A drink before suicide: analysis of the Queensland Suicide Register in Australia

Abstract

Aims Previous studies analysing blood alcohol concentration (BAC) at the time of suicide have primarily focused on sociodemographic factors. Limited research has focused on psychosocial factors and co-ingestion of other substances to understand the mechanisms of how alcohol contributes to death by suicide. The aim was to examine time trends, psychosocial factors related to acute alcohol use and co-ingestion of alcohol and other substances before suicide. Methods The Queensland Suicide Register in 2004–2015 was utilised and analysed in 2019. The cut-off point for positive BAC was set at ⩾0.05 g/dl. Substances were categorised as medicines, illegal drugs and other. Medicines were coded by the Anatomical Therapeutic Chemical (ATC) classification system. Joinpoint regression, univariate odds ratios, age and sex-adjusted odds ratios and Forward Stepwise logistic regression were performed. Results BAC information was available for 6744 suicides, 92% of all cases in 2004–2015. The final model showed that independent factors distinguishing BAC+ from BAC− were: age group 25–44 years, Australian Indigenous background, being separated or divorced, hanging, diagnosis of substance use, lifetime suicidal ideation, relationship and interpersonal conflict, not having psychotic and other psychiatric disorder, and no nervous system drugs or any other substances in blood at the time of suicide. Conclusions Our findings suggest that people who die by suicide while under the influence of alcohol are more likely to be under acute stress (e.g. separation) and not have earlier psychiatric conditions, except substance use. This highlights the importance of more strict alcohol policies, but also the need to improve substance use treatment.

Perfil toxicológico dos suicídios no Rio Grande do Sul, Brasil, 2017 a 2019

“…Apesar da importância das avaliações toxicológicas em todos os casos de suicídio, este trabalho revelou uma carência quanto à padronização de condutas médico-legais no que diz respeito à coleta de materiais biológicos. O mesmo problema foi observado anteriormente na cidade de São Paulo, onde apenas 38,8% dos suicídios foram submetidos a análises laboratoriais, assim como na Suíça e Austrália, com 87,3% e 92,0%, respectivamente ( 14 , 26 , 27 ).…”

“…Em função disso, a OMS lançou, em 2018, um conjunto de ações estratégicas baseadas em evidências sobre o impacto do consumo de bebidas alcoólicas na saúde pública, destacando a importância de um sistema de vigilância e monitoramento sustentável ( 32 ). O consumo de etanol concomitante ao de substâncias ilícitas foi observado entre os adultos jovens com ideações suicidas na cidade de Pelotas, Rio Grande do Sul, e entre as vítimas de suicídio na capital dos Estados Unidos e na Austrália ( 14 , 17 , 28 ).…”

“…Kõlves et al ( 14 ) também relataram uma correlação entre o etanol e a ausência de medicamentos, ausência de distúrbios psiquiátricos e presença de problemas de relacionamento. Por outro lado, as vítimas de suicídio no estado do Rio Grande do Sul no presente estudo diferiram dos casos australianos por apresentarem maior incidência de resultados positivos para etanol entre os casos de uso de arma de fogo e por mostrarem relação entre ausência de etanol e presença de antidepressivos.…”

Impact of Alcohol Policies on Suicidal Behavior: A Systematic Literature Review

“…Across all studies, the anti-suicide effects associated with restricting alcohol use were predominant in males. This is unsurprising, given males are more likely than females to drink alcohol, develop alcohol dependence [ 20 ], and have positive BAC at time of suicide death and die by suicide [ 19 , 45 ]. Stronger effects in males also supports a potential causal link between the ecological associations found—if the associations between alcohol restrictions and suicide rates were spurious, we would not expect to see such a prominent difference between the sexes.…”

Reporting of alcohol as a contributor to death in Australian national suicide statistics and its relationship to post‐mortem alcohol concentrations

“…We defined Alc+ suicides based on several lines of policy and evidence, that at and above a BAC of 0.05 g/100 mL: (i) the acute psychological effects of alcohol intoxication become more adverse [12]; (i) it is the threshold used in legal guidelines regarding drink driving in Australia (amongst other countries), because it has been empirically shown to be a concentration associated with impaired skills and judgement [6]; (iii) during decomposition alcohol can be produced endogenously, when this occurs low amounts of alcohol (i.e. <0.03 g/100 mL) are more likely to be formed than higher levels [11]; and (iv) it is the level used to classify an Alc+ suicide by previous post‐mortem studies in Australia [13,14].…”