BALTIMORE – Alcohol intoxication commonly exists at the time when Americans take their lives, especially among men, younger adults, and those who use firearms to commit suicide.
During 2003-2009, roughly 20% of all U.S. residents who killed themselves had blood alcohol levels that met the standard definition of intoxication, a level of at least 0.08 g/dL, Mark S. Kaplan, Dr.P.H. said at the annual conference of the American Association of Suicidology.
Mitchel L. Zoler/IMNG Medical Media
"Alcohol is especially relevant in younger-age adults because suicide is more impulsive." -Dr. Mark S. Kaplan
The prevalence of intoxication at the time of death was 24% among men and 17% among women, based on data from nearly 44,000 suicides that occurred from 2003 to 2009 in data reported to the National Violent Death Reporting System, a program of the Centers for Disease Control and Prevention.
"There is a relationship between young age, alcohol use, and use of highly lethal means" in suicide decedents, said Dr. Kaplan, professor of community health at Portland (Ore.) State University. "There is a lethal combination of gun availability, alcohol, and a precipitating life crisis. The message to clinicians is that they need to probe for alcohol misuse among patients at risk for suicide," he said in an interview.
"Alcohol is especially relevant in younger-age adults because suicide is more impulsive" at younger ages, he explained. "Alcohol serves as a lubricant, as a disinhibitor. What alcohol does in younger-age groups is short circuit the standard suicide trajectory. We see less of this in older-age people because, perhaps, their suicide attempts are more planned and there is less need for disinhibition."
Other types of drug abuse can play a similar role, but alcohol is by far the number-one agent for abuse because of its greater availability. "This is new evidence that is nationally based that suggests that acute intoxication is a problem for suicide that needs to be addressed," Dr. Kaplan said.
He and his associates used data collected by the National Violent Death Reporting System, which began collecting information on U.S. violent decedents in 2002 and currently gathers data in 18 states. The researchers used data collected during 2003-2009 from 16 states where information existed for the entire state. (The states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Wisconsin, and Virginia.) Among the 57,813 total suicide deaths included in the database, information on blood alcohol levels obtained soon after death was available for 76% of decedents.
Prevalence of alcohol intoxication varied by state and by sex, ranging from a high of about 47% among women and about 37% for men in Alaska to a low of about 7% in women and about 10% for men in New Jersey. Alaska was the only state where intoxication prevalence among women suicide decedents exceeded prevalence in men.
Alcohol intoxication prevalence also varied by age, race and ethnicity, education level, metropolitan versus nonmetropolitan residence, veteran status, and suicide method used.
In a series of adjusted analyses that controlled for these variables, the highest prevalence of alcohol intoxication by age was in men aged 25-34 years and those aged 35-44, who were 28% and 33%, respectively, more likely to be intoxicated at the time of their death than the reference group, men aged 18-24 – differences that were statistically significant. Men aged 55 and older were significantly less likely to be intoxicated than the reference group, and the prevalence of intoxication fell off markedly among men aged 65 and older. No subgroup of women by age showed a significantly increased rate of intoxication prevalence, but older women showed a significantly decreased prevalence.
The adjusted analyses also highlighted other subgroups with an especially high prevalence of intoxication at the time of their suicide. Decedents categorized as American Indian or Alaskan Native who were men had a significant 78% higher prevalence and women had a significant 99% higher prevalence, compared with white men and woman, the reference group.
When categorized by method of suicide, men who used firearms had a 76% increased prevalence and women who used firearms had a 68% increased prevalence compared with decedents who used poison, the reference group. Another method that linked with intoxication was hanging or suffocation, which was 38% higher in men and 48% higher in women, compared with the reference group. All these between-group differences were statistically significant.
Dr. Kaplan said that he had no relevant financial disclosures.