Alcohol and suicide-the Portuguese experience

Skog, Ole‐Jørgen; Teixeira, Zélia; BARRIAS, JOSE; Moreira, Rui Verlaine Oliveira

doi:10.1046/j.1360-0443.1995.90810534.x

Cited by 21 publications

(12 citation statements)

References 11 publications

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“…Also, in a previous study performed in 1980–1982 in Portugal, the inverse association between suicide rates and alcohol cirrhosis deaths had a distinctive regional distribution: whereas in the north, alcohol uptake and cirrhosis death was greater than in the south, suicide rates were much greater in the south [22], suggesting that alcohol addiction is on many occasions either a depression equivalent or a self-medication strategy [24]. Overall, cultural differences are also important in explaining variation in the associations across countries.…”

Section: Discussionmentioning

confidence: 79%

“…Furthermore, differing approaches in these studies to controlling for potential confounds are challenging for integration and interpretation. In some settings and contexts, economic development correlates with lower suicide rates [20], [21], while alcohol consumption [22]–[24], divorce both in men and women [25], [26] and unemployment [27], [28] can correlate with higher suicide rates.…”

Section: Introductionmentioning

confidence: 99%

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Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

et al. 2013

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BackgroundResearch concerning the association between use of antidepressants and incidence of suicide has yielded inconsistent results and is the subject of considerable controversy. The first aim is to describe trends in the use of antidepressants and rates of suicide in Europe, adjusted for gross domestic product, alcohol consumption, unemployment, and divorce. The second aim is to explore if any observed reduction in the rate of suicide in different European countries preceded the trend for increased use of antidepressants.MethodsData were obtained for 29 European countries between 1980 and 2009. Pearson correlations were used to explore the direction and magnitude of associations. Generalized linear mixed models and Poisson regression distribution were used to clarify the effects of antidepressants on suicide rates, while an autoregressive adjusted model was used to test the interaction between antidepressant utilization and suicide over two time periods: 1980–1994 and 1995–2009.FindingsAn inverse correlation was observed in all countries between recorded Standardised Death Rate (SDR) for suicide and antidepressant Defined Daily Dosage (DDD), with the exception of Portugal. Variability was marked in the association between suicide and alcohol, unemployment and divorce, with countries depicting either a positive or a negative correlation with the SDR for suicide. Every unit increase in DDD of an antidepressant per 1000 people per day, adjusted for these confounding factors, reduces the SDR by 0.088. The correlation between DDD and suicide related SDR was negative in both time periods considered, albeit more pronounced between 1980 and 1994.ConclusionsSuicide rates have tended to decrease more in European countries where there has been a greater increase in the use of antidepressants. These findings underline the importance of the appropriate use of antidepressants as part of routine care for people diagnosed with depression, therefore reducing the risk of suicide.

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Section: Discussionmentioning

confidence: 79%

Section: Introductionmentioning

confidence: 99%

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

et al. 2013

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“…Using similar time series methods, estimates of national level per capita alcohol consumption, and employing few covariates beyond unemployment and divorce rates as measures of Durkheim's social integration, a positive association of alcohol consumption with suicide has been shown in Sweden (Rossow, 1993); Norway (Norstrom, 1988); France (Norstrom, 1995); Hungary (Skog and Elekes, 1993); in Portuguese men (Skog et al, 1995); and in younger, under age 45, Finnish men (Makela, 1996). No relationship was found, however, between aggregate alcohol consumption and suicide among Portuguese women (Skog et al, 1995) nor among Swiss women, and a weak negative relationship was found for Swiss men (Gmel et al, 1998). In the United States, Wasserman (1989) found that suicide rates decreased during the U.S. prohibition era; Gruenewald and colleagues (1995) found that suicide rates were related to per capita consumption of spirits, but not beer or wine; and Caces and Harford (1998) found that alcohol consumption increased the suicide risk for men and women younger than age 60 when unemployment was included in their models.…”

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confidence: 99%

Suicide and Alcohol: Do Outlets Play a Role?

Johnson

Gruenewald

Remer

2009

Alcoholism Clin & Exp Res

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Background The purpose of this study was to determine whether the number of alcohol outlets in local and adjacent areas, in particular bars, was related over time to completed suicide and suicide attempts. There is evidence both from studies of individuals and time series aggregate studies, mostly at the national level, of substantial alcohol involvement in suicide, but no small-area, longitudinal studies have been carried out. The present study is the first that is both longitudinal and based on a large number of small spatial units, California zip codes, a level of resolution permitting analysis of the relationship between local alcohol access and suicide rates over time. Method Longitudinal data were obtained from 581 consistently defined zip code areas over 6 years (1995–2000) using data from the California Index Locations Database, a geographic information system that contains both population and place information with spatial attributes for the entire state. Measures obtained from each zip code included population characteristics (e.g., median age) and place characteristics (e.g., numbers of retail and alcohol outlets) which were related in separate analyses to (i) suicide mortality and (ii) the number of hospitalizations for injuries caused by suicide attempts. The effect of place characteristics in zip code areas adjacent to each of the 581 local zip codes (spatial lags) was also assessed. Analysis methods were random effects models corrected for spatial autocorrelation. Results Completed suicide rates were higher in zip code areas with greater local and lagged bar densities; and higher in areas with greater local but not lagged off-premise outlet densities. Whereas completed suicide rates were lower among blacks and Hispanics, completed suicide rates were higher among low income, older whites living in less densely populated areas, that is, rural areas. Rates of suicide attempts were higher in zip code areas with greater local but not lagged bar densities, and higher among low income younger whites living in smaller households and in rural areas. Rates of attempted suicide were also higher among blacks. Completed suicide and suicide attempt rates were lower in zip code areas with greater local restaurant densities; there were no lagged effects for restaurants. Conclusions Bar densities in particular appear related to suicide, meaning, because this is an aggregate-level spatial analysis, that suicides, both attempted and completed, occur at greater rates in rural community areas with greater bar densities. Because the suicide rate is highest in rural areas, this study suggests that although the number of completed and attempted suicides is no doubt greater in absolute numbers in urban areas, the suicide rate, both completed and attempted, is greater in rural areas, which draws attention, perhaps much needed, to the problems of rural America.

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“…Drinking patterns and the strength of their association with suicidal behaviour in adolescents appear to differ between European countries [26,58] and seem to be stronger in the northern, eastern and central European countries compared to southern Europe [4,57,[61][62][63][64]. Ramstedt proposed that the less intoxication-orientated drinking pattern of southern European countries appears to be more resistant to an elevated suicide-risk in younger age groups [61].…”

Section: Alcohol and Drug Abusementioning

confidence: 99%

Trends of youth suicide in Europe during the 1980s and 1990s – gender differences and implications for prevention

Mittendorfer‐Rutz

2006

The Journal of Men's Health & Gender

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Youth suicide constitutes a considerable public health problem in many European countries. Suicide mortality in adolescents and young adults has increased during the 1980s and 1990s in several European countries and predominantly in young males. This paper summarises the international discussion on potential reasons for these trends, including changes in ascertainment practices, in the prevalence of psychopathology (mainly depression and substance abuse), in psychosocial and socio-economic conditions and in the methods chosen for suicidal behaviour. Potential reasons for the gender differences in trends are scrutinised.

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Alcohol and suicide-the Portuguese experience

Cited by 21 publications

References 11 publications

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

Antidepressant Utilization and Suicide in Europe: An Ecological Multi-National Study

Suicide and Alcohol: Do Outlets Play a Role?

Trends of youth suicide in Europe during the 1980s and 1990s – gender differences and implications for prevention

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