Alcohol and Suicide

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Editorial in the Irish Association of Suicidology Spring/Summer newsletter by Dr John Connolly.

Alcohol is a factor in approximately 45% of suicides and in 39% of attempted suicide and deliberate self harm. The relationship is complex and it would be wrong to say that alcohol is the cause of suicide. In western countries it is believed that up to 90% of persons who die by suicide will have been suffering from a mental illness, most commonly depression, at the time of their death. In eastern countries, similar studies indicate that mental illness is a factor in only 30% of suicides. Presumably in those countries cultural, social and economic factors are of primary concern.

The combination of depression and alcohol misuse increases the risk of suicide by about 40%. Bear in mind that the lifetime risk of suicide in major depressive illness is adjudged to be between 8% and 15% of sufferers (research shows that between 8 and 15 persons suffering from major depressive illness will die by suicide). Numbers for mild to moderate depression are much lower.

Suicide rates in Ireland fell from 11.6 per 100,000 in 2005 to 10.8 per 100,000 in 2010 but increased to 11.4 in in 2011, and the final figures for 2012 are expected to show a 6% increase for that year. Be careful how statistics are interpreted as to most of us actual numbers, percentages and rates per hundred thousand can give quite different impressions. Remember also that suicide remains under reported by perhaps 20%.

The reasons why suicide rates increase or decrease are not clear and suicide remains an enigma. That said, the decrease in suicide rates has been paralleled by a decrease in the percapita consumption of alcohol. International research shows a clear relationship between the per-capita consumption of alcohol and suicide rates. For every increase of one litre of absolute alcohol, per-capita suicide rates increase by 1%. The reverse may also be the case, as demonstrated in Gorbachov’s Russia where suicide rates fell dramatically when the availability of alcohol was restricted.

While the overall national consumption of alcohol has decreased by 17% since 2001, research shows that there is an increased incidence of alcohol and other substances in times of recession among the unemployed and marginalised groups already at high risk of suicide. Research also shows that for every 1% increase in unemployment there is a 0.8% increase in suicide. Perhaps this is the reason why the fall in alcohol consumption has not been paralleled by the expected fall in suicide rates overall.

It is very difficult to establish what really works in a suicide prevention programme but the clear relationship between levels of alcohol consumption and suicide is compelling and demands that we develop a national alcohol policy and endorse The National Substance Misuse Strategy. Doing so, we must be careful to address the special needs of those already at high risk of suicide.