Impact of comorbid affective and alcohol use disorders on suicidal ideation and attempts

Abstract

The effect of concurrent affective and alcohol use disorders on suicidal ideation and behavior was investigated. The Diagnostic Interview Schedule Version III-R (DIS) was administered to 307 adult veteran men ranging in age from 23 to 78. Participants were classified into one of four groups based on their final DIS diagnosis-lifetime unipolar depression and lifetime bipolar I disorder with or without a lifetime alcohol use disorder. Logistic regression analyses indicated that veterans with a major affective disorder were at greater risk for suicidality than veterans without an affective disorder. However, veterans with unipolar depression were at no greater risk for suicidality than those with bipolar I disorder. Unipolar and bipolar I disorders with a concurrent alcohol use disorder were always associated with an increased risk for suicidality.

Coincident alcohol dependence and depression increases risk of suicidal ideation among Army National Guard soldiers

“…Indeed, Kessler and colleagues [15] found that both alcohol dependence and depression were independently associated with suicidal ideation and suicide attempts in cross-sectional data from a representative sample of the general US population. Finally, our findings of positive additive interaction between alcohol dependence and depression in suicidal ideation risk are consistent with civilian studies [27,16] demonstrating an increased risk of suicidal ideation and behavior for those with both conditions. The RERI (part of the total effect due to interaction) of 5.978 confirms positive additive interaction as the point estimate and its confidence intervals exceed 0; the AP of 0.461 tells us that almost 50% of the risk of suicidal ideation among those with both conditions is attributable to the synergy between those conditions; the S (ratio of combined and individual effects) of 1.998 confirms positive additive interaction, as this point estimate and its confidence intervals exceed 1 [45,46].…”

“…Depression is perhaps the most common and well-recognized predictor of suicidality both in civilian [14–16] and in military populations [12,17,5,18]. Depression is relatively common among OEF/OIF/OND service members and veterans, with prevalence estimates for National Guard and reserves forces ranging from 2.7% to 14.7% [19].…”

“…Evidence from civilian studies [27,16] suggests that comorbid alcohol dependence and depression are associated with a severity of suicidality greater than that for either condition alone. These civilian findings, along with the relatively common occurrence and comorbidity of both conditions among military service members [28,29], provide strong warrants for investigating their synergy in predicting suicidal ideation among service members.…”

Increased Risk for Suicidal Behavior in Comorbid Bipolar Disorder and Alcohol Use Disorders

“…Studies examining the co-occurrence of BD and AUD with respect to risk for suicidal acts in clinical samples report increased probability of suicidal behavior in BD individuals with comorbid lifetime AUD compared to BD individuals with no AUD comorbidity15–18. From a different vantage, BD suicide attempters are reported to be more likely to meet criteria for comorbid AUD (ORs = 2.44 – 3.25) compared to BD non-attempters19,20.…”

Late-life depression and alcoholism

“…Waller et al [47] found that mixed-age veterans with unipolar or bipolar affective disorders and a concurrent alcohol use disorder consistently had increased suicidality risk. Examining mixed-age depressed alcoholics distinguished from patients with either major depression or alcohol dependence alone, Cornelius et al [48] found depressed alcoholics "suffer an additive or synergistic effect of two separate disorders, resulting in a disproportionately high level of acute suicidality upon initial psychiatric evaluation.…”