Researchers know that alcohol disorders amplify suicide risk. At least one-third of individuals who committed suicide also met criteria for alcohol abuse or dependence; alcohol-use disorders are a potent risk factor for suicide attempts that are considered medically serious; and up to seven percent of alcoholics die by committing suicide. Suicide risk among alcoholics also appears to increase with age. A study in the July issue of Alcoholism: Clinical & Experimental Research (ACER) has found that middle-aged and older alcoholics are at greater risk for suicide than young alcoholic adults.
"Alcoholism is a common disorder and is also a potent risk factor for suicide," said Kenneth R. Conner, assistant professor at the University of Rochester Medical Center and first author of the manuscript. "This was the first study of a sample of adults across the age spectrum that explicitly focused on factors that increase the risk for suicide and medically serious suicide attempts associated with alcohol dependence."
For the purposes of this study, a medically serious suicide attempt was defined as one that required hospital admission for up to 24 hours and met one other criterion that described the type of treatment received. "Data were gathered from medically serious attempters because they are a subgroup of suicide attempters who engaged in especially dangerous behavior, suggesting a high intent to die," said Conner. Even if not successful the first time, he said, these individuals have an elevated risk of dying in subsequent attempts.
"In most countries, risk for attempted suicide is highest among adolescents and young adults," Conner continued, "whereas the risk for completed suicide is highest among older adults. This study’s findings – that alcohol-dependent middle-aged and older adults are at greater risk for suicide than alcohol-dependent young adults – reinforce the notion of different age-related patterns in attempted suicide and completed suicide."
"Little is known about how suicide risk may shift with age," said Paul R. Duberstein, associate professor of psychiatry and director of the Laboratory of Personality and Development at the University of Rochester Medical Center. "Too often researchers in this area ignore the role of age, assuming that risk is ‘stable’ across the life course, as if the risk for suicide in a 25-year-old alcoholic is identical to that in a 65-year-old alcoholic."
For the ACER study, researchers examined data gathered by Annette L. Beautrais and colleagues for the Canterbury Suicide Project, a case-control study of suicides, medically serious suicide attempts, and randomly selected comparison subjects from the Canterbury region of New Zealand. In the analyses, all of the subjects were 18 years of age or older: 193 (149 males, 44 females) had died by committing suicide; 240 (114 males, 126 females) had made a medically serious suicide attempt; and 984 (476 males, 508 females) were community controls. Researchers compared demographic and diagnostic variables.
Results indicate that the association between alcohol dependence and suicide becomes amplified with age; however, the association between alcohol dependence and medically serious suicide attempts does not. Increased age also appears to amplify the association between mood disorders and suicide, whereas decreased age appears to strengthen the association between mood disorders and medically serious suicide attempts.
"This study shows that suicide risk in alcoholics increases with age," said Duberstein. "This study also shows that if you have a mood disorder, such as depression, the likelihood of suicide increases as you get older. I think the authors are absolutely correct in concluding that ‘the increased risk for suicide among older adults documented in western cultures may be attributable in large part to the increased vulnerability of older adults to complete suicide in the context of alcohol dependence and mood disorders.’ Furthermore, the study also challenges the myth that suicide is ‘more rationale’ in older adults. Of course, there are rational suicides, but they are the exceptions. Most suicides have a diagnosable and treatable mental illness at the time of death."
Duberstein said there is a clear need for longitudinal research in order to better understand the mechanisms underlying the heightened risk of suicide associated with older age, [depression and alcohol dependence.] Conner said he plans to "examine suicidal behavior among individuals with alcoholism, including a focus on drinking patterns that distinguish those at especially high risk."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Conner, K.R., Beautrais, A.L., Conwell, Y. (July 2003). Moderators of the relationship between alcohol dependence and suicide and medically serious suicide attempts: Analyses of canterbury suicide project data. Alcoholism: Clinical & Experimental Research, 27(8), 1156 – 1162.
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