Alcohol Use Disorder and Risk of Suicide in a Swedish Population-Based Cohort
Research article
“Alcohol Use Disorder and Risk of Suicide in a Swedish Population-Based Cohort” is part of a series of population studies Virginia Commonwealth University has conducted with Lund University in Sweden.
Because of the study’s size, the findings were consistent in a way that is rare. Having data over decades was crucial to the study, allowing the researchers to examine how the association between alcohol use disorder and risk of suicide shifts over time.
It was striking to see that the elevated risk persisted for literally decades.
[Alcohol use disorder] is a potent risk factor for suicide, with a substantial association persisting after accounting for confounding factors,” concluded the study, conducted by lead author Alexis Edwards, Ph.D., at Virginia Commonwealth University.
These findings underscore the impact of AUD on suicide risk, even in the context of other mental illness, and implicate the time frame shortly after a medical or criminal AUD registration as critical for efforts to reduce alcohol-related suicide.”
Abstract
Objective
The researchers examined the association between alcohol use disorder (AUD) and risk of suicide, before and after accounting for psychiatric comorbidity, and assessed the extent to which the observed association is due to a potentially causal mechanism or genetic and familial environmental confounding factors that increase risk for both.
Methods
Longitudinal population-wide Swedish medical, criminal, and pharmacy registries were used to evaluate the risk of death by suicide as a function of AUD history. Analyses employed prospective cohort and co-relative designs, including data on 2,229,880 native Swedes born between 1950 and 1970 and observed from age 15 until 2012.
Results
The lifetime rate of suicide during the observation period was 3.54% for women and 3.94% for men with AUD, compared with 0.29% and 0.76% of women and men, respectively, without AUD.
In adjusted analyses, AUD remained robustly associated with suicide: hazard ratios across observation periods ranged from 2.61 to 128.0 among women and from 2.44 to 28.0 among men.
Co-relative analyses indicated that familial confounding accounted for some, but not all, of the observed association. A substantial and potentially causal relationship remained after accounting for a history of other psychiatric diagnoses.
Conclusions
AUD is a potent risk factor for suicide, with a substantial association persisting after accounting for confounding factors.
These findings underscore the impact of AUD on suicide risk, even in the context of other mental illness, and implicate the time frame shortly after a medical or criminal AUD registration as critical for efforts to reduce alcohol-related suicide.
It’s difficult to translate population-level statistics into individual stories, but one way to think of this is that someone could have come from a great family environment [with] no prominent risk factors—like childhood abuse, or poverty, or a parent with severe mental illness—and if they develop AUD, that alone puts them at a higher risk for suicide,” said lead author Alexis Edwards, Ph.D., at Virginia Commonwealth University.
The findings suggest that doctors should be especially aware of suicide risk among patients with a history of alcohol use disorder, particularly in the time frame closest to the AUD diagnosis, when risk is highest.
These patients should be formally assessed for suicide risk.”
