Predisposing and Precipitating Factors for Suicide Among Alcoholics: Empirical Review and Conceptual Integration

Conner, Kenneth R.; Duberstein, Paul R.

doi:10.1097/01.alc.0000127410.84505.2a

Cited by 153 publications

(131 citation statements)

References 123 publications

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“…In a prior study, Simon and colleagues (2001) reported that 40% of all suicide attempts in their sample were impulsive. Others have highlighted the potential role of alcohol use as an important component of impulsive suicidal behaviors (Conner, 2004;Conner and Duberstein, 2004). The rate of impulsive suicide attempts among those with a lifetime suicide attempt in the present sample of 62% likely reflects the severity of alcohol dependence in this sample.…”

Section: Discussionmentioning

confidence: 64%

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Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Wojnar

Ilgen

Jakubczyk

et al. 2008

Drug and Alcohol Dependence

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Background-The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined.Methods-A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months.Results-Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chisquare=2.37, df=1, p=0.124). However, impulsive suicide attempts strongly predicted relapse (OR=2.81, 95%C.I. = 1.13-6.95, p=0.026) and time to relapse (OR=2.10, 95% C.I. = 1.18-3.74, p=0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity.Conclusions-This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

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Section: Discussionmentioning

confidence: 64%

“…As noted earlier, Conner and colleagues have highlighted the strong overlap between alcohol use, impulsivity, and suicide risk (Conner, 2004;Conner and Duberstein, 2004). Much of this research is understandably focused on understanding and modeling risk for suicidality.…”

Section: Discussionmentioning

confidence: 97%

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Wojnar

Ilgen

Jakubczyk

et al. 2008

Drug and Alcohol Dependence

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“…6,7 In accordance with the literature, the risk of suicide in males with substance use disorder was significantly higher if coexisting affective disorder was present. 29,30 This was not the case among females, possibly due to a type II error.…”

Section: J Clin Psychiatry 76:2 February 2016mentioning

confidence: 91%

Suicide Risk After Nonfatal Self-Harm

Runeson¹,

Haglund²,

Lichtenstein³

et al. 2015

J. Clin. Psychiatry

109

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Objective: To study the short-term risk of suicide after nonfatal deliberate self-harm and its association with coexisting mental disorders and with the method of self-harm used. Method: We used linked Swedish national registers to design a cohort study with 34,219 individuals (59% females) who were admitted to hospital in 2000-2005 after deliberate selfharm (ICD-10-defined). They were followed for 3-9 years. The studied outcome was completed suicide; Cox regression models yielded hazard ratios (HRs) for suicide risk. Temporal patterns were plotted with Kaplan-Meier survival curves, calculated separately for each mental disorder and for the method used at the previous selfharm event.Results: 1,182 subjects committed suicide during follow-up (670 males and 512 females). Coexisting bipolar disorder (in males, adjusted HR = 6.3; 95% confidence interval [CI], 3.8-10.3; in females, adjusted HR = 5.8; 95% CI, 3.4-9.7) and nonorganic psychotic disorder (in males, adjusted HR = 5.1; 95% CI, 3.5-7.4; in females, adjusted HR = 4.6; 95% CI, 2.8-7.7) implied the highest risk of suicide after previous self-harm. Hanging as index self-harm method was a strong predictor of later suicide in both males (adjusted HR = 5.3; 95% CI, 4.0-7.0) and females (adjusted HR = 4.5; 95% CI, 2.5-8.1). Of those with bipolar disorder who used a method other than poisoning at the index event, 20.4% had already committed suicide after 3-9 years. Conclusion: Individuals with severe mental disorders (affective and psychotic disorders) have a poor prognosis in the first years after hospital admission due to self-harm. The risk of subsequent suicide is higher after attempts by hanging and other self-injury methods (vs selfpoisoning). Aftercare for those with a self-harm episode should focus on treatment of the mental disorder present at the time of the episode.

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“…Knowing a person who has attempted suicide, whether a relative or not, has also been reported to be a risk factor for suicidal behavior in mid-life (66). It is possible, though, that exposure to suicidal behavior is the result of "assortative friendships," insofar as friends of individuals with psychological difficulties are more likely to have mental disorder themselves.…”

Section: Imitationmentioning

confidence: 99%

Familial Transmission of Suicidal Behavior

Brent¹,

Melhem²

2008

Psychiatric Clinics of North America

257

199

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Suicide and suicidal behavior is highly familial, and appears to be familially transmitted independently from the familial transmission of psychiatric disorder per se (1). Adoption, twin, and family studies support the view that the etiology of the familial transmission of suicidal behavior is at least in part genetic, and may be mediated by the transmission of intermediate phenotypes, such as impulsive aggression. In addition, there may be environmental causes for familial transmission, including imitation, and the intergenerational transmission of family adversity. In this review, we cover the evidence supporting the familial transmission of suicidal behavior, possible genetic and environmental explanations for this phenomenom, describe putative intermediate phenotypes, and discuss the contributory roles of early child-rearing and concurrent familial environmental stressors to suicidal risk. A better understanding of the mechanisms for the familial transmission of suicidal behavior can help to shed light on etiology, identify individuals at high risk for the development of incident suicidal behavior, and frame targets for intervention and prevention.Adoption studies (see Table 1) Three adoption studies have been conducted, all using the same Danish adoption registry. Kety et al., in a study designed to examine the genetics of schizophrenia and mood disorders, found a non-significant trend towards higher concordance for suicide in biological, compared to adoptive relatives of adoptees who committed suicide (2). Subsequently, a second study compared the rates of suicide among the biological and adoptive relatives of adoptees who committed suicide vs. biological and adoptive relatives of a matched living adoptee control group in Denmark (3). This study found a six-fold higher rate of suicide in the biological relatives of the suicide vs. those of the control adoptees, and an absence of suicide among the adopted relatives of the suicide vs. control adoptees supporting a genetic rather than environmental etiology (see Table 1). The rate of suicide was higher in the biologic relatives of suicide adoptees regardless of whether the adoptees were psychiatric patients or not. However, it was not possible to determine if the genetic liability to suicide was attributable to the transmission of major psychiatric disorders or to a suicide diathesis per se.In a third adoption study using this registry, a comparison of biological and adoptive relatives of adult adoptees with mood disorder and matched unaffected adoptees were examined (4), revealed a 15-fold increase in suicide among the biological relatives of the mood-disordered adoptees vs. those of the unaffected adoptees (4). This finding supports the role of mood disorder in the genetics of suicide. However, the greatest increased risk for suicidal behavior was found in the relatives of those probands with "affect reaction," a diagnosis akin to Corresponding Author: Dr. David Brent, BrentDA@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript th...

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Predisposing and Precipitating Factors for Suicide Among Alcoholics: Empirical Review and Conceptual Integration

Cited by 153 publications

References 123 publications

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients

Suicide Risk After Nonfatal Self-Harm

Familial Transmission of Suicidal Behavior

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