Drink, drugs and death by suicide

Article in review: Kolves, K., Wen Koo, Y. & de Leo, D. (2020). A drink before suicide: Analysis of the Queensland Suicide Register in Australia. Epidemiology and Psychiatric Sciences, DOI: 10.1017/S2045796020000062

Summary: This comprehensive study analysed the ingestion of alcohol and other substances at the time of the suicide, together with considerations for life factors that may also have impacted the person in the time prior to their death. The research consolidated other research findings with respect to relationship pressures and separation and the likelihood for people to be under significant pressures at the time of intoxication and suicide.  

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We’ve long suspected there a correlation between alcohol consumption and suicide. Kolves and colleagues (2020) highlighted that alcohol has been recognised as the leading risk factor for death in 15-49-year-olds, with suicide being the third most common cause of death with attribution to alcohol.

A meta-analysis of data from 1979-2012 found that acute alcohol intake contributed to around a third of suicides during that period. This could be explained by the way alcohol causes an increase in impulsivity and aggression, or by the reduction of a fear of death through altered inhibitions. For some people, alcohol is associated with increased depression and feelings of hopelessness, and in some cases, this creates a tendency to overemphasis recent upsets and adverse life events.

The study by Kolves, Koo, and De Leo (2019) aimed to analyse and understand the frequency of alcohol use in those who died by suicide. Their study aimed to examine the data where both alcohol and other substances had been consumed before suicide. It is the first known comprehensive study of the co-ingestion of alcohol and medicines or substances at the time of death by suicide.

It is also one of the few to consider socio-demographic, life events, psychiatric illness, and death details in relation to levels of alcohol found. A total of 6744 cases of death by suicide and probable death by suicide were considered. Data for the study was sourced from

• police reports
• post-mortem autopsy reports
• toxicology reports
• Coroner’s findings

A blood alcohol content of 0.05 was considered to be blood alcohol positive for the purpose of the study.

Findings

• In total, 32.3% of people had a positive blood alcohol rate at the time of death. The figure was higher for males (33.6%) than females (28.3%).
• Young adults (25-44) years were most likely to have a positive blood alcohol rate at the time of death, with those older than 65 years the least likely to have a positive blood alcohol rate.
• Aboriginal and Torres Strait Islanders were 2.72 times more likely to have a positive blood alcohol rate than Caucasians.
• Positive blood alcohol rates were more prevalent in those who used hanging and suicide as a method when compared to those who died by poisoning and other drugs, firearms or explosives, or other means.
• The presence of positive blood alcohol rates was 26% lower in those diagnosed with a psychiatric disorder however positive alcohol rates were more commonly found in those untreated mental health problems and long-term suicide ideation.
• Positive blood alcohol rates were higher among those experiencing relationship conflict, interpersonal conflict, custody disputes, relationship separation, and employment concerns.
• People with positive blood alcohol rates were less likely to have other medicines in their blood than those who did not have alcohol in their blood.
• People who had been separated and divorced more frequently had positive blood alcohol rates than those who were married or never married and marital status was seen as a significant contributor to suicide where alcohol was detected.

What we can do

The most standout finding was this last point; that people who die by suicide while under the influence of alcohol are more likely to have relationship problems. This prompts the suggestion of increased support and information about suicide to be provided for those who are going through counseling related to relationships.

Improved access to information and support for those with substance abuse problems is also recommended. This would mean providing resources and training for staff working in the drug and alcohol fields, to enable them to recognise suicide risk signs.

Better access to support and treatments for Aboriginal and Torres Strait Islanders is also proposed, to aid in the address of the significantly higher number of ATSI people who had positive alcohol levels at the time of their suicide. The fact that recognition that many ATSI people live in regional and remote areas must also be addressed when planning support services to these groups.

The article closes with a suggestion about a review of the alcohol-related policy. International examples of regulatory activities such as limiting access by increasing price, campaigns to change attitudes and the improvement of treatment practices may assist.