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Acute alcohol use is an important risk factor for attempted and completed suicide. We evaluated the effect of acute alcohol intake on the lethality of suicide attempts to test the hypothesis that acute alcohol intoxication is associated with more lethal suicide attempts. This retrospective study included 317 suicide attempters enrolled in mood disorders protocols. Demographic and clinical parameters were assessed. The use of alcohol at the time of the most lethal suicide attempt was determined. On the basis of their responses participants were classified into three groups: participants who reported "Enough alcohol intake to impair judgment, reality testing and diminish responsibility" or "Intentional intake of alcohol in order to facilitate implementation of attempt" were included in the group "Alcohol" (A); participants who reported "Some alcohol intake prior to but not related to attempt, reportedly not enough to impair judgment, reality testing" were included in the group "Some Alcohol" (SA); and participants who reported "No alcohol intake immediately prior to attempt" were included in the group "No Alcohol" (NA). Lethality of the most lethal suicide attempts was higher in the A group compared to the SA and NA groups. Prevalence of patients with alcohol use disorders was higher in the A group compared to the SA and NA groups. SA participants reported more reasons for living and lower suicide intent scores at the time of their most lethal suicide attempt compared to the A and NA groups. Acute alcohol use increases the lethality of suicide attempts in individuals with mood disorders.

Background: We aimed to examine the adequacy of antidepressant treatment and compliance with treatment in bipolar patients with and without alcohol use disorders (AUD). We hypothesize that the adequacy of antidepressant treatment and the compliance with treatment for those with AUD are lower than for those without AUD., Methods: Subjects were 97 patients with current bipolar major depressive episode, 39 (40.2%) with lifetime history of AUD and 58 (59.8%) without AUD. Adequacy of antidepressant medication treatment in the 3 previous months was assessed using the Antidepressant Treatment History Form. Compliance rates were estimated., Results: Rates of inadequate treatment were high in all patients. Bipolar patients with AUD (74.3%) showed higher rates of inadequate antidepressant treatment than those without AUD (67.3%). The proportion of intensive treatment was higher in bipolars without AUD (15.5%) than in those with AUD (2.6%). Median compliance was similar in bipolars with and without AUD., Limitations: We lack serum medication levels to assess the compliance. We do not have data to address the possibility that the presence of AUD adversely affected prescribing practices., Conclusions: Bipolars with AUD had lower rates of adequate treatment than those without AUD, but the two groups were not different in terms of self-reported treatment adherence. The finding that bipolar patients with or without comorbid AUD did not receive adequate treatment is of considerable clinical relevance. It raises the question as to whether inadequate treatment of depression contributes to the high rates of morbidity, and attempted and completed suicides in bipolar patient populations.

Objective: Alcohol use and depressive disorders are frequently comorbid. Few studies have assessed the impact of comorbid alcohol use disorders (AUDs) on clinical aspects of major depression. We compared depressed subjects with and without co-occurring AUDs with respect to demographic and clinical parameters., Method: 505 individuals participated. 318 subjects had DSM-IV major depressive disorder (MDD) without a history of any alcohol or substance abuse/dependence (MDD only), and 187 individuals had MDD and a history of alcohol abuse/dependence (MDD/AUD). Demographic, clinical, and psychiatric history measures of patients in the 2 groups were examined and compared. The study was conducted from January 1990 to June 2005., Results: MDD/AUD patients were younger at their first psychiatric hospitalization (p = .014), their first major depressive episode (p = .041), and their first suicide attempt (p = .001). They reported more previous major depressive episodes (p = .001), suicide attempts (p = .001), and recent life events (p = .001); and had higher lifetime aggression (p < .001), impulsivity (p < .001), and hostility (p < .001) scores. MDD/AUD patients were also more likely to report tobacco smoking (p < .001), a lifetime history of abuse (p = .004), and a history of AUD among first-degree relatives (p < .001) compared to MDD only patients. MDD/AUD individuals also had higher childhood (p < .001), adolescent (p < .001), and adult (p < .001) aggression scores and reported more behavioral problems during their childhood compared to their counterparts. Logistic regression analysis demonstrates that the number of previous depressive episodes, lifetime aggression, and smoking drive the difference between the groups., Conclusions: Our findings suggest that comorbid MDD/AUD may result from worse antecedents and lead to early onset, more comorbidity, and a more severe course of illness.

Unlabelled: Adolescent suicide is a major social and medical problem. Alcohol use disorders with comorbid major depression represent an especially high-risk profile for suicidal behavior, repeated suicidal behavior and completed suicide. We compared demographic and clinical characteristics, prevalence of interpersonal triggers and the number of triggers for suicidal behavior in depressed late adolescents and young adults with or without comorbid alcohol use disorders., Methods: 18-26-year-old subjects were recruited through advertising and referrals and participated in mood disorders research in a university hospital. Thirty-eight depressed suicide attempters without a history of any alcohol or substance abuse/dependence and 29 depressed suicide attempters with comorbid alcohol abuse or dependence participated in the study. Demographic and clinical parameters including parameters related to suicidal behavior were examined and recorded., Results: There was no difference with regard to demographic parameters between the two groups. Depressed suicide attempters with comorbid alcohol use disorders had higher aggression and impulsivity scale scores and were more likely to be tobacco smokers compared to their counterparts without alcohol use disorders. Additionally, there was a trend towards higher lethality of suicide attempts in subjects with alcohol use disorders compared to the other group. We found no difference in the prevalence of interpersonal triggers or in the number of triggers for suicidal behavior between the two groups., Conclusion: It appears that among 18-26-year-old depressed suicide attempters, individuals with comorbid alcohol use disorders are more impaired with regard to aggressiveness and impulsivity compared to persons without comorbid alcohol abuse/dependence.

Adolescent suicide is the 3rd leading cause of death in the United States and alcohol consumption is estimated to cause adolescent males to be up to 17 times more likely to attempt suicide, and females three times more likely to attempt suicide. Suicide and suicide attempt rates vary across different ethnicities. Also, associated psychopathology, stressors and substance use differ across ethnic groups in adolescents. In an exhaustive review of the literature, we found that depressed Asian-American youth were four times more likely to display suicidal behavior when compared to other Asian youths with other diagnoses; and depressed African-American females were more likely to report suicidal ideation than male adolescents. We also found that Asian-Americans who experience high parental conflict are 30 times more likely to engage in suicidal behavior when compared to Asian-American youths with low parental conflict. African-American adolescents are 6.4 times more likely to attempt suicide as a result of parental conflict. With respect to alcohol use and dependence, Caucasian adolescents were twice as likely as the African American victims to have used alcohol before committing suicide. Alcohol use among adolescents was associated with increased suicidal behavior. Cultural differences in alcohol consumption may account for disparities, however future research is needed to further examine cultural trends in suicidal behavior and alcoholism.