Alcohol and suicide attempts

The danger of drinking while feeling down.

WHILE there have been improvements in suicide rates in recent years, it remains a significant public health problem for adolescents and young adults.

During 2006, 1.3% of all deaths in Australia were due to suicide, according to the Australian Bureau of Statistics. In relation to total deaths, the percentage of deaths from suicide varies according to different age groups and gender.

In 2006, 21% of male deaths and 14% of female deaths among those aged 20-24 years were attributed to suicide. The peak ages for suicide among males is 35-39 years and 45-49 years (163 in each), while for females the highest number was among those aged 35-39 years (46 deaths).

Just over half the male suicide deaths were by hanging (44% in females) with 20% due to poisoning (36% in females). Unfortunately, suicide among the Indigenous population is greatly increased, accounting for 4.9% of all deaths in 2006.

When assessing teenagers with at-risk behaviours or depression, it is vitally important to ensure their safety. According to US data, a third of adolescents report suicidal ideation at some stage, and 10% have attempted suicide.

While most research focuses on assessing suicidal risk factors in order to intervene and prevent suicide, research demonstrates that 50% of adult and adolescent suicides may be impulsive, with little preparation or premeditation.

This trend has recently been demonstrated in adolescents, with increasing numbers of suicide attempts but a decrease in suicidal ideation and planning.

Unplanned attempts seem to be associated with younger adolescent males with high levels of aggression and may also be increased following stressful life events. Planned attempts, in contrast, tend to be associated with higher levels of depression and hopelessness.

Unplanned attempts are therefore more difficult to identify but increasingly important. Recent research explored whether patterns of alcohol use could be used to differentiate between planned and unplanned attempts and thereby assist in identifying more adolescents at risk of suicide attempts.

RISKY BEHAVIOUR INCREASES

Alcohol intoxication may increase disinhibited, impulsive and aggressive behaviour and also affects cognitive processing and problem-solving skills, all of which may contribute to suicide attempts.

Drinking alcohol while feeling down was reported to show a threefold increase in self-reported suicide attempts among adolescents who did not report suicidal ideation.

Almost 18% of the study group of students who drank while down reported a suicide attempt in the past year, compared to only 3.1% of those who did not report drinking while experiencing low mood.

Binge drinking, or heavy episodic drinking, was also associated with suicide attempts. Of students with heavy episodic drinking, 8.8% reported a suicide attempt in the past year versus 3.3% of students who did not report heavy episodic drinking.

The authors concluded that the use of alcohol while sad or depressed could be seen as a marker for suicidal behaviour in adolescents who might not plan an attempt and therefore would not be detected by the usual screening questions.

They encouraged paediatricians, family physicians and GPs to screen for risky alcohol use in adolescents.

The use of alcohol and other drugs in adolescents is now being recognised as an important area for further clinical services and research. An adolescent-specific addiction medicine program was established in 2008 at the Children’s Hospital at Westmead (Service for Addiction Medicine in Youth).

The service incorporates a medical and psychosocial team and plays a very active role in helping to identify young people at risk presenting to the emergency department or throughout the hospital.

Once identified the adolescents can be comprehensively assessed with specific management and follow-up negotiated with the young person and their family.

Associate Professor Susan Towns, MBBS, FRACP, MMH, is head of adolescent medicine at the Children’s Hospital at Westmead.

References

1. Schilling EA, et al. Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health 2009;44:335-41
2. Australian Suicide Statistics, 2006 – key findings. Australian Network for Promotion, Prevention and Early Intervention for Mental Health, June 2008