Alcohol Consumption as a Risk Factor for Suicidal Behavior: A Systematic Review of Associations at the Individual and at the Population Level

Is shyness related to depression and suicide risk?

INTRODUCTION

Suicidal behavior is an important health issue, representing a leading cause of mortality, particularly among young adults. Depression was found to be predictive of suicide risk and predicted by shyness. Consequently, we tested a model wherein shyness leads to depression, which in turn leads to suicide risk. Moreover, we expected gender to moderate the effect of shyness on depression and suicide risk.

METHODS

A convenience sample of 478 first-year college students (51% women, Age: M = 25.42, SD = 3.61) completed online self-report questionnaires assessing suicide risk, depression, shyness, and demographic variables.

RESULTS

As expected, shyness was significantly correlated with depression (r = 0.40) and suicide risk (r = 0.24), and depression and suicide risk were also correlated with each other (r = 0.57). Depression statistically mediated the relationship between shyness and suicide risk (indirect effect for women = 0.92, SE = 0.16; for men = 0.72, SE = 0.17). Gender did not moderate the mediation effect. However, a direct link between shyness and suicide risk was found only among men (direct effect = 0.52, SE = 0.21).

CONCLUSIONS

The results suggest that shyness may be a significant factor in the development of depression and suicide risk, potentially serving as a valuable marker for identifying at-risk individuals. Moreover, clinicians should be aware of these associations, particularly among men, in order to maintain and support mental health as well as reduce suicidality.

Alcohol use disorder and risk of specific methods of suicide death in a national cohort

INTRODUCTION

Alcohol use disorder (AUD) is among the strongest correlates of suicide death, but it is unclear whether AUD status is differentially associated with risk of suicide by particular methods.

METHODS

The authors used competing risks models to evaluate the association between AUD status and risk of suicide by poisoning, suffocation, drowning, firearm, instruments, jumping, or other means in a large Swedish cohort born 1932-1995 (total N = 6,581,827; 48.8% female). Data were derived from Swedish national registers, including the Cause of Death Register and a range of medical registers.

RESULTS

After adjusting for sociodemographic factors and familial liability to suicidal behavior, AUD was positively associated with risk of suicide for each method evaluated (cumulative incidence differences: 0.006-1.040 for females, 0.046-0.680 for males), except the association with firearm suicide in females. AUD was most strongly associated with risk of suicide by poisoning. Sex differences in the effects of AUD and family liability were observed for some, but not all, methods. Furthermore, high familial liability for suicidal behavior exacerbated AUD's impact on risk for suicide by poisoning (both sexes) and suffocation and jumping (males only), while the inverse interaction was observed for firearm suicide (males only).

CONCLUSIONS

AUD increases risk of suicide by all methods examined and is particularly potent with respect to risk of suicide by poisoning. Differences in risk related to sex and familial liability to suicidal behavior underscore AUD's nuanced role in suicide risk. Future research should investigate targeted means restriction effectiveness among persons with AUD.

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.

Factors Related to Suicidal Ideation by Gender and Age Group in Korean Adults

BACKGROUND

According to the results of the age-standardized suicide rate (suicide deaths per 100,000 population) published by Organization for Economic Cooperation and Development countries from 2003 to 2019, the suicide rate in Korea is ranked first almost every year, so it should be managed at the national level. To reduce the suicide rate, many scholars are studying suicide. The suicidal process begins with suicidal ideation, progresses through suicide attempts, and ends with suicide. Among them, the frequency of suicidal thoughts was found to be highly correlated with suicide plans and attempts, and it is said that 60% of those who change from suicidal ideation to attempts appear within one year. Therefore, research related to suicidal ideation to lower the suicide rate will contribute to preventing suicide at an early stage.

METHODS

This study used data from the Korea National Health and Nutrition Examination Survey (KNHANES). Among them, data from 2013, 2015, 2017, and 2019 surveyed adults were compared for suicidal ideation among 18,339 adults. Considering the characteristics of the KNHANES data, complex sample analysis was performed considering the primary extraction unit (region), stratification variables, and weights. The Rao-Scott χ² test was stratified by age group to confirm the distribution of suicidal ideation according to general characteristics. Univariate and multiple logistic regression analyses were performed to understand the effect on suicidal ideation.

RESULTS

Among all subjects, the rate of suicidal ideation was 4.75%, and among the age groups, the rate of suicidal thoughts was the highest among those over 80 years old (10.39%). Compared to those who were 50s, those in their 30s had the lowest suicidal ideation (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.39-0.70), and those in their 80s had the highest rate of suicidal ideation (OR, 1.97; 95% CI, 1.38-2.82). Except for those in their 20s, the rate of suicidal ideation tends to increase with age. Overall, the lower 25% of the Euro Quality of Life-5 Dimensions (EQ-5D) index, depression lasting more than two weeks, and subjects with poor subjective health or high stress were more likely to have suicidal ideation. In particular, EQ-5D Index (OR, 5.86; 95% CI, 3.73-9.20), depressive symptoms (OR, 19.65; 95% CI, 9.94-38.83) in 20s, and stress in 80s (OR, 10.87; 95% CI, 5.63-20.96) was the highest, and those had the good subjective health perception in 30s (OR, 0.10; 95% CI, 0.05-0.20) was lowest. Participants in their 30s, 40s, and 60s who were divorced or widowed and those in their 50s and 60s who had never married or lived together were more likely to consider suicide ideation. Except for those in their 20s and 80s, the rate of suicidal ideation tends to increase with lower household income levels.

CONCLUSIONS

In the results of this study, it can be seen that a combination of factors such as a person's personality traits, stress or coping ability to various events, social support, and mental or physical limitations influence suicidal behavior. Suicidal ideation is not simply affected by a single factor but may be influenced by multiple factors.

Effects of restricting alcohol sales on fatal violence: Evidence from Sunday sales bans

INTRODUCTION

Homicides and suicides are the second- and third-leading causes of death among young people (aged 10-24) in the US. While a substantial share of these deaths involve alcohol, evidence is needed on whether specific alcohol policies, such as day-based sales restrictions, help prevent these deaths.

METHODS

We constructed total and firearm-related homicide and suicide counts by state, year, and day-of-week from the Multiple Cause of Death Micro-data 1990-2019. Repeals of Sunday bans were taken from the Alcohol Policy Information System. Two-way fixed effects Poisson models with standard errors clustered at state-level and population offset control for state, year and day-of-the-week fixed effects and state time-varying covariates.

RESULTS

Repealing Sunday bans is associated with an increase in homicides (IRR=1.125; 95% confidence interval [CI]:1.02-1.24) and firearm homicides (IRR=1.17; 95% CI:1.03-1.33). Analyses by day-of-the-week show significant associations with homicides not only on Sundays, but also other days, consistent with delays in death. There was no significant relationship for suicides.

CONCLUSION

Restricting alcohol availability may prove a useful policy tool to reduce homicides, given that day-based restrictions are associated with changes in deaths rather than only shifting across days-of-the-week.

Suicidal behavior across a broad range of psychiatric disorders

Suicide is a leading cause of death worldwide. In 2020, some 12.2 million Americans seriously contemplated suicide, 3.2 million planned suicide attempts, and 1.2 million attempted suicide. Traditionally, the approach to treating suicidal behavior (SB) has been to treat the "underlying" psychiatric disorder. However, the number of diagnoses associated with SB is considerable. We could find no studies describing the range of disorders reported to be comorbid with SB. This narrative review summarizes literature documenting the occurrence of SB across the lifespan and the full range of psychiatric diagnoses, not only BPD and those that comprise MDE, It also describes the relevance of these observations to clinical practice, research, and nosology. The literature searches contained the terms "suicid*" and each individual psychiatric diagnosis and identified 587 studies. We did not include case reports, case series, studies only addressing suicidal ideation or non-suicidal self-injury (NSSI), studies on self-harm, not distinguishing between SB and NSSI and studies that did not include any individuals that met criteria for a specific DSM-5 diagnosis (n = 366). We found that SB (suicide and/or suicide attempt) was reported to be associated with 72 out of 145 diagnoses, although data quality varied. Thus, SB is not exclusively germane to Major Depressive Episode (MDE) and Borderline Personality Disorder (BPD), the only conditions for which it is a diagnostic criterion. That SB co-occurs with so many diagnoses reinforces the need to assess current and past SB regardless of diagnosis, and supports the addition of charting codes to the DSM-5 to indicate current or past SB. It also comports with new data that specific genes are associated with SB independent of psychiatric diagnoses, and suggests that SB should be managed with specific suicide prevention interventions in addition to treatments indicated for co-occurring diagnoses. SB diagnostic codes would help researchers and clinicians document and measure SB's trajectory and response to treatment over time, and, ultimately, help develop secondary and tertiary prevention strategies. As a separate diagnosis, SB would preclude situations in which a potentially life-threatening behavior is not accounted for by a diagnosis, a problem that is particularly salient when no mental disorder is present, as is sometimes the case.

Alcohol use, self-harm and suicide: a scoping review of its portrayal in the Sri Lankan literature

Background

Suicide is a global public health problem. Compared to other middle-income countries, much literature has been generated on the topic of self-harm and suicide in Sri Lanka. Harmful use of alcohol is a well-known risk factor to self-harm and suicide, however the connection needed further exploration.

Aim

The aim was to investigate alcohol's role in self-harm and suicide in Sri Lanka to inform policy and prevention programs and future research priorities.

Methods

We performed a scoping review exploring how the association between alcohol use, self-harm and suicide in Sri Lanka is presented in scientific literature from August 1, 2008 to December 31, 2022. Thematic analysis was used to explore emerging themes.

Results

Altogether 116 peer-reviewed articles were included. Three themes emerged: (i) gendered, inter-relational explanations of alcohol's role in self-harm, (ii) hospital management of patients who co-ingested alcohol and pesticides, and (iii) proposed research and interventions targeting alcohol, self-harm and suicide. The articles' recommendations for policy, prevention and research priorities included: Family- and community-based alcohol, self-harm and suicide reduction interventions; viewing self-harm as a window of opportunity for health personnel to intervene in families affected by harmful alcohol consumption; and introduction of and increased access to treatment of alcohol use disorder at the individual level.

Conclusion

Suggestions for alcohol, self-harm, and suicide prevention interventions were primarily targeted at the community, though this might also reflect the limited treatment, mental health, and alcohol support available in the country. Future research should explore and test context-appropriate interventions integrating alcohol and self-harm prevention and treatment.

Exploring psychological and psychosocial correlates of non-suicidal self-injury and suicide in college students using network analysis

BACKGROUND

Non-suicidal self-injury (NSSI) and suicide are a serious health concern in young people. Remarkable progress has been made in understanding the correlates and risk factors for suicidality. However, it remains unclear the complex interplay between different factors and which factors are most saliently associated with NSSI and suicide risk and should be targeted for interventions.

METHODS

This study utilized network analysis to examine the interrelationship between NSSI, suicide and a variety of psychological (e.g., depression, psychotic-like experiences) and psychosocial (e.g., childhood maltreatment, family dysfunction, being bullied and social support) correlates in a sample of Chinese first year college students (n = 2328).

RESULTS

The severity of depressive symptoms was the only factor connected to both NSSI and suicide. Other psychiatric factors like psychotic experiences could only act in an indirect way via the bridging effect of depression. Emotional abuse, compared with other forms of childhood adversities, was found to be the most influential maltreatment form associated with suicidal ideation and attempts. Finally, social support showed the potential to lower the risk of self-injury and suicide in young people.

LIMITATIONS

Only a subset of risk and resilience factors of NSSI and suicide were included. Causal inference was impossible due to the cross-sectional design.

CONCLUSIONS

Our findings highlighted the importance of identifying risk groups with mental illnesses or negative childhood events, and providing additional support during the key time of transitioning into higher education.

Exposure to alcohol outlets and risk of suicidal behavior in a Swedish cohort of young adults

BACKGROUND

Greater alcohol accessibility, for example in the form of a high density of alcohol outlets or low alcohol taxation rates, may be associated with increased risk of suicidal behavior. However, most studies have been conducted at the aggregate level, and some have not accounted for potential confounders such as socioeconomic position or neighborhood quality.

METHODS

In a Swedish cohort of young adults aged 18 to 25, we used logistic regressions to evaluate whether living in a neighborhood that included bars, nightclubs, and/or government alcohol outlets was associated with risk of suicide attempt (SA) or suicide death (SD) during four separate 2-year observation periods. Neighborhoods were defined using pre-established nationwide designations. We conducted combined-sex and sex-stratified analyses, and included as covariates indicators of socioeconomic position, neighborhood deprivation, and aggregate genetic liability to suicidal behavior.

RESULTS

Risk of SA was increased in some subsamples of individuals living in a neighborhood with a bar or government alcohol outlet (odds ratios [ORs] = 1.05 to 1.15). Risk of SD was also higher among certain subsamples living in a neighborhood with a government outlet (ORs = 1.47 to 1.56), but lower for those living near a bar (ORs = 0.89 to 0.91). Significant results were driven by, but not exclusive to, the male subsample. Individuals with higher aggregate genetic risk for SA were more sensitive to the effects of a neighborhood government alcohol outlet, pooled across observation periods, in analyses of the sexes combined (relative excess risk due to interaction [RERI] = 0.05; 95% confidence intervals [CI] 0.01; 0.09) and in the male subsample (RERI = 0.06; 95% CI 0.001; 0.12).

CONCLUSIONS

Although effect sizes are small, living in a neighborhood with bars and/or government alcohol outlets may increase suicidal behavior among young adults. Individuals with higher genetic liability for SA are slightly more susceptible to these exposures.

Conceptualising the commercial determinants of suicide: broadening the lens on suicide and self-harm prevention

Suicide is preventable, yet, in many settings, robust suicide prevention strategies have not been implemented. Although a commercial determinants of health lens is increasingly being applied to industries important to the field of suicide prevention, the interplay between the vested interests of commercial actors and suicide has received little attention. There is a need to shift attention to the causes of the causes, directing more focus to the ways that commercial determinants influence suicide and shape suicide prevention strategies. Such a shift in perspective, with an evidence base and precedents to draw upon, has transformative potential for research and policy agendas dedicated to understanding and addressing upstream modifiable determinants of suicide and self-harm. We propose a framework intended to help guide efforts to conceptualise, research, and address the commercial determinants of suicide and their inequitable distribution. We hope these ideas and lines of inquiry help to catalyse connections between disciplines and open further debate and discussion as to how to take such an agenda forward.

Suicide Risk, Alcohol Consumption and Attitudes towards Psychological Help-Seeking among Lithuanian General Population Men, Conscripts and Regular Active Duty Soldiers

The aim of this study was to investigate the relationship between suicide risk, alcohol consumption, and attitudes towards professional psychological help among Lithuanian general population men, conscripts, and regular active duty (AD) soldiers. In total, 1195 Lithuanian adult males participated in the study: 445 men from the general population, 490 conscripts, and 260 regular AD soldiers from the Lithuanian Armed Forces. The study's measures included: general suicide risk, alcohol consumption levels, frequency of using alcohol as a means to suppress difficult thoughts and feelings, and attitudes toward psychological help. Both military samples showed significantly lower suicide risk than men from the general population. Alcohol use as a means to suppress difficult thoughts and feelings was the most significant predictor of suicide risk and a significant mediator between alcohol consumption and suicide risk in all study groups. Another significant suicide risk predictor and mediator between alcohol consumption and suicide risk-i.e., the value of seeking psychological treatment-was found only in the conscript sample. Results of the current study suggest that there is an opportunity for intervention aimed at the attitudes toward seeking professional psychological help for conscripts. However, that might not be the case for regular AD soldiers, nor the general population of Lithuanian men.

Identification and management of acute alcohol intoxication

Acute alcohol intoxication (AAI) is a harmful clinical condition, potentially life-threatening, secondary to the intake of large amounts of alcohol. Clinical manifestations of AAI are characterized by behavioural and neurological symptoms, even if its effects involve several organs and apparatus. Moreover, severe alcohol intoxication can produce a global neurological impairment leading to autonomic dysfunction, respiratory depression, coma and cardiac arrest. The evaluation of blood alcohol concentrations (BAC) is useful to confirm the suspicion of intoxication, both for clinical and legal reasons. Most of patients with AAI are referred to Emergency Departments due to behavioural, social, traumatic or clinical complications. Patient's stabilization is the first step in the management of AAI, in order to support vital functions and to prevent complications. Metadoxine represents a useful drug to increase ethanol metabolism and elimination. Given that AAI could represent a sentinel event of chronic alcohol abuse, patients presenting with acute intoxication should be screened for the presence of an underlying alcohol use disorder and referred to and an alcohol addiction unit to start a multidisciplinary treatment to achieve long term alcohol abstinence. The present review will focus on clinical features, diagnostic criteria and treatment strategies of AAI.

Alcohol use and the gender-specific risk of suicidal behavior: a systematic review and meta-analysis protocol

BACKGROUND

Alcohol use is an important risk factor for suicidal behavior, with a heightened risk found among women. The objective of this study is to determine the gender-specific risk of suicidal behaviors (suicide attempt and death by suicide) for different levels and dimensions of alcohol use-i.e., for (1) average alcohol volume consumed, (2) binge drinking, and (3) individuals with an alcohol use disorder.

METHODS

We will systematically search the available literature for primary studies on the risk relationships specified above. Using a predetermined set of keywords, a comprehensive systematic literature search will be conducted in the following electronic databases: Embase, PsycINFO, PubMed, and Web of Science. The basic inclusion criteria will be (1) an original, quantitative (cohort, case-control or cross-sectional) study; with (2) a measure of risk of at least one dimension of our alcohol exposures in relation to at least one of our outcomes of interest (suicide attempt or death by suicide), and its corresponding measure of variability is reported (or sufficient data to calculate these); and (3) estimates of risk stratified by gender. Studies (1) that use only qualitative labels of alcohol use, and (2) where suicide attempt and non-suicidal self-harm cannot be disaggregated will be excluded. There will be no restrictions on language, geographical region, or year of publication. Two reviewers will independently perform the search and systematic assessment of each identified study and subsequent extraction of data. Categorical random-effects meta-analyses will be conducted to obtain gender-specific pooled risk estimates. Risk of bias will be assessed using the Risk of Bias In Non-randomised Studies-of Interventions tool and the Grading of Recommendations Assessment, Development and Evaluation approach will be used to rate the quality of evidence.

DISCUSSION

This study will synthesize all available data on the gender-specific relationship between various dimensions of alcohol use and suicidal behavior simultaneously in a coherent framework. We will provide risk estimates with the detail needed to better understand the respective risk relationships and appreciate the burden of alcohol-attributable suicide.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022320918.

The association between alcohol use disorder and suicidal ideation in a New Zealand birth cohort

BACKGROUND

Alcohol use disorder is associated with increased suicide risk; however, both alcohol use disorder and suicide share risk factors which must be accounted for in order to understand this relationship. This study aimed to explore the longitudinal relationship between alcohol use disorder and suicidal ideation in adulthood, while accounting for both child background and adult covariate factors.

METHOD

Data were collected from the Christchurch Health and Development Study, a birth cohort of 1265 children born in Christchurch (New Zealand) in mid-1977. Alcohol use disorder (operationalised as alcohol abuse and alcohol dependence) was quantified between age 18 and 40 in five data waves. The outcome measure suicidal ideation was reported over the same time periods. Childhood confounding variables were controlled for, as well as time-dynamic covariates collected in adulthood, including internalising disorders, distress due to relationship dissolutions and other substance use disorders.

RESULTS

The association between alcohol abuse and suicidal ideation was not statistically significant before or after adjusting for childhood confounding and adulthood covariate factors, when compared to no alcohol disorder. However, the association between alcohol dependence and suicidal ideation was significant both before and after adjustment (unadjusted odds ratio = 2.89, 95% confidence interval = [2.09, 3.99]; adjusted odds ratio = 1.52, 95% confidence interval = [1.04, 2.23]), when compared to no alcohol disorder. Furthermore, alcohol dependence remained significant when compared to alcohol abuse (unadjusted odds ratio = 2.33, 95% confidence interval = [1.61, 3.37]; adjusted odds ratio = 1.54, 95% confidence interval = [1.00, 2.37]).

CONCLUSION

This analysis found an association between alcohol dependence and suicidal ideation within a New Zealand birth cohort, which persists even after adjustment for childhood confounding and adulthood covariate factors. Given the high rates of suicide and heavy drinking within the New Zealand population, any comprehensive national or regional suicide prevention plan should seek to reduce risky alcohol consumption at an individual and population level, as this represents a modifiable risk factor for suicide.

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.

Suicidal behavior and associated factors among prisoners at Dessie town correctional institution, Dessie, Ethiopia

BACKGROUND

Suicide is a prominent cause of death among inmates worldwide, accounting for over 30% of all deaths. Several factors, including prison-related, psychiatric disorders, stressful life events, and substance use-related factors are believed to be associated with an increased risk of suicidal behavior in a correctional facility. The present study aimed to determine the prevalence and associated factors of Suicidal Behavior among prisoners at Dessie town correctional institution, Ethiopia.

METHODS

From February 16 to March 5, 2020, a cross-sectional survey was conducted among 288 inmates at the Dessie Town Correctional Center. A systematic random sampling technique was used to select study participants during the study period. Data was collected through face-to-face interview methods using Suicidal Behavior Revised (SBQ-R). The collected data were coded, entered into Epi-data data version 3.1, and analyzed by SPSS Version 26. Binary logistic regression was carried out to identify independent predictors of suicidal behavior at a 95% confidence level. Variables at a p-value < 0.05 with 95% CI were declared statistically significant.

RESULTS

The prevalence of Suicidal behavior among prisoners was found to be 25.3% [(95% CI: 20.5, 30.6)]. This study showed that being female [AOR = 5.14;95% CI (1.62,16.29)], depression [AOR = 4.97;95%CI (2.53,9.77)], anxiety [AOR = 3.14; 95%CI (1.59,6.22)], experienced stressful life events [AOR = 5.11; 95%CI (2.24, 11.65)], and ever substance use [AOR = 2.83; 95%CI (1.41, 5.59)] were variables significantly associated with suicidal behavior among prisoners in Dessie town correctional institution.

CONCLUSION AND RECOMMENDATIONS

In this study, suicidal behavior was highly prevalent among prisoners compared to the general population. Being female, depression, anxiety, stress full life events, and substance use were variables that are independent predictors of suicidal behavior. This study recommends that the institution needs to deliver an appropriate psychiatric facility to diagnose and treat prisoners with suicidal behavior. Also, special attention should be given to early screening and treatment of prisoners through prison health services, which is the most critical prevention strategy of suicide in prisoners.

Depressive symptoms and suicidality by menopausal stages among middle-aged Korean women

AIMS

There has been increasing evidence of hormonal changes during reproductive events that lead to mood changes. However, studies on the severity of psychological problems according to the menopausal stage are limited. Thus, this study aimed to investigate the association between menopausal stages, depression and suicidality.

METHODS

A total of 45 177 women who underwent regular health check-ups between 2015 and 2018 at Kangbuk Samsung Hospital were included. Participants were stratified into four groups (pre-menopause, early transition, late transition and post-menopause) based on the Stages of Reproductive Aging Workshop Criteria. The Center for Epidemiological Studies-Depression scale (CESD) was used to evaluate depressive symptoms, and the degree of depressive symptoms was classified as moderate (CESD score 16-24) or severe (CESD score ⩾ 25). To measure suicide risk, we administered questionnaires related to suicidal ideation.

RESULTS

Overall, the prevalence of CESD scores of 16-24 and ⩾ 25 was 7.6 and 2.8%, respectively. Menopausal stages were positively associated with depressive symptoms in a dose-dependent manner. Multivariable-adjusted prevalence ratios (PRs, 95% confidence intervals) for CESD scores of 16-24 comparing the stages of the early menopausal transition (MT), late MT and post-menopause to pre-menopause was 1.28 (1.16-1.42), 1.21 (1.05-1.38) and 1.58 (1.36-1.84), respectively. The multivariable-adjusted PRs for CESD scores ⩾ 25 comparing the stages of the early MT, late MT and post-menopause to pre-menopause were 1.31 (1.11-1.55), 1.39 (1.12-1.72), 1.86 (1.47-2.37), respectively. In addition, the multivariable-adjusted PRs for suicidal ideation comparing the early MT, late MT and post-menopause stages to the pre-menopause stage were 1.24 (1.12-1.38), 1.07 (0.93-1.24) and 1.46 (1.25-1.70) (p for trend <0.001), respectively.

CONCLUSIONS

These findings indicate that the prevalence of depressive symptoms and suicidal ideation increases with advancing menopausal stage, even pre-menopause.

Alcohol use and death by suicide: A meta-analysis of 33 studies

INTRODUCTION

Decades of research show an association between alcohol use and death by suicide. However, findings on the temporal link between alcohol use and death by suicide are unclear. In the most comprehensive meta-analysis on the topic to date, we analyzed data from longitudinal studies to determine if alcohol use is a risk for death by suicide. We also explored moderators to uncover conditions where the alcohol use-suicide link is strengthened/weakened.

METHODS

Our literature search of six databases yielded 33 eligible studies involving 10,253,101 participants (community, psychiatric, and military samples).

RESULTS

Alcohol use was associated with a 94% increase in the risk of death by suicide. Specifically, random-effects meta-analysis revealed alcohol use displayed small-to-large significant risk and odds ratios with suicide for quantity of alcohol use and alcohol use diagnosis/alcohol-related problems. Meta-regression generally indicated larger effect sizes for studies with a higher percentage of women, younger age, unadjusted estimates, longer follow-up periods, military samples, and higher frequencies and quantities of alcohol use (relative to drinker/non-drinker status).

CONCLUSION

Our study highlights alcohol use as a substantive risk factor for death by suicide and underscores the importance of monitoring alcohol use among suicidal individuals and screening for suicidality among heavier alcohol users.

Suicide Deaths Among Women in California Living With Handgun Owners vs Those Living With Other Adults in Handgun-Free Homes, 2004-2016

Importance

Little is known about the extent to which secondhand exposure to household firearms is associated with risk of suicide in adults who do not own guns, most of whom are women.

Objective

To evaluate changes in risk of suicide among women living in gun-free households after one of their cohabitants became a handgun owner.

Design, Setting, and Participants

This cohort study observed participants for up to 12 years and 2 months from October 18, 2004, to December 31, 2016. Data were analyzed from April to November 2021. The study population included 9.5 million adult women in California who did not own guns and who entered the study while living with 1 or more adults in a handgun-free home.

Exposures

Secondhand exposure to household handguns.

Main Outcomes and Measures

Suicide, firearm suicide, nonfirearm suicide.

Results

Of 9.5 million women living in handgun-free homes, 331 968 women (3.5% of the study population; mean [SD] age, 41.6 [18.0] years) became exposed to household handguns during the study period. In the entire study population, 294 959 women died: 2197 (1%) of these were by suicide, 337 (15%) of which were suicides by firearm. Rates of suicide by any method during follow-up were higher among cohort members residing with handgun owners compared with those residing in handgun-free homes (hazard ratio, 1.43; 95% CI, 1.11-1.84). The excess suicide rate was accounted for by higher rates of suicide by firearm (hazard ratio, 4.32; 95% CI, 2.89-6.46). Women in households with and without handguns had similar rates of suicide by nonfirearm methods (hazard ratio, 0.90; 95% CI, 0.63-1.27).

Conclusions and Relevance

In this study, the rate of suicide among women was significantly higher after a cohabitant of theirs became a handgun owner compared with the rate observed while they lived in handgun-free homes.

Roles of alcohol use disorder and resilience in risk of suicide attempt in men: A Swedish population-based cohort

INTRODUCTION

Alcohol use disorder (AUD) has been identified as a strong risk factor for suicide attempt. However, few studies have considered protective factors that may moderate this association, such as resilience.

METHODS

We used longitudinal nationwide Swedish data of 903,333 males born 1960-1980 and 48,285 males born 1949-1951. We performed Cox proportional hazards models to test the role of AUD, resilience, and their interaction on risk for suicide attempt. We used co-relative models to account for familial factors.

RESULTS

Alcohol use disorder was strongly associated with increased risk of suicide attempt [hazard ratio (HR) = 12.22], while resilience was associated with reduced risk (HR = 0.73). Multiplicative interaction (HR = 1.21) showed that, in the context of AUD, the protective role of resilience on risk of suicide attempt was somewhat attenuated. Co-relative analyses supported both familial liability and a possible causal pathway between AUD, resilience, and suicide attempt. In the cohort born 1949-1951, resilience subcomponents-social maturity, interests, psychological energy, home conditions, and emotional control-were all associated with reduced suicide attempt risk (HRs between 0.63 and 0.74).

CONCLUSION

While resilience is associated with reduced risk of suicide attempt, this effect is less pronounced in the context of AUD. These associations are potentially causal.

A time-series analysis of the association between alcohol and suicide in Australia

INTRODUCTION

800,000 people die by suicide every year according to World Health Organisation data. Studies have shown associations between alcohol consumption and suicide, with most demonstrating that alcohol consumption increases suicide risk. However, some studies from high consumption countries show results in the opposite direction. This present study examines the association between per capita (PC) alcohol consumption and same year suicide mortality in Australia, and tests for lag effects, between 1910 and 2017.

MATERIALS AND METHODS

Age and gender-specific autoregressive integrated moving average (ARIMA) models were used to examine associations between alcohol consumption PC and suicide mortality rates. Associations between unemployment, divorce, barbiturates access, and the Great Depression and World War II, and suicide were examined.

RESULTS

A 10% increase in PC alcohol consumption was associated with a 5% and 5.1% decrease in overall and male suicide mortality respectively in the same year. However, a 10% increase in PC alcohol consumption was associated with an 5.1% and 5.4% increase in overall and male suicide mortality respectively 12 years later. This association differed among age groups and was significant in the male population only. Unemployment, divorce, the Great Depression and WW2, and barbiturates access were significantly associated with same year suicide mortality.

DISCUSSION

Contemporaneous alcohol consumption was associated with decreased suicide mortality, but was also associated with an increased risk of suicide 12 years later. Unemployment and barbiturates access were associated with an increased risk of suicide. Interventions and policies that address chronic alcohol consumption and support the unemployed may reduce suicide mortality.

Risk factors for suicidal behaviour in late-life depression: A systematic review

BACKGROUND

Suicide is a leading cause of preventable death worldwide, with its peak of maximum incidence in later life. Depression often puts an individual at higher risk for suicidal behaviour. In turn, depression deserves particular interest in old age due to its high prevalence and dramatic impact on health and wellbeing.

AIM

To gather integrated evidence on the potential risk factors for suicide behaviour development in depressive older adults, and to examine the effects of depression treatment to tackle suicide behaviour in this population.

METHODS

A systematic review of empirical studies, published from 2000 onwards, was conducted. Suicidal behaviour was addressed considering its varying forms (i.e., wish to die, ideation, attempt, and completed suicide).

RESULTS

Thirty-five papers were selected for review, comprising both clinical and epidemiological studies. Most of studies focused on suicidal ideation (60%). The studies consistently pointed out that the risk was related to depressive episode severity, psychiatric comorbidity (anxiety or substance use disorders), poorer health status, and loss of functionality. Reduced social support and loneliness were also associated with suicide behaviour in depressive older adults. Finally, the intervention studies showed that suicidal behaviour was a robust predictor of depression treatment response. Reductions in suicidal ideation were moderated by reductions in risk factors for suicide symptoms.

CONCLUSION

To sum up, common and age-specific risk factors seem to be involved in suicide development in depressive older adults. A major effort should be made to tackle this serious public health concern so as to promote older people to age healthily and well.

Alcohol use disorder and non-fatal suicide attempt: findings from a Swedish National Cohort Study

BACKGROUND AND AIMS

Alcohol use disorder (AUD) is associated with increased risk of non-fatal suicide attempt. We aimed to measure the strength and mechanistic nature of the association between AUD and increased suicide attempt and determine any causal pathways and/or shared risk factors.

DESIGN

We used Cox proportional hazards models in population-level and co-relative analyses to evaluate the risk of first non-fatal suicide attempt as a function of previous AUD.

SETTING AND PARTICIPANTS

We used continuously updated longitudinal nationwide Swedish registry data on native Swedes born from 1950 to 1970 (n = 2 229 619) and followed from age 15 until 2012.

MEASUREMENTS

AUD and suicide attempt were identified using International Classification of Diseases (ICD)-8, ICD-9, and ICD-10 codes. AUD was also identified using pharmacy and criminal records. Genetic and family environmental risks were derived based on relatedness via the Multi-Generation Register and shared residency via the Population and Housing Census and the Total Population Register.

FINDINGS

AUD was robustly associated with suicide attempt in crude models (hazard ratio [HR] = 15.24 [95% CI: 14.92, 15.56]). In models adjusted for sociodemographic factors and psychiatric comorbidity, the association was attenuated: for women, HRs declined gradually across time, ranging from 5.55 (3.72, 8.29) during the observation period that ranged from age 15 to 19 years to 1.77 (1.65, 1.90) at age 40 or older. For men, the corresponding figures were 6.12 (4.07, 9.19) and 1.83 (1.72, 1.94); in contrast to women, risk of suicide attempt among men increased from age 15 to 29 before declining. In co-relative models, a residual association remained, consistent with a causal path from AUD to suicide attempt.

CONCLUSIONS

In Sweden, alcohol use disorder appears to be an important predictor of suicide attempt even in the context of other psychiatric disorders. The observed association is likely the result of features that jointly impact risk of alcohol use disorder and suicide attempts (genetic liability, psychiatric illness, and childhood stressors) and a potentially causal pathway, acting independently or in conjunction with one another.

Association of chronic diseases and lifestyle factors with suicidal ideation among adults aged 18-69 years in Eswatini: evidence from a population-based survey

Background

How chronic diseases and lifestyle affect suicidal ideation in the sub-Saharan region remains unclear. We investigated the association of chronic diseases and lifestyle with suicidal ideation in the past year and the potential modifying role of sociodemographic status on this association. The findings can guide suicide prevention interventions.

Methods

We analyzed 3026 respondents from the World Health Organization STEPwise approach to noncommunicable disease risk factor surveillance conducted in Eswatini in 2014. The outcome was past-year suicidal ideation, and the main predictors were chronic diseases and lifestyle. Multiple logistic regression was used to estimate predictors, and subgroup analysis was performed to assess effect modification.

Results

The prevalence of past-year suicidal ideation was 9.9%. After adjustment for covariates, including sex, marital status, employment status, and education level, individuals aged 18–30 years (adjusted odds ratio [aOR]: 2.27, 95% confidence interval [CI]: 1.22–4.22) were more likely to have had past-year suicidal ideation than those aged 45–69 years. After adjustment for covariates among employed individuals, having high blood pressure (aOR: 3.38, 95% CI: 1.54–7.40), not exercising (aOR: 2.65, 95% CI: 1.09–6.39), drinking alcohol (aOR: 2.40, 95% CI: 1.14–5.05), being aged 18–30 years (aOR: 3.50, 95% CI: 1.01–12.1), and being exposed to threats (aOR: 2.37, 95% CI: 1.01–5.53) were significantly associated with past-year suicidal ideation.

Conclusions

Among currently employed individuals, having high blood pressure, not exercising, and drinking alcohol were associated with past-year suicidal ideation. The findings highlight the importance of developing and strengthening systems for early identification of suicidal ideation risk.

Mental health and economic stressors associated with high-risk drinking and increased alcohol consumption early in the COVID-19 pandemic in the United States

Physical distancing measures to curb COVID-19 transmission introduced mental health and economic stressors, possibly impacting problematic drinking. This cross-sectional study examines mental health and economic stressors early in the COVID-19 pandemic which may be associated with heavy alcohol use and increased alcohol use. We administered an online survey of U.S. adults via social media April 5 to May 5, 2020. High-risk drinking was defined by WHO risk drinking levels, a daily average of ≥4 drinks for men and ≥3 drinks for women. Participants reported retrospective assessments of increased alcohol use if their past-week alcohol consumption exceeded their past-year average weekly alcohol consumption. We used logistic regression to assess possible covariates of high-risk drinking and increased alcohol use. Among 2175 participants, 10% (n = 222) reported high-risk drinking, and 36% (n = 775) reported increased alcohol consumption. In multivariable analysis, high-risk drinking was significantly associated with household job loss (OR = 1.41, 95%CI = (1.06, 1.88)) and depressive symptoms (OR = 1.05, 95% CI = (1.02, 1.07)), and women had higher odds of high-risk drinking than men (OR = 2.37, 95% CI = (1.32, 4.69)). Previous mental health diagnosis was not significantly associated with high-risk drinking during the pandemic (OR = 1.31, 95% CI = (0.98, 1.76)) in univariable analysis. High-risk drinkers were almost six times as likely to report retrospective assessments of increased alcohol consumption, controlling for mental health and economic stressors (OR = 5.97, 95% CI = (4.35, 8.32)). Findings suggest a need for targeted interventions to address the complex mental health and economic stressors that may increase alcohol consumption and high-risk drinking during and after the pandemic.

Contributing factors to suicide: Political, social, cultural and economic

This review summarizes recent research in four environmental areas affecting risk of deaths by suicide. Politically, the weight of the evidence suggests that laws increasing social welfare expenditures and other policies assisting persons with low incomes (e.g., minimum wage) tend to lower suicide rates. Other legal changes such as those restricting firearms and alcohol availability can also prevent suicides. The social institutions of marriage, as well as parenting, continue to serve as protective factors against suicide, although the degree of protection is often gendered. Religiousness tends to be inversely associated with suicide deaths at the individual level of analysis, but the mediators need exploration to determine what accounts for the association: social support, better mental health, better physical health, less divorce, or other covariates. Cultural definitions of the traditional male role (e.g., breadwinner culture) continue to help explain the high male to female suicide ratio. New work on the "culture of suicide" shows promise. The degree of approval of suicide is sometimes the single most important factor in predicting suicide. At the individual level of analysis, two of the strongest predictors of suicide are economic ones: unemployment and low socio-economic status. Attention is drawn to enhancing the minimum wage as a policy known to lower state suicide rates. Limitations of research include model mis-specification, conflicting results especially when ecological data are employed, and a need for more research exploring moderators of established patterns such as that between religiousness and suicide.

Suicides during the Swedish midsummer holiday: analysis of cause of death data 1980-2018

INTRODUCTION

Previous studies have demonstrated increased suicide rates on holidays such as New Year, nationally and internationally. Comparable to New Year's Eve, Swedish Midsummer is a major holiday, linked to high levels of alcohol consumption in the population. We, therefore, hypothesized that suicides and deaths with undetermined intent would increase during the Midsummer celebration.

METHODS

We used a retrospective death registry design to investigate all suicides that occurred on Midsummer's Eve (ME), Midsummer's Day (MD) and 28 adjacent days (AD) during 1980-2018. Data were stratified by diagnosis type, sex and age, and was analyzed with paired t-tests, Poisson regression, and time-series charts with 95% confidence intervals.

RESULTS

During the 30-day investigation period, the observed average was 4.3 deaths per day (23.3% cases with undetermined intent). ME, but not MD, was associated with significantly fewer suicides compared to AD (-1.08 deaths, p < .01). ME, but not MD, was simultaneously associated with more deaths with undetermined intent (+0.58 deaths, p = .007). No moderating sex or age effects were found. Descriptive statistics showed that poisonings, drownings and traffic-related injuries were common among the undetermined ME cases.

DISCUSSION

The study found that suicide decreases and deaths with undetermined intent increases on ME. The findings are interpreted considering that substance use may affect both suicidal intentions and diagnosis classifications. Social and cultural support and holiday anticipations might also account for suicidal behaviors on ME.

Comorbid alcohol-related problems and suicidality disproportionately impact men and emerging adults among individuals with depressive symptoms

OBJECTIVE

Depressive disorders are common among adults with alcohol use disorder and with suicidality; however, demographic differences in comorbid alcohol use disorder, binge drinking, and suicidality are understudied. The objective of this study was to determine the extent to which comorbid suicidality and alcohol use disorders and comorbid suicidality and binge drinking differ by age and gender among adults with depressive symptoms.

METHOD

The sample included adults (unweighted N=29,460) in the United States who completed the 2015-2018 National Survey of Drug Use and Heath and screened positively for depression. Gender and age groups odds of alcohol use disorder only, suicidality only, and alcohol use disorder+suicidality were compared to neither problem. Similar analyses were conducted for binge drinking.

RESULTS

Men showed disproportional odds of alcohol use disorder only, all suicidality and alcohol use disorder comorbidities, and binge drinking+active suicidal ideation than women. Emerging adults showed higher odds of: passive and active suicidal ideation only and suicidality+alcohol use disorder than adults 35 and older; binge drinking only, binge drinking+passive suicidal ideation, and binge drinking+active suicidal ideation than all older adults; binge drinking+suicide planning and binge drinking+attempts than adults 50 and older.

LIMITATIONS

Because participants all reported depression symptoms either at the subclinical or clinical level, demographic differences in suicidality, alcohol use disorder, and binge drinking found in this study cannot be generalized to non-depressed samples.

CONCLUSIONS

Treatment providers should be aware of disproportionately higher odds of comorbid suicidality and alcohol use disorder, and suicidality and binge drinking among men and emerging adults.

Suicide prevention in psychiatric patients

An increased risk of suicide has been reported for psychiatric patients. In several world regions, an underlying psychiatric disorder is reported in up to 90% of people who die from suicide, though this rate seems to be considerably lower in low- and middle-income countries. Major psychiatric conditions associated with suicidality are mood disorders, alcohol and substance use disorders, borderline personality disorder, and schizophrenia. Comorbidity between different disorders is frequently associated with a higher suicide risk. A history of suicide attempts, feelings of hopelessness, impulsivity and aggression, adverse childhood experiences, severe psychopathology, and somatic disorders are common risk factors for suicide among psychiatric patients. Stressful life events and interpersonal problems, including interpersonal violence, are often triggers. A comprehensive and repeated suicide risk assessment represents the first step for effective suicide prevention. Particular attention should be paid during and after hospitalization, with the first days and weeks after discharge representing the most critical period. Pharmacological treatment of mood disorders and schizophrenia has been shown to have an anti-suicidal effect. A significant reduction of suicidal thoughts and behavior has been reported for cognitive behavioral therapy and dialectical behavior therapy. Brief interventions, including psychoeducation and follow-ups, are associated with a decrease in suicide deaths. Further development of suicide prevention in psychiatric patients will require a better understanding of additional risk and protective factors, such as the role of a person's decision-making capacity and social support, the role of spiritual and religious interventions, and the reduction of the treatment gap in mental health care.

Effect of alcohol interventions on suicidal ideation and behaviour: A systematic review and meta-analysis

BACKGROUND

Alcohol consumption is related to both suicidal ideation and behaviour, but evidence regarding the effect of psychological interventions to reduce alcohol use on self-harm, suicidal behaviour and ideation is limited. Therefore, the aim of the current study was to conduct a systematic literature review and meta-analysis of the effect of alcohol-related psychological interventions on these outcomes at the individual level.

METHODS

We searched the Cochrane CENTRAL, Cochrane DARE, EMBASE, Medline, ProQuest, PsycINFO, PubMed, SCOPUS, and Web of Science electronic databases to 5 January 2021. We included all English-language papers worldwide utilising psychological interventions with a focus on harmful alcohol use and suicidal ideation, self-harm, and/or suicidal behaviour.

RESULTS

We identified 11 studies, nine provided sufficient numerical data for meta-analysis. Although the methods and effect sizes varied substantially in the studies, reducing alcohol may led to a reduction in self-harm and suicide attempt by the final follow-up assessment (Odds ratio [OR] 0.57, 95% confidence interval [CI] 0.33 to 0.97, 6 studies, 491 participants, I² = 0%). However, there was no apparent effect for these interventions on suicidal ideation or suicide deaths. There was no significant difference in effect by therapeutic approach. Neither intervention dose (in hours) nor duration (in months) significantly explained differences in treatment effectiveness.

CONCLUSIONS

Interventions targeting harmful alcohol consumption may contribute towards a reduction in self-harm at the individual level. However, there was no apparent effect of these interventions on suicidal ideation (measured either continuously or dichotomously) or suicide deaths.

Variations in seasonal solar insolation are associated with a history of suicide attempts in bipolar I disorder

Background

Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries.

Methods

Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries).

Results

This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p < 0.01.

Conclusion

A large change in solar insolation, both between winter and summer and between the minimum and maximum monthly values, may increase the risk of suicide attempts in bipolar I disorder. With frequent circadian rhythm dysfunction and suicidal behavior in bipolar disorder, greater understanding of the optimal roles of daylight and electric lighting in circadian entrainment is needed.

Age at first alcohol use and weapon carrying among adolescents: Findings from the 2019 Youth Risk Behavior Survey

BACKGROUND

Although studies have investigated the association between alcohol use and violent behaviors such as weapon carrying, few studies have examined the association between age at first alcohol use and weapon-carrying among adolescents. The objective of this study was to investigate the association between age at first alcohol use and weapon carrying among adolescents.

METHODS

Data for this study came from the 2019 Youth Risk Behavior Survey. An analytic sample of 13,442 adolescents aged 14-18 years old (51% female) was analyzed using binary logistic regression. The outcome variable investigated in this study was weapon carrying during the past 30 days, and the main explanatory variable investigated was age at first alcohol use.

RESULTS

Of the 13,442 adolescents, 13.5% carried a weapon during the past 30 days, and 15.4% reported having their first alcoholic drink before age 13. In the multivariable logistic regression, adolescents who reported having alcohol before age 13 had more than double the odds of carrying a weapon when compared to those who never had alcohol before age 13 (AOR = 2.32, p < .001, 95% CI = 1.87-2.89). Other significant factors associated with weapon carrying include male gender, victim of bullying, teen dating violence, sexual violence, suicidal ideation, and history of substance use. Adolescents who self-identified as Black/African American or Hispanic were significantly less likely to carry a weapon when compared to adolescents who self-identified as non-Hispanic White.

CONCLUSION

The findings of this study underscore the importance of developing age appropriate intervention strategies to curb early initiation of alcohol use and weapon carrying among adolescents.

Alcohol and the Risk of Injury

Globally, almost four and a half million people died from injury in 2019. Alcohol's contribution to injury-related premature loss of life, disability and ill-health is pervasive, touching individuals, families and societies throughout the world. We conducted a review of research evidence for alcohol's causal role in injury by focusing on previously published systematic reviews, meta-analyses and where indicated, key studies. The review summarises evidence for pharmacological and physiological effects that support postulated causal pathways, highlights findings and knowledge gaps relevant to specific forms of injury (i.e., violence, suicide and self-harm, road injury, falls, burns, workplace injuries) and lays out options for evidence-based prevention.

Prevalence and Risk Factors of Mental Health Symptoms and Suicidal Behavior Among University Students in Wuhan, China During the COVID-19 Pandemic

Background: University students who are exposed to coronavirus disease 2019 (COVID-19) could be mentally distressed. We aimed to evaluate the pattern and risk factors of mental health and suicidal behavior among students who experienced long-term school closure due to the COVID-19 pandemic. Methods: This large-sample, cross-sectional, online survey was conducted from June 29, 2020, to July 18, 2020. Eleven thousand two hundred fifty four participants were recruited from 30 universities located in Wuhan, Hubei Province, China. The prevalence of symptoms of depression, anxiety, insomnia, and posttraumatic stress disorder (PTSD) and suicidal behavior was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, Posttraumatic Stress Disorder Checklist for DSM-5, and questions about suicidal ideation and attempts, respectively. Logistic regression was used to explore risk factors for mental health problems and suicidal behavior. Results: The prevalence of mental health problems was 41.5% for depressive symptoms, 32.6% for anxiety symptoms, 35.0% for insomnia symptoms, 8.5% for PTSD symptoms, and 2.0% for suicidal behavior. Participants with high stress during the pandemic were at higher risk of symptoms of depression [adjusted odds ratio (OR) = 1.67, 95% confidence interval (CI) = 1.43-1.95, p < 0.01), anxiety (adjusted OR = 1.90, 95% CI = 1.63-2.23, p < 0.01), insomnia (adjusted OR = 1.64, 95% CI = 1.44-1.87, p < 0.01), PTSD (adjusted OR = 1.71, 95% CI = 1.38-2.11, p < 0.01) and suicidal behavior (adjusted OR = 3.51, 95% CI = 2.28-5.40, p < 0.01). Distant relationship with parents, changes in lifestyle and alcohol use during the pandemic were associated with higher risk of mental health symptoms and suicidal behavior, whereas regular physical exercise reduced the risk of mental health problems. Conclusions: The psychological symptoms and suicidal behavior were relatively high among students who attended university in Wuhan, China after 6 months of the COVID-19 outbreak in China. Comprehensive mental health services and suicide prevention strategies are essential for university students during the COVID-19 pandemic.

Religion and Health in Arctic Norway - the association of religious and spiritual factors with suicidal behaviour in a mixed Sámi and Norwegian adult population - The SAMINOR 2 Questionnaire Survey

Given the higher suicide rates among the adult population in the northernmost part of Norway and some unfavourable psychosocial outcomes associated with the Laestadian revival movement in this region, it is reasonable to investigate the relationship between religiosity/spirituality and suicidal behaviour in this context. This study used cross-sectional data from the population-based SAMINOR 2 questionnaire survey (2012; n = 11,222; 66% non-Sámi; 22% Laestadian-affiliated; 27% response rate) in mixed Sámi-Norwegian areas of Mid and North Norway. We analysed the associations between religious/spiritual factors and lifetime suicidal ideation and attempts, age at the first attempt, motives, and number of attempts. Multivariable-adjusted regression models considering sociodemographics, Sámi background and self-ascription, and health-related risk factors were applied. Sámi and Laestadian affiliations were significantly associated with religious self-ascription, regular attendance, and Established Church membership. In a fully adjusted model, Laestadian family background was negatively associated with lifetime suicide attempts (OR = 0.66, 95% CI: 0.47–0.93) compared with other family circumstances, whereas regular religious participation was inversely associated with suicide ideation (OR = 0.74, 95% CI: 0.61–0.91) compared with non- or rare attendance. The findings suggest that Laestadianism and religious attendance contribute to less suicidal behaviour among adults in Sámi-Norwegian areas.

Interventions to Support Mental Health among Those with Health Conditions That Present Risk for Severe Infection from Coronavirus Disease 2019 (COVID-19): A Scoping Review of English and Chinese-Language Literature

This study aimed to address knowledge gaps related to the prevention and management of mental health responses among those with a condition that presents risk of severe COVID-19 infection. A scoping review that mapped English and Chinese-language studies (2019-2020) located in MEDLINE (Ovid), Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, Sociological Abstracts, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and Airiti Library was undertaken. Search terms related to COVID-19, mental health, and physical health were used and articles that included all three of these factors were extracted (n = 77). With the exception of one hospital-based pilot study, there were no intervention studies targeting mental health in those at risk of severe COVID-19 infection. Promising practices such as integrated care models that appropriately screen for mental health issues, address health determinants, and include use of digital resources were highlighted. Patient navigator programs, group online medical visits, peer support, and social prescribing may also support those with complex needs. Future policies need to address digital health access inequities and the implementation of multi-integrated health and social care. Furthermore, research is needed to comprehensively assess multi-integrated interventions that are resilient to public health crises.

Awareness and Attitudes of Mongolian Adolescents and Youth toward Alcohol Consumption and Alcohol-related Harm

BACKGROUND

This study aimed to examine alcohol consumption among Mongolian adolescents and youth, as well as their awareness and attitudes toward alcohol-related consequences.

METHODS

We analyzed cross-sectional data collected from students in secondary schools, colleges, and universities in Ulaanbaatar, Mongolia, using descriptive analysis methods.

FINDINGS

More than half of respondents had tried alcohol in the past, and 15.9% of high school students and 58.8% of university students had consumed alcohol in the last month (P = 0.0001). In total, 70.0% of respondents celebrated holidays with alcohol, 23.4% had economic problems due to alcohol consumption, 7.8% had health problems 1-2 times in the last 30 days, and roughly 36.0% had negative attitudes toward alcohol. Approximately, 15.0% of adolescents and young people had an insufficient understanding of anti-alcohol measures and laws.

CONCLUSION

Our findings suggest that Mongolian adolescents and youth have a high level of alcohol consumption and insufficient awareness and attitude regarding alcohol-related harm.

Prevalence and factors associated with major depression among female sex workers in post-conflict Gulu district: a cross-sectional study

Background

Female sex workers operating in conflict-affected settings could be at a much greater risk of major depression. However, the epidemiology of major depression in this population remains understudied. We aimed to determine the prevalence and the factors associated with major depression among FSWs in the post-conflict Gulu district in Northern Uganda.

Methods

We conducted a cross-sectional study among 300 randomly selected adult female sex workers in Gulu. We utilized a pre-tested semi-structured questionnaire, embedded with MINI 7.0.0, to gather information from each participant through face-to-face interviews. We collected data on socio-demographic characteristics, sex-work-related characteristics, alcohol and drug use, HIV status, and major depression. Then, data were entered into EPI INFO 7 and analyzed using logistic regression with the aid of STATA 14.0.

Results

The mean age (SD) of the study participants was 26.4 (± 6) years, 57.7% attained primary education, 51.7% never married, and 42.1% were living with HIV. The prevalence of major depression among FSWs in the district was 47.7%. In addition, the majority of the FSWs with major depression (91.0%) had either severe (50.4%) or moderate (40.6%) depressive symptoms. Independently, life stress (adjusted OR = 10.8, 95%CI: 5.67–20.57), living with HIV (adjusted OR = 2.25, 95%CI: 1.25–4.05), verbal abuse (adjusted OR = 2.27, 95%CI: 1.27–4.08), and older age (adjusted OR = 1.06, 95%CI: 1.01–1.12) all showed positive associations with major depression. Conversely, provision of sexual services from clients’ homes (adjusted OR = 0.50, 95%CI: 0.25–0.97), use of a non-barrier modern family planning method (adjusted OR = 0.44, 95%CI: 0.24–0.82), and daily intake of alcohol (adjusted OR = 0.50, 95%CI: 0.28–0.88) all showed negative associations with major depression.

Conclusions

There is a high prevalence of major depression among female sex workers in post-conflict Gulu. The high prevalence of major depression underscores the need for government and development partners to urgently and adequately address the mental health needs of female sex workers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11207-8.

Online interventions for people hospitalized for deliberate self-harm and problematic alcohol use: Lessons learned from the iiAIM trial

Deliberate self-harm and suicide affect all age groups, sexes, and regions, and their prevention is a global health priority. Acute alcohol misuse and chronic alcohol misuse are strong, modifiable risk factors, and Internet interventions aiming to reduce alcohol misuse and comorbid mental health problems (e.g., depression) are a promising and effective treatment modality. The research team aimed to evaluate the feasibility and effectiveness of an Internet-based comorbidity intervention primarily aiming to reduce alcohol consumption, and secondarily to reduce readmission for deliberate self-harm and improve psychological outcomes among people hospitalized for deliberate self-harm who also engage in problematic alcohol use. However, due to several barriers to recruitment, the trial could not be completed and was discontinued. The authors present a "Lessons Learned" discussion and describe the Internet Intervention for Alcohol Improvement (iiAIM) trial, discuss the key barriers experienced by the research team, and recommend potential solutions that may help future trials in this area.

Nonsuicidal Self-Injury Disorder, Borderline Personality Disorder, and Lifetime History of Suicide Attempts among Male and Female Veterans with Mental Health Disorders

BACKGROUND

Expanding on research that has identified nonsuicidal self-injury (NSSI) as a strong predictor of suicide risk, the present study examined NSSI disorder (NSSID) and borderline personality disorder (BPD) as unique contributors to lifetime suicide attempts. To our knowledge, the present study represents the first exploration of these associations among veterans.

METHODS

Participants included 124 male (74%) and female (26%) veterans diagnosed with at least one mental health disorder. Posttraumatic stress disorder (93%) and major depression (86%) were the most common mental health diagnoses. Large proportions of the sample met criteria for NSSID (48%) and BPD (40%). Suicide attempts were reported by 28% of the sample. Chi-square tests determined the bivariate associations among NSSID, BPD, history of suicide attempts, and other variables. Significant diagnostic (i.e., MDD, BPD, and NSSID) and demographic (i.e., age) characteristics were included as covariates in a logistic regression model examining the associations of BPD and NSSID with suicide attempts.

RESULTS

BPD, Χ²=11.1, p<0.001, and NSSID, Χ²=13.9, p<0.001, were uniquely associated with suicide attempts. When all significant predictors were included in the final model, only NSSID emerged as a significant contributor to suicide attempts, OR = 4.9, p < 0.001.

LIMITATIONS

Causality cannot be determined from cross-sectional analyses.

CONCLUSION

These findings highlight NSSID as a powerful and unique correlate of suicide attempts among veterans, beyond the associations of established diagnostic risk factors. Improving our understanding of the relationship between NSSID and suicide risk has the potential to inform suicide prevention efforts and improve clinical outcomes among veterans.

Preliminary analysis of low-level alcohol use and suicidality with children in the adolescent brain and cognitive development (ABCD) baseline cohort

Cross-sectional analyses were conducted in the baseline cohort of the Adolescent Brain and Cognitive Development (ABCD) Study to determine if lifetime low-level alcohol use was associated with an increased likelihood of lifetime suicidality (N=10,773, ages 9-10). Among the lifetime suicide ideation and attempt groups, 37.7% and 36.2% reported lifetime low-level alcohol use, respectively; versus 22.2% in the non-suicidality group. Children reporting lifetime alcohol use (i.e., ≥ a sip) showed a nearly two-fold increase in their odds of lifetime suicidality compared to those with no previous alcohol use. Future prospective research with this cohort will continue to probe alcohol-suicidality associations.

Alcohol and cocaine use prior to suspected suicide: Insights from toxicology

INTRODUCTION

This study investigates whether there is a relationship between alcohol and cocaine use in deaths where suicide by self-injury is the suspected cause of death.

METHODS

Adults referred by coroners to the Imperial College London Toxicology Unit for toxicological analysis between 2012 and 2016 were reviewed for inclusion criteria. Those who died by self-injury reasoned to be deliberate were included in the analysis. Femoral blood alcohol concentration (BAC) and presence of cocaine or benzoylecognine (a metabolite of cocaine) in blood and/or urine were tabulated and odds ratios calculated.

RESULTS

A total of 1722 decedents met inclusion criteria. BAC was ≥50 mg/dL in 29% of decedents. Cocaine was detected in 8.4% of cases. The likelihood of testing positive for cocaine increased with BAC and was most frequent between 100 and 199 mg/dL, consistent with moderate to severe intoxication (odds ratio 5.88, 95% confidence interval 3.80, 9.09; P ≤ 0.001) compared to those with BAC <10 mg/dL.

DISCUSSION AND CONCLUSIONS

This study demonstrates a correlation between increasing BAC and likelihood of cocaine use prior to suspected suicide, up to a level consistent with severe intoxication. Cocaine use was found in a high proportion of cases relative to the general population reporting regular use. This pattern of drug and alcohol use has previously been given little attention in suicide prevention strategies and clinical prioritisation.

Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders

Purpose of Review

Suicide is a major public health concern and a leading cause of death in the US. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior.

Recent Findings

Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior.

Summary

Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.

Suicides in Nunavik: a life course study

This study reports results of a life course study conducted with Inuit in Nunavik to obtain information on the life adversities and cumulative burden of adversity for three groups: those who died by suicide, those who attempted suicide, and those who experienced suicidal ideation but never attempted. The study involved different levels of collaboration between health authorities, front-line health workers and the research team. Results indicate that substance misuse and relational difficulties are most associated with the burden of adversity for those people who died by suicide, while bullying is most associated with the burden of adversity for those people who have made suicide attempts and those who have never made a suicide attempt. Specifically targeting parent–child relations, substance misuse, and bullying may be an important upstream strategy for reducing future suicidality in Nunavik.

A Comparison of Presentations with Self-Harm to Hospital in Lithuania and Ireland

Suicide is a serious problem globally, especially in Europe, with suicide rates varying between different countries. Self-harm is a known risk factor for dying by suicide and represents an opportunity to intervene in order to treat any associated mental illness and reduce risk. This study aimed to compare the characteristics of people presenting to hospital with self-harm at two clinical sites: Galway, Ireland and Kaunas, Lithuania. Data were obtained from the services’ database and anonymised for analysis. Over a 5-month period, 89 patients presented with self-harm at the Lithuanian site and 224 patients presented with self-harm at the Irish site. This study found significant differences in presentation, diagnosis and treatment between the two sites. All patients at the Lithuanian site were admitted to psychiatry, compared to 22% of patients at the Irish site (p < 0.001). In Lithuania, the main clinical diagnoses were adjustment disorder (37.1%) and major depression (20.2%), compared to substance misuse being the main clinical diagnosis (33.8%) in Ireland (p < 0.001). There were significant differences in the prescription of psychotropic medications (which were three times more commonly prescribed at the Lithuanian site) after controlling for age, gender and psychiatric history (p < 0.001). Further research is required to understand the cultural context behind and further association between hospitalisation and future death by suicide.

Alcohol consumption and suicide rate: A cross-sectional analysis in 183 countries

The age-standardized suicide rate and per capita alcohol consumption from 183 countries were acquired, and its relationship with per capita alcohol consumption was examined by the regression analysis. The positive associations between per capita alcohol consumption and the suicide rate were found among males and females in all income groups of countries. Compared with other environmental factors, controlling alcohol consumption has a distinct target and can be feasible and effective for reducing suicides. Health policy makers should keep in mind that alcohol consumption is costing lives not just by long-term physical ailments but also by making people vulnerable to suicide.

Suicidal behaviours among adolescents in Liberia

BACKGROUND

Whereas suicide remains in the top 12 leading causes of death among young people aged 10-24 in sub-Saharan Africa, little is known about suicidal behaviours among adolescents in Liberia. We aimed to estimate the 12-month prevalence and describe some of the correlates of suicide behaviours (ideation, planning, and attempt) among school-going adolescents in Liberia.

METHODS

We analysed data from the 2017 Liberia Global School-based Student Health Survey conducted nationwide among secondary school students. We performed bivariate and multivariable analyses to assess the correlates of suicidal ideation, planning, and attempt in the previous 12 months.

RESULTS

Of the 2744 students, 26.8% reported suicidal ideation, 36.5% made a specific plan to attempt suicide and 33.7% attempted suicide during the 12 months preceding the survey. In the final adjusted logistic models, bullying victimisation and food insecurity were associated with increased odds of ideation, planning, and attempt. Whereas no factor was uniquely associated with suicidal ideation, having many close friends, and parental monitoring were associated with the increased odds of suicidal planning only. Leisure-time sedentary behaviour was associated with increased odds of suicidal planning and attempt. Cannabis use, alcohol drunkenness, being physically attacked, and parental supervision were uniquely associated with increased odds of suicidal attempt, while parental understanding and having a smaller number of close friends were uniquely associated with reduced odds of suicidal attempt.

CONCLUSIONS

The relatively high prevalence estimates of suicide behaviours and the multi-contextual nature of the associated factors warrant the need for the design and implementation of universal and multi-level, collaborative targeted intervention efforts towards the prevention of the onset of ideation, planning, and attempt, and the possible transition to deaths by suicide among school-going adolescents in Liberia.