Acute alcohol intoxication increases risk of suicide in American Indians

American Indians are at much greater risk of suicide after acute alcohol intoxication, according to a study led by researchers at The University of Texas Health Science Center at Houston (UTHealth).

The study examined the prevalence and social demographic correlates of suicide involving acute alcohol intoxication among United States ethnic minorities. Results will be published in the May 2013 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

"Some reviews suggest that people with alcohol use disorders are nine times more likely to die by suicide than the general population," said Raul Caetano, M.D., Ph.D., M.P.H., the study's corresponding author and regional dean of The University of Texas School of Public Health Dallas Regional Campus, part of UTHealth. "Our paper looks at the issue more specifically, examining suicide and acute intoxication among U.S. ethnic minorities. It is not the first study to do so, but few among them have used such large data set as the National Violent Death Reporting System (NVDRS)."

Suicide is the 10th leading overall cause of death in the United States in 2009, according to the Centers for Disease Control and Prevention. Prior research has also shown that alcohol use disorders confer increased risk for suicide.

"Other studies have found that large numbers of people who have recently committed suicide, or attempted to commit suicide, have alcohol in their blood," added Sarah Zemore, Ph.D., a scientist at the Alcohol Research Group and an associate adjunct professor at the University of California, Berkeley. "There is also reason to believe that binging on alcohol is a risk for suicide attempt regardless of whether the person is dependent on alcohol. Yet research has not fully answered the question of why alcohol misuse increases the likelihood of a suicide attempt, whether due to major depression, increases in impulsivity or poorer life conditions common among alcohol-dependent people."

Caetano and his colleagues used data derived from the 2003-2009 NVDRS, analyzing sociodemographic and toxicological information for 59,384 suicide decedents from 16 states. Acute alcohol intoxication at the time of death was defined as having a blood alcohol content (BAC) equal to or greater than 0.08.

"We showed considerable differences across ethnic groups in the association between alcohol intoxication and suicide and types of suicide," said Caetano, professor of epidemiology at the UT School of Public Health. "Although alcohol intoxication is important for all groups, American Indians are much more at risk than other groups."

Zemore added, "This study is consistent with the larger literature suggesting that more than a third of those committing suicide use alcohol prior to the event. The study also extends the literature by showing that alcohol use and intoxication prior to suicide is particularly prevalent among American Indian and Alaskan Native populations and, to some extent, Latinos, compared to Whites, but less prevalent among Blacks and Asians. Finally, this article highlights the fact that suicide is a particular problem among young American Indian and Alaskan Native people. In this sample, 22 percent of those completing suicide were under 21, and half were under 29."

The authors suggest that alcohol-related prevention strategies focus on suicide as a consequence of alcohol use, especially among American Indian and Alaskan Native youth and young adults.

"These associations indicate that heavier drinkers are more at risk and should be targeted for prevention efforts," said Caetano. "Alcohol treatment facilities should focus on suicide, and be aware of the potential risk that their clients have in regard to suicide. Clinicians working with heavier drinkers, especially those who are depressed, should be aware of the increased risk that these patients have."

"Suicidal threats or insinuations by individuals who misuse alcohol should be taken particularly seriously," said Zemore. "Family and friends play an important role here, as people intending to commit suicide often fail to seek formal help—though they do often inform their social circle in some manner. Findings also suggest a need for emergency room departments and health care providers to more broadly screen for suicidal ideation among alcohol-dependent individuals."