Alcohol abuse and suicidal behaviour in young and middle aged men: differentiating between attempted and completed suicide

Ingeborg Margrete Rossow · Anders Romelsjö · Håkan Leifman

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Suicide and Self-Harm Studies Substance Abuse Treatment and Outcomes Homicide, Infanticide, and Child Abuse

Abstract

AIMS: To establish whether alcohol abuse as a risk factor in suicidal behaviour would be different in parasuicide compared to completed suicide, and to explore the relative impact of alcohol abuse on completed suicide among parasuicides. DESIGN: A 25-year follow-up study by linking data from military conscription, inpatient treatment and death register. PARTICIPANTS: A cohort of 46,490 Swedish male conscripts born in 1950-51. MEASUREMENTS: Psychiatric diagnosis was recorded at conscription, diagnoses related to alcohol abuse and suicidal behaviour were recorded at any inpatient treatment during follow-up, and underlying cause of death was recorded for those who died during follow-up. FINDINGS: Bivariate analyses showed alcohol abusers to have an elevated risk of attempted suicide (OR = 27.1) as well as completed suicide (OR = 4.7), but in the latter case to a significantly lesser extent. Correspondingly, alcohol abusers constituted a significantly larger proportion of the parasuicides (33.3%) than of the completed suicides (10.0%). A relatively stronger impact of alcohol abuse on parasuicide than on completed suicide remained after controlling for psychiatric co-morbidity, the adjusted odds ratios for attempted suicide and completed suicide being 8.8 and 2.4, respectively. Attempted suicide was a highly significant risk factor for completed suicide (OR = 13.5). Among those who attempted suicide, alcohol abusers were found to have a significantly lower risk of completed suicide than other suicide attempters (OR = 0.46). CONCLUSION: The significantly stronger association between alcohol abuse and attempted suicide compared to completed suicide may be viewed in the light of possible impact of intoxication and impulsiveness on non-fatal suicidal behaviour in alcohol abusers.

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References

1992Parasiticide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989 1990The Lifetime Risk of Suicide in Alcoholism 1995Epidemiology of Suicidal Behavior 1993Factors associated with suicide after parasuicide in young people.1971ALCOHOLISM AND SUICIDE 1976Alcoholism, hopelessness and suicidal behavior.1990Suicide among young men: psychiatric illness, deviant behaviour and substance abuse 2003Alcohol abuse and suicide: a 40-year prospective study of Norwegian conscripts

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2004Suicide in Alcohol-Dependent Individuals

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