Binge drinking and the risk of suicidal thoughts, plans, and attempts

Differences in the relation of binge drinking and prescription drug misuse to suicide ideation and attempts between college-aged adults and adults above the age of 25: Findings from the 2015-2019 National Survey on Drug Use and Health (NSDUH)

OBJECTIVE

To clarify the role of age in risk associated with drug misuse and binge drinking, this study examines the differential relations of binge drinking and prescription drug misuse to risk of suicidal ideation and attempts in young adults of college age (18-24) compared to those above the age of 25.

METHODS

We used data from the National Survey on Drug Use and Health (NSDUH) for the years 2015 through 2019 (N = 269,078).

RESULTS

The study found that, for adults above college age, the presence of any past-month binge drinking was associated with a higher likelihood of past-year suicide ideation (b = 0.427, OR = 1.532, 95%CI [1.388, 1.692]) and attempts (b = 0.637, OR = 1.891, 95%CI [1.271, 2.813]) compared to college-aged adults. Similarly, past-month prescription drug misuse showed stronger associations with past-year suicide ideation (b = 0.831, OR = 2.297, 95%CI [1.952, 2.701]) and attempts (b = 0.539, OR = 1.715, 95%CI [1.264, 2.327]) in adults above college age.

CONCLUSION

These findings highlight that binge drinking and prescription drug misuse appears to become more strongly associated with suicide ideation and attempts after adults age beyond young adulthood.

Adolescent predictors of psychiatric disorders in adulthood: The role of emotional distress and problem drinking in emerging adulthood

The current study evaluated risk factors in adolescence on problem drinking and emotional distress in late adolescence and emerging adulthood, and meeting criteria for diagnosed disorders in adulthood. The study included 501 parents and their adolescent who participated from middle adolescence to adulthood. Risk factors in middle adolescence (age 18) included parent alcohol use, adolescent alcohol use, and parent and adolescent emotional distress. In late adolescence (age 18), binge drinking and emotional distress were assessed, and in emerging adulthood (age 25), alcohol problems and emotional distress were examined. Meeting criteria for substance use, behavioral, affective, or anxiety disorders were examined between the ages of 26 and 31. Results showed parent alcohol use predicted substance use disorder through late adolescent binge drinking and emerging adulthood alcohol problems. Behavioral disorders were indirectly predicted by adolescent and emerging adult emotional distress. Affective disorders were indirectly predicted by parent emotional distress through adolescent emotional distress. Finally, anxiety disorders were predicted by parent alcohol use via adolescent drinking; parent emotional distress via adolescent emotional distress, and through adolescent alcohol use and emotional distress. Results provided support for the intergenerational transmission of problem drinking and emotional distress on meeting criteria for diagnosed psychiatric disorders in adulthood.

Psychological Distress and Heavy Alcohol Consumption Among U.S. Young Women During the COVID-19 Pandemic

INTRODUCTION

The predictors of heavy drinking among U.S. young women during the COVID-19 pandemic are not well-examined. This study aims to determine the prospective relationship between COVID-19 psychological distress and heavy alcohol use among U.S. young adult women.

DESIGN

This study used the COVID-19 Adult Resilience Experiences Study (CARES) data collected from April 13, 2020, to August 31, 2020 (T₁) and September 21, 2020, to March 15, 2021 (T₂). Among the young adults (ages 18-30) who participated in both surveys, a total of 684 identified as women (including transgender women) and were included in the analysis. Three or more drinks as a typical intake were defined as heavy drinking. Psychological distress in T₁ was measured using scores for financial stress, COVID-19-related worry, and COVID-19-related grief. A series of logistic regression analyses were performed to identify risk factors associated with young women's heavy drinking during the pandemic.

RESULTS

Twenty-two and one-half percent of young women reported heavy drinking in a typical intake. After controlling for covariates, women who reported high levels of COVID-19-related grief were more likely to report heavy drinking (odds ratio, 1.06; 95% confidence interval [CI], 1.01-1.13; p < .05). Those with high levels of COVID-19-related worry were less likely to report drinking heavily (odds ratio, 0.90; 95% confidence interval, 0.85-0.97; p < .01).

CONCLUSIONS

Those who suffer from a deeper sense of COVID-19-related grief are particularly at risk of heavy drinking and should be targeted for outreach and clinical intervention. Further research is necessary to determine the long-term impacts of the pandemic on heavy drinking among young women and should include a more comprehensive assessment of psychological distress.

Alcohol use and its association with suicide attempt, suicidal thoughts and non-suicidal self-harm in two successive, nationally representative English household samples

BACKGROUND

Alcohol use is a risk factor for suicidal behaviour, yet the nature of the relationship is unclear. Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population.

AIMS

We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample.

METHOD

A total of 14 949 adults who completed the 2007 or 2014 Adult Psychiatric Morbidity Survey were included. We measured alcohol use with the Alcohol Use Disorders Identification Test (AUDIT). Domains of alcohol use relating to risk categories, weekly consumption, binge drinking, dependence symptoms, harmful effects and concern from others were derived from relevant AUDIT items. Self-reported past year suicide attempt, suicidal thoughts and non-suicidal self-harm were measured with the Clinical Interview Schedule, Revised.

RESULTS

We found a linear association between total AUDIT score and outcomes. Three of six specific domains of alcohol use (dependence symptoms, harmful effects of drinking and binge drinking) were associated with increased odds of all three outcomes. There was no association of outcomes with the other domains of alcohol use.

CONCLUSIONS

We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Longitudinal research is needed to further understand these relationships.

Suicide and Cardiovascular Death Among Patients With Multiple Primary Cancers in the United States

Background

Previous studies have demonstrated that patients with a cancer diagnosis have an elevated risk of suicide and cardiovascular death. However, the effects of the diagnosis of multiple primary cancers (MPCs) on the risk of suicide and cardiovascular death remain unclear. This study aimed to identify the risk of suicide and cardiovascular death among patients with MPCs in the United States.

Methods

Patients with a single or MPC(s) between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results database in a retrospective cohort study. Mortality rates and standardized mortality ratios (SMRs) of suicides and cardiovascular diseases among patients with MPCs were estimated.

Results

Of the 645,818 patients diagnosed with MPCs included in this analysis, 760 and 36,209 deaths from suicides and cardiovascular diseases were observed, respectively. The suicide and cardiovascular-disease mortality rates were 1.89- (95% CI, 1.76-2.02) and 1.65-times (95% CI, 1.63-1.67), respectively, that of the general population. The cumulative mortality rate from both suicides and cardiovascular diseases among patients with MPCs were significantly higher than those of patients with a single primary cancer (Both p < 0.001). In patients with MPCs diagnosed asynchronously, the cumulative incidence rates of suicides and cardiovascular deaths were higher than those diagnosed synchronously. Among all MPCs, cancers of the pancreas and esophagus had the highest SMRs of suicide (5.98 and 5.67, respectively), while acute myeloid leukemia and brain cancer had the highest SMRs of cardiovascular diseases (3.87 and 3.62, respectively). The SMR of suicide was highest within 1 year after diagnosis, while that of cardiovascular diseases was highest 5 years after diagnosis.

Conclusions

This study showed that the mortality rates from suicides and cardiovascular diseases among patients with MPCs were higher than those with a single primary cancer. Therefore, our results underscore the need for psychological assessment and targeted preventive interventions for suicides and cardiovascular diseases among patients with MPCs.

Suicidal ideation, plans, and attempts and the use of psychoactive substances by adolescents

Introduction: Suicidal behavior and substance abuse constitute a serious public health problem.

Aim: The study was to analyze the relationships between suicidal behaviors (ideation, plans, attempts) and substance abuse in adolescents. The authors also took into account the respondents’ motivation to attempt suicide and use psychoactive substances, as well as some demographic variables.

Participants: The study involved 3493 secondary school students aged 16-17 years. The group included 69.41% girls and 30.59% boys.

Methods: The participants were surveyed with a self-report questionnaire designed by one of the authors.

Results: Statistically significant relationships were found between the respondents’ suicidal behaviors and the risky use of alcohol, cannabis, amphetamine, and designer drugs.

Conclusions: 1. The use of psychoactive substances increases the risk of suicidal ideation and plans, as well as suicidal attempts in adolescents and young adults.

2. Significantly more respondents who report suicidal ideation, plans and attempts, in comparison to those who do not report such thoughts and behaviours, abuse alcohol and consumer cannabis, amphetamine and designer drugs to cope with problems and olster self-confidence.

3. In the group of respondents who report suicidal behaviour, psychoactive substances are consumed by significantly more men than women and by significantly more city inhabitants than people living in the country.

4. Young people, who report suicidal thoughts, plans, and attempts, are initiated into alcohol consumption at an earlier age than their non-suicidal peers.

Is Binge Drinking Associated with Suicidal Behaviors among Brazilian Adolescents?

OBJECTIVE

To evaluate the association between suicidal behaviors and binge drinking among Brazilian adolescents.

METHODS

A cross-sectional study was conducted with 2,476 students 14 to 19 years of age from 26 public high schools in the city of Olinda, Brazil. Data collection occurred between March and June 2018 through the self-administered Youth Risk Behavior Survey. Descriptive analysis and Poisson regression (p < 0.05, 95%CI) were performed.

RESULTS

The prevalence of suicidal ideation, planning and attempt in the previous 12 months was 23.7%, 17.4% and 13.5%, respectively. Suicidal ideation was associated with binge drinking one to two days (PR:1.053, 95%CI:1.011-1.096) and ≥ three days in the previous 30 days (PR:1.069, 95%CI:1.016-1.125), sadness/hopelessness in the previous 12 months (PR:1.313, 95%CI:1.267-1.360), a report of family physical aggression in the previous 12 months (PR:1.111, 95%CI:1.068-1.155), the female sex (PR:1.082, 95%CI:1.049-1.115) and a non-nuclear family (PR:1.037, 95%CI:1.004-1.071). Suicidal planning was associated with sadness/hopelessness in the previous 12 months (PR:1.257, 95%CI:1.214-1.302), report of family physical aggression in the previous 12 months (PR:1.110, 95%CI:1.065-1.156) and the female sex (PR:1.072, 95%CI:1.041-1.104). Suicide attempt was associated with binge drinking ≥ three days in the previous 30 days (PR:1.062, 95%CI:1.008-1.119), sadness/hopelessness in the previous 12 months (PR:1.202, 95%CI:1.161-1.244), report of family physical aggression in the previous 12 months (PR:1.105, 95%CI:1.060-1.153) and the female sex (PR:1.064, 95%CI:1.034-1.095). The Catholic (PR:0.938, 95%CI:0.899-0.979; PR:0.925, 95%CI:0.888-0.9865; PR:0.937, 95%CI:0.899-0.977) and Evangelical (PR:0.956, 95%CI:0.922-0.992; PR:0.954, 95%CI:0.919-0.991) religions acted as a possible protective factor against suicidal behaviors.

CONCLUSIONS

Suicidal ideation and attempt were associated with binge drinking.

Practical Report of Disaster-Related Mental Health Interventions Following the Great East Japan Earthquake during the COVID-19 Pandemic: Potential for Suicide Prevention

Background: This practical report aims to publicize the ongoing disaster-related mental health interventions following the Great East Japan Earthquake during the COVID-19 pandemic. Methods: Disaster-related mental health interventions consisted of: (1) screening high-risk evacuees with high psychological distress (Kessler 6 score ≥ 13) or binge drinking; and (2) visiting selected high-risk individuals and providing them counseling through outreach in evacuee housing. These activity records were compiled from existing material in the Sendai City Office; therefore, no new interviews or questionnaire surveys were conducted. Results: During the COVID-19 pandemic, we introduced telephone counseling and shortened the time of support as a result of the restrictions. Counselors addressed issues of “loneliness” or “isolation” among evacuees, who had little connection with society due to the pandemic. Moreover, the procedure for obtaining COVID-19 special financial aid was explained to evacuees in financial difficulty. During this period, the suicide rates in the affected area did not increase significantly as compared to the national average. Conclusions: Our report may be instructive in terms of preventing suicide during the pandemic using high-risk approaches and counselors trained in disaster-related mental health interventions.

Cigarette use and binge drinking among Korean adolescents: examining the moderating role of multicultural status

Cigarette is usually used conjointly with alcohol however its impact may vary with how much alcohol is being consumed. Besides the general use of alcohol, this study specifically focused on identifying the association between cigarette use and binge drinking of Korean adolescents. Furthermore, it aims to testify whether the multicultural status plays a moderating role in this relationship, and to discover other problem behavior theory constructs that may be associated with binge drinking of the Korean adolescents. Using the nationally representative data from the 2018 Korea Youth Health Risk Survey, 60,040 students were selected to perform chi-square, t-test, and hierarchical multiple regression. There was a strong association between cigarette use and binge drinking, and multicultural status had the moderating effect in this relationship. More specifically, adolescents from the multicultural families had higher levels of cigarette use and binge drinking than the non-multicultural adolescents. Besides these main findings, covariates such as suicidal ideation, sexual intercourse, e-cigarette use, and harmful experiences from the alcohol use of others were found to be the additional significant factors of Korean adolescents' binge drinking. Based on these findings, author suggests for the combined interventions for alcohol and tobacco, and raise awareness on the possible health disparities that could occur between multicultural families and non-multicultural families in South Korea.

Changes in Types of Drinking Behavior in Korean Adults: Differences in Demographics, Depression, and Suicidal Thoughts

Background: Longitudinal studies of drinking behavior have reported inconsistent changes in drinking behavior as people age. Thus, this study aims to characterize the changes in drinking behavior among Korean adults and to reveal differences in their demographics, depression, and suicidal thoughts. Methods: This study used the Korea Welfare Panel Study data over nine years (2009 to 2017), analyzing a total of 7506 participants. Growth mixture modeling was applied to classify patterns of change in drinking in these participants. The χ² test and analysis of variance were used to analyze the differences in demographics, depression, and suicidal thoughts according to patterns of change in drinking. Results: Changes in drinking among Korean adults were categorized into four types: "high-risk retention", "medium-risk to high-risk", "high-risk to low-risk", and "low-risk retention". Gender, age, education, marital status, living arrangement, living area, and depression differed among these groups. Conclusion: We identified four types of changes in adult drinking behavior in South Korea, which varied in their demographics and depression levels. These results suggest that tailoring interventions to the type of behavioral changes might be more useful than batch interventions.

Alcohol dependence and heavy episodic drinking are associated with different levels of risk of death or repeat emergency service attendance after a suicide attempt

BACKGROUND

Alcohol use is a multidimensional risk factor for suicidal behaviour. However, suicide prevention strategies often take 'one-size-fits-all' approaches to alcohol use, reflecting an evidence base built on unidimensional measures. Latent Class Analysis can use a range of measures to differentiate distinct patterns of alcohol using behaviour and their associated risks.

METHODS

We analysed Electronic Health Record data from 650 suicidal adults detained for up to 36 h using police powers (Section 136 of the Mental Health Act 1983, amended 2007) to facilitate psychiatric assessment at a Health-Based Place of Safety, a dedicated emergency psychiatric care centre in London, UK. We conducted a Latent Class Analysis of alcohol using behaviours at first detention, and used multivariable logistic regression to estimate the association of each identified latent class with subsequent death or recontact with emergency psychiatric care over a median follow-up of 490 days, adjusting for sex, age and past-year psychiatric diagnosis.

RESULTS

Three classes of alcohol use were identified: low risk drinkers, heavy episodic drinkers and dependent drinkers. The dependent drinking class had twice the odds of death or recontact with emergency psychiatric care as the low risk drinking class (OR 2.32, 95 %CI 1.62-3.32, p < 0.001). Conversely, the heavy episodic drinking class was associated with lower odds of death or recontact than the low risk drinking class (OR 0.66, 95 %CI 0.53-0.81, p < 0.001).

CONCLUSIONS

The risk of adverse outcomes after a suicide attempt are not uniform for different alcohol use classes. Clinical assessment and suicide prevention efforts should be tailored accordingly.

Temporal variation in suicide in peri-urban Pretoria

Background

Suicide is a public health problem, and the third major cause of death in Indian, black and mixed race groups. In whites suicide is the second cause of death. The patterns of suicide vary by time of day, day of the week, month of the year and seasons. As a result of limited and inaccurate data, these variations have not been fully examined in the developing world. This study investigated the diurnality and seasonality of suicide in peri-urban Pretoria, as opposed to studies conducted previously in the country’s metropolitan.

Methods

A retrospective analysis of suicides recorded between 2007 and 2019 was undertaken. Data were extracted from the forensic pathology department’s database (university mortuary).

Results

Of the 1515 cases of suicides examined, majority were black Africans (95.9%), male (83.9%), aged 21–40 years (50.5%). Hanging was the most common method of suicide irrespective of demographics (72.8%). Diurnal suicide variations were distinct for men and women, occurring at (16:00–20:00) and (08:00–12:00), respectively. Suicide peaked on days preceding and after the weekend (Mondays and Fridays) and in warmer seasons (summer and spring)

Conclusion

The overall patterns of suicide in peri-urban Pretoria, mimic local and global trends with regard to methods, demographics and temporal characteristics. The underlying mechanism for these trends is unclear requiring in-depth investigation in order to develop appropriate interventions.

Characteristics of Psychosocial Factors in Liver Transplantation Candidates with Alcoholic Liver Disease before Transplantation: A Retrospective Study in a Single Center in Taiwan

Liver transplantation (LT) is an essential treatment for end-stage alcoholic liver disease (ALD). The patients’ psychosocial condition plays a vital role in post-transplantation prognosis. A survey of the candidates’ psychosocial wellbeing is necessary before LT. This study aims to investigate the psychosocial characteristics, including the depression degree, family function, alcohol use duration, and alcohol abstinence period, of LT candidates with ALD. In addition, 451 candidates for LT due to ALD were enrolled. They received psychosocial evaluations, including depression scale (Hamilton depression rating scale) and family functioning assessment (adaptability, partnership, growth, affection, resolve (APGAR) index). The test scores were analyzed according to age, alcohol use duration, and alcohol abstinence period. The Hamilton depression rating scale (HAM-D) score and the family APGAR index score differentiated significantly according to the age, alcohol use duration, and abstinence period of the LT candidates. The patients with shorter alcohol use duration tended to have more severe depressive symptoms and poorer family support. The younger patients showed a significantly shorter abstinence period, more severe depression, and poorer family functioning than older patients. The younger ALD patients and patients with shorter alcohol use duration showed an increased severity of depression before transplantation. They need more mental health care over time.

Delta Event-Related Oscillations Are Related to a History of Extreme Binge Drinking in Adolescence and Lifetime Suicide Risk

Alcohol exposure typically begins in adolescence, and heavy binge drinking is associated with health risk behaviors. Event-related oscillations (EROs) may represent sensitive biomarkers or endophenotypes for early alcohol exposure as well as other risk behaviors such as suicidal thoughts and actions. In this study, young adults (age 18–30 years) of American Indian (AI) (n = 479) and Mexican American (MA) (n = 705) ancestry were clinically assessed, and EROs were generated to happy, sad and neutral faces. Extreme adolescent binge drinking (10+ drinks) was common (20%) in this population of AI/MA and associated with a significantly increased risk of a lifetime history of suicidal acts (SA, suicide attempts, deaths) but not suicidal thoughts (ST, ideation, plans). ST were reported among MA participants, whereas SA were more common among AI young adults. Extreme adolescent binge drinking was also associated with errors in detection of sad and neutral faces, increases in delta ERO energy, and decreases in phase locking (PL), particularly in parietal areas. A lifetime history of ST was associated with increases in delta ERO energy and PL, whereas SA were associated with decreases in both. These studies suggest that ERO measures may represent important potential biomarkers of adolescent extreme binge drinking and risk for suicidal behaviors.

Sulforaphane alleviates ethanol-mediated central inhibition and reverses chronic stress-induced aggravation of acute alcoholism via targeting Nrf2-regulated catalase expression

Acute ethanol intoxication by excessive drinking is an important cause of alcohol-induced death. Stress exposure has been identified as one risk factor for alcohol abuse. Previous reports indicated that stressors may augment inhibitory effects of alcohol, but the underlying mechanism remains unknown. Here, we reported that chronic unpredictable stress increased the sensitivity to the acute ethanol intoxication in mice via impairing nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-catalase signaling. Nrf2 activity regulates the expression of catalase, a key antioxidant enzyme that mediates ethanol oxidation in the brain. Pharmacological blockade of catalase or Nrf2 activity significantly aggravated acute ethanol intoxication. Sulforaphane, a cruciferous vegetable-derived activator of Nrf2, significantly attenuated acute ethanol intoxication. Furthermore, the stress-induced aggravation of acute alcoholism was rapidly reversed by sulforaphane. Our findings suggest that Nrf2 may function as a novel drug target for the prevention of acute alcoholism, especially in psychiatric patients, by controlling catalase-mediated ethanol oxidation.

Association of transphobic discrimination and alcohol misuse among transgender adults: Results from the U.S. Transgender Survey

BACKGROUND

Alcohol misuse remains a leading preventable risk factor for morbidity and mortality in the United States. Evidence suggests that alcohol misuse is more prevalent among transgender populations. This study examined the association between transphobic discrimination and alcohol use/misuse among a large sample of transgender people.

METHODS

Using the 2015 U.S. Transgender Survey (N = 27,715), logistic regression models were conducted to estimate the adjusted odds ratios (AOR) and 95 % confidence intervals (CI) of current alcohol use, past-month binge drinking (≥1 occasion of consuming ≥5 alcoholic beverages within the past month), and past-month frequent binge drinking (≥5 occasions of binge drinking within the past month) among transgender people.

RESULTS

Of the respondents, 60.4 % reported current alcohol use, 24.3 % reported past-month binge drinking, and 8.5 % reported past-month frequent binge drinking. The majority (70.1 %) had experienced some form of past-year transphobic discrimination. Experiencing 3+ forms of transphobic discrimination was significantly associated with past-month binge drinking (AOR = 1.49, 95 % CI = 1.37-1.62) and past-month frequent binge drinking (AOR = 1.57, 95 % CI = 1.37-1.79) than individuals who did not experience transphobic discrimination. Persons who cross-dress showed higher odds of current alcohol use (AOR = 1.52, 95 % CI = 1.32-1.74), past-month binge drinking (AOR = 2.51, 95 % CI = 2.21-2.85), and past-month frequent binge drinking (AOR = 4.13, 95 % CI = 3.45-4.94) than transgender women. Discrimination within public spaces and housing domains had the most robust associations with alcohol misuse.

CONCLUSIONS

Experiencing transphobic discrimination increased the odds of alcohol misuse among transgender people. Stakeholders and providers should be cognizant of the multifaceted nature of transphobic discrimination as unique social stressors that many transgender persons experience.

Relationship between physical conditions and attempted or completed suicide in more than 9,300 individuals from the United Kingdom: a case-control study

AIMS

The present study of 9,352 adults from the United Kingdom aimed to analyze associations between physical conditions and attempted or completed suicide.

METHODS

This case-control study included patients aged 16-90 years with a first attempted or completed suicide who were followed in general practices in the United Kingdom between January 2008 and December 2017 (index date). Individuals who had not attempted or completed suicide were matched (1:1) to those who had attempted or completed suicide by sex, age, index year, index month, and practice. Variables included sex, age, index year, index month, and all physical and psychiatric conditions diagnosed in more than 1% of patients who had attempted or completed suicide in the year prior to the index date. A multivariable logistic regression analysis was performed to assess possible associations.

RESULTS

The case-control study included 4,676 patients who had and 4,676 patients who had not attempted or completed suicide. After (1:1) matching, 52.1% of the patients were women and the mean (standard deviation) age was 33.6 (15.1) years. After adjusting for psychiatric conditions, we found that three past-year physical conditions were significantly associated with attempted or completed suicide. These conditions were unspecified injuries to the head (odds ratio [OR]=4.26, 95% confidence interval [CI]=2.27-8.00), sleep disorders (OR=1.60, 95% CI=1.09-2.32), and epilepsy (OR=1.57, 95% CI=1.04-2.39).

CONCLUSIONS

Head injuries, sleep disorders, and epilepsy were associated with attempted or completed suicide. Further research is needed to gain a better understanding of the mechanisms underlying these relationships.

A preliminary examination of the association between drinking as a typical coping strategy and level of acute alcohol consumption prior to a suicide attempt

Drinking to cope is associated with suicide ideation and attempts. Event-based research shows drinking, particularly when alcohol is consumed in large quantities, increases the intensity of suicidal thoughts and immediate risk for attempt. Such findings suggest those who typically drink to cope may be especially likely to drink heavily in the hours preceding a suicide attempt. In the first examination of the association between regular use of alcohol as a coping strategy and acute alcohol consumption prior to a suicide attempt, participants included 130 patients hospitalized for a recent attempt. The number of drinks consumed in the acute period preceding the attempt, as well as past-year heavy drinking frequency, typical drinking motives, and depressive symptoms were assessed. The unique impacts of coping motives on odds of consuming any alcohol, and of using specific amounts of alcohol in the acute period, were determined through binary and multinomial logistic regressions. Results demonstrated that commonly drinking for coping motives increased the odds of heavy drinking - but not of using alcohol at low levels - during the acute period. Results held after adjusting for relevant covariates. Clinicians should assess drinking motives and prioritize prevention of drinking to cope to reduce risk of alcohol-related suicide attempts.

Sex differences in binge drinking and suicide attempts in a nationally representative sample

OBJECTIVE

Prevalence of suicide continues to present a major public health problem, particularly among women. Identifying risk factors for suicide is vital to reduce the number of suicide deaths per year. Alcohol use is a well-known risk factor for suicidal behavior, but the association between binge drinking and suicide attempts across genders is less clear.

METHODS

The current study used combined 2008-2014 National Survey on Drug Use and Health data (n = 269,078) to examine the association between binge drinking and suicidal ideation and suicide attempts across sex.

RESULTS

Logistic regression analyses revealed that binge drinking was associated with suicide attempts in females (OR = 1.37, 95% CI: 1.09-1.73) but not in males (OR = 1.07, 95% CI: 0.80-1.43). Binge drinking was not associated with suicidal ideation in either males or females.

CONCLUSIONS

Identifying and addressing binge drinking in women may be useful as part of a suicide prevention strategy.

Depressive symptoms and age of alcohol use onset interact to predict suicidal ideation

Distal risk factors of alcohol use may increase suicidal ideation in the presence of proximal risk factors, such as depressive symptoms. We tested whether depressive symptoms and age at onset of alcohol use interact to predict suicidal ideation in 500 individuals (67% men; 68% Black/African American) under criminal justice supervision. Regression analysis revealed that age of onset negatively associated with suicidal ideation only at average and high levels of depressive symptoms while controlling for suicide attempt history. Clinicians may consider individuals with an early age of onset of alcohol use and current depressive symptoms at risk for suicidal ideation.

Suicide rates among patients with cancers of the digestive system

OBJECTIVE

Previous studies have suggested that suicide rates are elevated among cancer patients relative to the general population. In this analysis, we comprehensively evaluated characteristics associated with higher suicide rates among patients with cancers of the digestive system.

METHODS

Using the United States Surveillance, Epidemiology, and End Results database, we identified all patients diagnosed with digestive system cancers during 2000 to 2014. Patients were classified as having died of suicide if their cause of death in Surveillance, Epidemiology, and End Results was listed as "suicide and self-inflicted injury." Suicide rates were compared to age-, sex-, and race-adjusted rates in the general population.

RESULTS

A total of 881 suicides were identified among 856 293 patients diagnosed with digestive system cancers. The suicide rate in this population was 32.8 per 100 000 person-years and was nearly twice that in the general population (standardized mortality ratio [SMR] = 1.91; 95% CI, 1.79-2.04). Suicide rates were significantly elevated for all cancer sites but were highest for esophageal (SMR = 5.03), pancreatic (SMR = 5.28), stomach (SMR = 2.84), and liver (SMR = 2.14) cancers. Standardized mortality ratios for suicide were highest within the first 5 years of diagnosis and increased with age at diagnosis for all sites except colon and stomach.

CONCLUSIONS

Patients with cancers of the digestive system have a higher incidence of suicide than the general population. Suicide rates among esophageal and pancreatic cancer patients are more than 5 times general population rates. The involvement of psychiatrists and other mental health professionals may be a critical component of cancer care for these high-risk patient subgroups.

Associations between substance use disorders and suicide or suicide attempts in people with mental illness: a Danish nation-wide, prospective, register-based study of patients diagnosed with schizophrenia, bipolar disorder, unipolar depression or personality disorder

AIM

To estimate and test associations between substance use disorders (SUDs) and both completed suicides and suicide attempts in a population with severe mental illness.

DESIGN

Register-based cohort study with adjusted Cox regression of substance use disorders as time-varying covariates.

SETTING

Denmark.

PARTICIPANTS

People born in Denmark since 1955 with a diagnosis of schizophrenia (n = 35 625), bipolar disorder (n = 9279), depression (n = 72 530) or personality disorder (n = 63 958).

MEASUREMENTS

Treated SUDs of alcohol and illicit substances identified in treatment registers; suicide attempt identified in treatment registers; and completed suicides identified in the Cause of Death register. Covariates were sex and age at diagnosis.

FINDINGS

Having any SUD was associated with at least a threefold increased risk of completed suicide when compared with those having no SUD. Alcohol misuse was associated with an increased risk of completed suicide in all populations with hazard ratios (HR) between 1.99 [95% confidence interval (CI) = 1.44-2.74] and 2.70 (95% CI = 2.40-3.04). Other illicit substances were associated with a two- to threefold risk increase of completed suicide in all populations except bipolar disorder, and cannabis was associated with increased risk of attempted suicide only in people with bipolar disorder (HR = 1.86, 95% CI = 1.15-2.99). Alcohol and other illicit substances each displayed strong associations with attempted suicide, HR ranging from 3.11 (95% CI = 2.95-3.27) to 3.38 (95% CI = 3.24-3.53) and 2.13 (95% CI = 2.03-2.24) to 2.27 (95% CI = 2.12-2.43), respectively. Cannabis was associated with suicide attempts only in people with schizophrenia (HR = 1.11, 95% CI = 1.03-1.19).

CONCLUSION

Substance use disorders are associated strongly with risk of completed suicides and suicide attempts in people with severe mental illness.

Use of a machine learning framework to predict substance use disorder treatment success

There are several methods for building prediction models. The wealth of currently available modeling techniques usually forces the researcher to judge, a priori, what will likely be the best method. Super learning (SL) is a methodology that facilitates this decision by combining all identified prediction algorithms pertinent for a particular prediction problem. SL generates a final model that is at least as good as any of the other models considered for predicting the outcome. The overarching aim of this work is to introduce SL to analysts and practitioners. This work compares the performance of logistic regression, penalized regression, random forests, deep learning neural networks, and SL to predict successful substance use disorders (SUD) treatment. A nationwide database including 99,013 SUD treatment patients was used. All algorithms were evaluated using the area under the receiver operating characteristic curve (AUC) in a test sample that was not included in the training sample used to fit the prediction models. AUC for the models ranged between 0.793 and 0.820. SL was superior to all but one of the algorithms compared. An explanation of SL steps is provided. SL is the first step in targeted learning, an analytic framework that yields double robust effect estimation and inference with fewer assumptions than the usual parametric methods. Different aspects of SL depending on the context, its function within the targeted learning framework, and the benefits of this methodology in the addiction field are discussed.

Suicide Ideation, Alcohol Consumption, Motives, and Related Problems: Exploring the Association in College Students

Previous findings on the relationship between suicide ideation (SI) and alcohol misuse among college students are inconsistent, leading to conflicting clinical implications. We aimed to clarify this relationship in order to determine the utility of regarding alcohol misuse as a risk factor for SI in this population. Unselected college students (N = 545) completed an online survey including measures of alcohol consumption, problems, drinking motives, SI, and related variables. Our results suggest alcohol misuse is not a correlate of SI among college students; therefore, one should not assume that students who misuse alcohol are necessarily at increased risk for SI.

Proximal Influences on the Trajectory of Suicidal Behaviors and Suicide during the Transition from Adolescence to Young Adulthood

Youth transitioning to adulthood have unique developmental tasks that make them vulnerable to suicide. Brain development, life stressors, and psychological adjustments during the transition contribute to a high rate of suicidal gestures. To reduce the incidence of self-harm in this age group, a public health approach that identifies and reduces risk factors and enhances protective factors should be used. Institutions and employment arenas should consider structural supports to facilitate this transition of youth into adulthood, with a particular focus on youth with self-harm thoughts, and should provide education about suicide, evidence-based resources, and intervention programs to encourage help seeking.

Intensity of Binge Drinking a Decade After the September 11th Terror Attacks Among Exposed Individuals

INTRODUCTION

The 9/11 terrorist attacks on the World Trade Center resulted in elevated post-traumatic stress disorder (PTSD) and alcohol use among exposed individuals. The relationship among traumatic exposure, PTSD, and excessive drinking is well documented; however, little is known about these relationships in the long term. This study examines factors increasing binge drinking risk among exposed individuals a decade post-9/11.

METHODS

In 2015-2016, data were analyzed from 28,592 World Trade Center Health Registry enrollees aged ≥18 years who completed the Wave 3 (2011-2012) survey. Women comprised 38.9% of participants. Binge drinking in the last 30 days was categorized as low (men, five to seven drinks; women, four to six drinks) or high intensity (men, eight or more drinks; women, seven or more drinks). Probable 9/11-related PTSD was defined as scoring ≥44 on the PTSD Checklist. Exposures to 9/11 (e.g., witnessing horror, sustaining an injury) were categorized as none/low (zero to two) or high (three or more).

RESULTS

Binge drinking was reported by 24.7% of participants, of whom 36.9% reported high-intensity binge drinking. Compared with non-binge drinkers, the odds of low- and high-intensity binge drinking were greater among enrollees who were male, aged 18-34 years, non-Hispanic white, had income >$75,000, were rescue/recovery workers, had high 9/11 exposure, or 9/11-related PTSD.

CONCLUSIONS

The observed associations among traumatic exposure, PTSD, and excessive drinking underscore the need for improved therapies addressing excessive drinking and PTSD concurrently, inclusion of repeated post-event screening for excessive drinking, and evidence-based population-level interventions to reduce alcohol consumption.

Trends in binge drinking in Canada from 1996 to 2013: a repeated cross-sectional analysis

BACKGROUND

Heavy drinking is a major factor in morbidity and mortality worldwide. Little information is available on trends in Canada regarding alcohol abuse. We sought to estimate abstinence, binge drinking and alcohol intake exceeding low-risk drinking guidelines in the Canadian population from 1996 to 2013.

METHODS

The data sources for this analysis were a series of cross-sectional national health surveys of the Canadian population carried out by Statistics Canada between 1996 and 2013. These were cross-sectional files from the National Population Health Surveys of 1996 and 1998, plus the Canadian Community Health Surveys from 2000 to 2013. Respondents were aged 18 years and older.

RESULTS

The proportion of binge drinkers increased steadily from 13.7% (95% confidence interval [CI] 13.2%-14.2%) in 1996 to 19.7% (95% CI 19.1%-20.3%) in 2013. The corresponding proportions for men were 20.8% (95% CI 19.9%-21.7%) in 1996, and 25.7% (95% CI 24.7%-26.6%) in 2013; for women, these proportions were 6.9% (95% CI 6.4%-7.5%) in 1996, and 13.8% (95% CI 13.1%-14.5%) in 2013. No significant increases were seen in the proportion of people who exceeded low-risk drinking guidelines or of abstainers during the same period.

INTERPRETATION

The rate of self-reported binge drinking in Canada has increased from 1996 to 2013, relatively more so among women than among men. No evidence of an increase in the proportion of people exceeding low-risk drinking guidelines or of abstainers was seen during the same period. These results suggest that binge drinking is of particular concern regarding intervention strategies aimed at improvement of public health.

Pre-deployment Alcohol Misuse Among Shipboard Active-Duty U.S. Military Personnel

INTRODUCTION

The burden of alcohol misuse is unknown among shipboard U.S. Navy and Marine Corps military personnel immediately prior to deployment and may be elevated.

METHODS

Anonymous survey data on hazardous, dependent, and binge alcohol misuse and involuntary drug consumption were collected during 2012-2014 among shipboard personnel within approximately 2 weeks of deployment. Using the Alcohol Use Disorders Identification Test Consumption (AUDIT-C), hazardous alcohol misuse was defined using two cut-point scoring criteria: (1) ≥3 for women and ≥4 for men; and (2) ≥4 for women and ≥5 for men; binge drinking as ≥4 drinks for women and ≥5 drinks for men on a typical day in past 30 days; and dependent alcohol misuse as an AUDIT-C score of ≥8. Demographic- and sex-stratified self-reported alcohol misuse prevalence was reported for analysis conducted during 2014-2015.

RESULTS

Among 2,351 male and female shipboard personnel, 39%-54% screened positive for hazardous, 27% for binge, and 15% for dependent alcohol use. Seven percent reported involuntary drug consumption history. A larger proportion of those aged 17-20 years screened positive for dependent alcohol use compared with the overall study population prevalence.

CONCLUSIONS

A large proportion of shipboard personnel screened positive for hazardous and dependent alcohol use (18% among those aged <21 years) at deployment onset. These data can inform interventions targeting shipboard personnel engaging in hazardous use before progression to dependent use and enable early identification and care for dependent users. Future studies should include more comprehensive assessment of factors associated with involuntary drug consumption.

Predictors for self-directed aggression in Italian prisoners include externalizing behaviors, childhood trauma and the serotonin transporter gene polymorphism 5-HTTLPR

Suicidal behavior and self-mutilation can be regarded as the expression of self-directed aggression and both are common in prison populations. We investigated the influence of externalizing behaviors, depressive symptoms, childhood trauma, 5-HTTLPR variants on self-directed aggression (N = 145) in a group of 702 male Italian prisoners. Participants were comprehensively evaluated, including for psychiatric disorders, impulsive traits, lifetime aggressive behavior [Brown-Goodwin Lifetime History of Aggression (BGHA)], hostility, violent behavior during incarceration, depressive symptomatology [Hamilton Depression Rating Scale (HDRS)], childhood trauma [Childhood Trauma Questionnaire (CTQ)]. Logistic regression analysis showed false discovery rate corrected independent main effects of externalizing behaviors: BGHA (P = 0.001), violent behavior in jail (P = 0.007), extraversion (P = 0.015); HDRS (P = 0.0004), Axis I disorders (P = 0.015), CTQ (P = 0.004) and 5-HTTLPR genotype (P = 0.02). Carriers of 5-HTTLPR high (LA LA ), intermediate (LA LG , SLA ) activity variants were more likely to have exhibited self-directed aggression relative to the low activity (LG LG , SLG , SS) variant: high/low: odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.27-4.68, P = 0.007; intermediate/low: OR = 1.96, 95% CI 1.09-3.68, P = 0.025. The CTQ main effect was driven by physical abuse. There was no interactive effect of 5-HTTLPR and CTQ. Secondary logistic regression analyses in (1) all suicide attempters (N = 88) and (2) all self-mutilators (N = 104), compared with controls showed that in both groups, childhood trauma (P = 0.008-0.01), depression (P = 0.0004-0.001) were strong predictors. BGHA, violent behavior in jail predicted self-mutilation (P = 0.002) but not suicide attempts (P = 0.1). This study was able to distinguish differing influences on self-directed aggression between groups of closely related predictor variables within the externalizing behavioral domain. 5-HTTLPR had an independent, variant dosage effect.

Alcohol use and depression during adolescence and young adulthood: a summary and interpretation of mixed findings

Alcohol Use Disorder (AUD) and alcohol misuse are common among adolescents and young adults and are associated with significant personal and societal problems. Similarly, Major Depressive Disorder (MDD) and depressive symptoms are prevalent in this population and when they co-occur with alcohol misuse lead to even more severe consequences. Numerous studies have investigated the association between depressive symptoms, AUD and various drinking behaviors presenting an unclear picture. In this review we summarize studies among adolescents and young adults that have examined these relationships. From this review it emerges that several factors affect results, including study design (cross-sectional vs longitudinal), participants' age (adolescents vs young adults), severity of problems considered (AUD vs heavy drinking; MDD vs depressive symptoms), and gender. Adolescents with AUD are at higher risk for MDD in particular at a younger age. During adolescence, several drinking behaviors, including weekly alcohol use and heavy drinking, increase the risk for depressive symptoms and MDD, while during young adulthood primarily AUD, but not other drinking behaviors, is associated with increased risk for MDD. Gender may have an effect on the association between depression and drinking behaviors but its role is still unclear. Some evidence suggests that the association between AUD and MDD is bidirectional such that mood problems contribute to the onset of alcohol problems and vice-versa. More longitudinal studies are needed to examine these associations in young adults and to clarify the effect of gender on these associations. To date, findings suggest the critical need to reduce any alcohol use at a young age and to treat both depressive symptoms and AUD to prevent the occurrence of comorbid disorders.