Risk of suicide following an alcohol-related emergency hospital admission: An electronic cohort study of 2.8 million people

Abstract

ObjectiveAlcohol misuse is a well-known risk factor for suicide however, the relationship between alcohol-related hospital admission and subsequent risk of death from suicide is unknown. We aimed to determine the risk of death from suicide following emergency admission to hospital with an alcohol-related cause.MethodsWe established an electronic cohort study of all 2,803,457 residents of Wales, UK, aged from 10 to under 100 years on 1 January 2006 with six years’ follow-up. The outcome event was death from suicide defined as intentional self-harm (ICD-10 X60-84) or undetermined intent (Y10-34). The main exposure was an alcohol-related admission defined as a ‘wholly attributable’ ICD-10 alcohol code in the admission record. Admissions were coded for the presence or absence of co-existing psychiatric morbidity. The analysis was by Cox regression with adjustments for confounding variables within the dataset.ResultsDuring the study follow-up period, there were 15,546,355 person years at risk with 28,425 alcohol-related emergency admissions and 1562 suicides. 125 suicides followed an admission (144.6 per 100,000 person years), of which 11 (9%) occurred within 4 weeks of discharge. The overall adjusted hazard ratio (HR) for suicide following admission was 26.8 (95% confidence interval (CI) 18.8 to 38.3), in men HR 9.83 (95% CI 7.91 to 12.2) and women HR 28.5 (95% CI 19.9 to 41.0). The risk of suicide remained substantial in subjects without known co-existing psychiatric morbidity: HR men 8.11 (95% CI 6.30 to 10.4) and women HR 24.0 (95% CI 15.5 to 37.3). The analysis was limited by the absence in datasets of potentially important confounding variables and the lack of information on alcohol-related harm and psychiatric morbidity in subjects not admitted to hospital.ConclusionEmergency alcohol-related hospital admission is associated with an increased risk of suicide. Identifying individuals in hospital provides an opportunity for psychosocial assessment and suicide prevention of a targeted at-risk group before their discharge to the community.

Incidence, mortality and survival in children and young people aged 11-25 in Wales with co-occurring mental disorders and problem, hazardous or harmful substance use: estimates derived from linked routine data

“…Alcohol and drug use have been shown to commonly precede suicide (39). Our ndings are consistent with previous studies suggesting individuals with a history of alcohol use disorder are at signi cantly increased risk of death (26), even in the absence of a co-occurring MD (40). MD (particularly with comorbid SUD) is associated with all-cause mortality rates signi cantly higher than those for the general population: as well as the inherent risk of death directly attributable to substance use, there may be greater medical morbidity, which is not always well recognised by service providers (41).…”

“…associated with an increased risk of death from speci c causes such as suicide, as well as deaths from natural causes (39), (26), (40), (41), (17), (23), (32).…”

“…requiring the presence of a second MD or SUD code (for example Read v2 codes in section Eu%, designating 'Mental and behavioural disorders due to psychoactive substance use'): this included codes for mental and behavioural disorders due to acute intoxication, as there is an association between contact with services for acute intoxication and subsequent suicide risk (26).…”

Lifestyle Interventions and Prevention of Suicide

“…Consumption of alcohol immediately prior to suicide is common ( 94 , 95 ), with an estimated 37% of deaths from suicide having positive blood alcohol concentrations on toxicology screening indicating acute alcohol consumption before death ( 96 ). Bowden et al ( 97 ) in a large cohort study of 2,803,457 residents of Wales, UK, highlighted the relationship between emergency alcohol-related hospital admission and the increased risk of suicide. A recent systematic review of 108 studies explored the associations between substance use and suicide risk in low- and middle-income countries ( 98 ) demonstrated an association between alcohol use, intoxication and pathological use of alcohol, tobacco, cannabis, illicit drugs and non-medical use of prescription drugs and suicide risk.…”

Using Novel Data Types for Big Data Research in Epilepsy: Patient Records, Clinic Letters and Genetic Mutation

“…The Suicide Information Database Cymru (SID-Cymru) was set up using mortality and secondary care data in the SAIL databank to identify 2664 cases of suicide in Wales between 2003-2011 [71]. The SID-Cymru dataset was used to obtain suicides following alcohol related emergency admissions to hospital which showed that women were at double the risk of suicide than men and that 10% of suicides took place within 4 weeks of admission [72].…”