired due to psychiatric comorbidity,
other substance
use disorders and alcohol-dependence characteristics.
2. Have first degree relatives who
show higher rate of suicide attempts
3. When in treatment: screen and treat psychiatric comorbidity to prevent suicide attempts and subsequent completed suicide.