Dying for a drink

Global suicide prevention should focus more on alcohol use disorders

Suicide prevention requires a comprehensive response to the intimate link between alcohol use disorders and suicide. Major community based biographical (psychological autopsy) studies in the West and the East have consistently reported a high prevalence of alcohol use disorders among people who committed suicide—for example, 56% in New York,1 43% in Northern Ireland,2 and 34% in Madras.3 Such figures are far in excess of the prevalence of alcohol use disorders in the general population. In fact, alcohol use disorder was the most frequent DSM-III-R axis I psychiatric disorder (mood, psychotic, substance use, etc) in the studies cited. According to a meta-analysis of mortality studies, the lifetime risk of suicide is 7% for alcohol dependence.4 Interestingly, in a recently reported time series analysis a significant positive relation between per capita alcohol consumption and gender and age specific suicide rates was revealed most often in dry (low consumption) cultures (northern Europe) and least often in wet cultures (southern Europe).5 How may we use this link in devising strategies to prevent suicide?

In the Northern Ireland suicide study (case-control psychological autopsy) the estimated risk of suicide in the presence of current alcohol …