Suicide and Alcohol: Do Outlets Play a Role?

Abstract

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.

Alcohol Policies and Suicide: A Review of the Literature

“…Yet no association was detected between outlet density and young female suicide mortality in the study. Another study by Johnson and colleagues (2009) conducted a repeated cross-sectional analysis with a spatial random effects model on zip code-level suicide rates in California from 1995 to 2000 to evaluate the impact of outlet density. They found that death by 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 (e.g., liquor stores).…”

Acute Use of Alcohol and Methods of Suicide in a US National Sample

“…1 Suicide is among the leading types of injury mortality linked with alcohol consumption. 2 Most investigations of the alcohol-suicide relationship have examined the role of long-term patterns of alcohol use and related problems, including population studies of alcohol consumption or availability and suicide rates 3–5 and individual-level studies of the risk for suicide associated with alcohol use disorder. 6–8 There are more limited data on acute use of alcohol before suicide, although available data indicate that it plays a significant role.…”

Acute alcohol use among suicide decedents in 14USstates: impacts of off‐premise and on‐premise alcohol outlet density

“…Previous studies have pointed to a positive association between alcohol outlet density and suicide rates (15, 19, 25, 26). Escobedo and Ortiz (26) examined data from New Mexico for 1990 to 1994 and found that as outlet density increases so do suicides and alcohol-related crashes, reporting that these associations continued to be statistically significant when they considered the effects of age, sex and minority status.…”

“…Studies focusing at the population level have shown that alcohol consumption (10–14) outlet density (15), price (16), and sales (17–19) are associated with increased suicide rates. There is substantial international evidence over several decades indicating that alcohol outlet density is associated with a range of alcohol-related harms including suicide (8, 20–23).…”