1. Copyright Alcohol Medical Scholars Program1 Suicide Attempts in Alcoholics Ulrich W. Preuss University of Munich, University of California, San Diego July 2001

2. Copyright Alcohol Medical Scholars Program2 Epidemiology: 7-15% of alcohol-dependent individuals complete suicide 25% of completed suicides are carried out by alcoholics There is a significant relationship between completed and attempted suicide

3. Copyright Alcohol Medical Scholars Program3 General Risk Factors for Suicide Attempts: Diagnoses: - Mood disorders - Substance use disorders - Personality disorders, esp. antisocial personality disorder Demographics: - Female gender - Separated or divorced - Being unemployed - Fewer years of education

4. Copyright Alcohol Medical Scholars Program4 Risk Factors for Suicide Attempts among Alcoholics: Family history of alcoholism Early onset of drinking and alcohol dependence Higher alcohol intake Being treated for alcoholism

5. Copyright Alcohol Medical Scholars Program5 Problems with Existing Research Imprecise definition Small study samples No differentiation between independent and induced disorders

6. Copyright Alcohol Medical Scholars Program6 Identify and confirm risk factors for suicide attempts in alcohol dependent individuals Test predictors in a multivariate design Compare suicide attempts in relatives of alcoholics with and without a history of suicide attempts Aims of this Analysis:

7. Copyright Alcohol Medical Scholars Program7 Be:Have more: - Female- Severe alcoholism - Younger - Substance use disorders - Unemployed - Psychiatric comorbidity - Separated or divorced - Suicide attempts and - Less educated psychiatric comorbidity in relatives We hypothesize that Alcoholics with Suicide Attempts will:

8. Copyright Alcohol Medical Scholars Program8 Methods The COGA sample: - 3,190 alcohol-dependent individuals - Probands, controls and relatives - SSAGA interviews covered: Suicidal behavior Socioeconomic characteristics Psychiatric comorbidity Substance use disorders Characteristics of alcohol dependence - Univariate and multivariate statistics were used to test hypotheses

9. Copyright Alcohol Medical Scholars Program9 Sample: Subjects in each group: Group 1: alcohol dependent individuals with a suicide attempt history (n = 522) Group 2: alcohol-dependent individuals without suicide attempts (n = 2668)

10. Copyright Alcohol Medical Scholars Program10 Sociodemography: Group 1 Group 2 Age (years)36.8±10.639.1±12.5 *** Education (years)12.1±2.112.8±2.3*** % % Female gender 59.6 34.6*** Employed full time 49.8 61.5*** Separated or divorced 34.9 24.5 *** ***: p < 0.001

11. Copyright Alcohol Medical Scholars Program11 Alcohol dependence: Group 1 Group 2 Age at onset of alcohol dependence 22.1±7.7 24.0±8.5*** Number of DSM-IIIR criteria endorsed6.9±2.1 5.8±2.1 *** Number or alcohol- related violence 2.7±1.5 2.1±1.5*** Number of alc.-rel. physical problems 0.5±0.8 0.3±0.6*** ***: p < 0.001

12. Copyright Alcohol Medical Scholars Program12 Comorbidity: Group 1 Group 2 Number of illicit sub- stances dependent on 1.2±1.30.8±1.1*** % % Independent depression 27.813.0*** Induced depression 43.325.3*** Independent panic disorder 8.8 3.6*** Induced panic disorder 1.9 0.6** **: p < 0.01; ***: p < 0.001

13. Copyright Alcohol Medical Scholars Program13 Family History of Suicide Attempts : Relatives of Group 1 %Group 2 % % % Any Relatives 11.9 7.7*** Mothers n = 5322.0 1.1 Fathers n = 8530.6 0.1*** Siblings n = 7597.8 5.0*** Offspringn = 26701.5 1.4 ***: p < 0.001

14. Copyright Alcohol Medical Scholars Program14 Logistic Regression Predicting Suicide Attempts: *: p < 0.05; **: p < 0.01; ***: p < 0.001 Item in the equation OR Female 2.86 *** Younger age 0.99 ** Being unemployed 1.34 * Separated/divorced 1.26 * Induced depression 3.39 *** Independent depression 2.30 *** # DSMIIIR alcohol-dependence criteria 1.12 * # alc.-rel. physical problems 1.38 * # alc.-rel. violence 1.18 *** # illicit substances dependent on 1.09 * Not in the equation: age of onset of alcoholism, being married

15. Copyright Alcohol Medical Scholars Program15 Conclusion More severely impaired due to psychiatric comor- bidity, other substance use disorders and alcohol- dependence characteristics Have a stronger family history of suicide attempts in first degree relatives In treatment: screen and treat psychiatric comorbidity and family history to prevent suicide attempts and subsequent completed suicide Alcoholics with a history of suicide attempts are: