The association between alcohol use disorder and suicidal ideation in a New Zealand birth cohort

Abstract

Background: Alcohol use disorder is associated with increased suicide risk; however, both alcohol use disorder and suicide share risk factors which must be accounted for in order to understand this relationship. This study aimed to explore the longitudinal relationship between alcohol use disorder and suicidal ideation in adulthood, while accounting for both child background and adult covariate factors. Method: Data were collected from the Christchurch Health and Development Study, a birth cohort of 1265 children born in Christchurch (New Zealand) in mid-1977. Alcohol use disorder (operationalised as alcohol abuse and alcohol dependence) was quantified between age 18 and 40 in five data waves. The outcome measure suicidal ideation was reported over the same time periods. Childhood confounding variables were controlled for, as well as time-dynamic covariates collected in adulthood, including internalising disorders, distress due to relationship dissolutions and other substance use disorders. Results: The association between alcohol abuse and suicidal ideation was not statistically significant before or after adjusting for childhood confounding and adulthood covariate factors, when compared to no alcohol disorder. However, the association between alcohol dependence and suicidal ideation was significant both before and after adjustment (unadjusted odds ratio = 2.89, 95% confidence interval = [2.09, 3.99]; adjusted odds ratio = 1.52, 95% confidence interval = [1.04, 2.23]), when compared to no alcohol disorder. Furthermore, alcohol dependence remained significant when compared to alcohol abuse (unadjusted odds ratio = 2.33, 95% confidence interval = [1.61, 3.37]; adjusted odds ratio = 1.54, 95% confidence interval = [1.00, 2.37]). Conclusion: This analysis found an association between alcohol dependence and suicidal ideation within a New Zealand birth cohort, which persists even after adjustment for childhood confounding and adulthood covariate factors. Given the high rates of suicide and heavy drinking within the New Zealand population, any comprehensive national or regional suicide prevention plan should seek to reduce risky alcohol consumption at an individual and population level, as this represents a modifiable risk factor for suicide.

Alcohol milestones and internalizing, externalizing, and executive function: longitudinal and polygenic score associations

“…This pattern of results is consistent with recent analyses showing that AUD criteria mapping onto the Withdrawal/Negative Affect and Preoccupation/Anticipation stages are more frequently endorsed by those with severe AUD (Miller et al, 2023) and that anxiety and depression are linked with alcohol dependence symptoms more strongly than with initiation or quantity/frequency measures (Dick et al, 2014). Suicidal ideation has been cross-sectionally linked to more severe problematic alcohol use (Crossin et al, 2022), and suicide attempt has been longitudinally linked to future DSM-IV alcohol dependence in the COGA prospective cohort (Agrawal et al, 2017); present findings suggest that in a high-risk sample, suicidal ideation may escalate progression of AUD.…”

Psychological dimensions in alcohol use disorder: comparing active drinkers and abstinent patients

“…Finally, the higher levels of hopelessness reported by active-drinkersraise significant concerns about the mental health and well-being of those struggling with AUD. The association between AUD and suicide has been well-documented and demands immediate attention from mental health professionals to enact effective prevention strategies and targeted interventions ( 24 , 26 , 27 , 67 ). The correlation between alcohol use and suicidal ideation highlights the life-threatening consequences of AUD.…”

Proximity of alcohol outlets and presentation to hospital by young people after self-harm: A retrospective geospatial study using the integrated data infrastructure

“…While mental health difficulties make a large contribution to the risk of self-harm (Hawton et al, 2013;Witt et al, 2019), multiple interacting factors that accumulate over the lifetime have been shown to be associated with self-harm (Beautrais, 2000;Fliege et al, 2009;Mars et al, 2014a;Serafini et al, 2015). In NZ, as in other countries where Indigenous peoples are affected by the ongoing impacts of colonisation, there are disproportionately higher rates of self-harm among Māori, the Indigenous people of NZ (Crengle et al, 2013;Ministry of Health, 2018;Theodore et al, 2022) There is a well-established link between alcohol use, misuse, intoxication, and suicide (Crossin et al, 2022) and self-harm (Borges et al, 2017;Cherpitel et al, 2004;Haw et al, 2005;Melson and O'Connor, 2019;Rossow and Norström, 2014). A longitudinal study of a database of sentinel surveillance of self-harm in England showed that the role of alcohol use in self-harm appears to have increased over the last few decades (Ness et al, 2015).…”

“…There is a well-established link between alcohol use, misuse, intoxication, and suicide ( Crossin et al, 2022 ) and self-harm ( Borges et al, 2017 ; Cherpitel et al, 2004 ; Haw et al, 2005 ; Melson and O’Connor, 2019 ; Rossow and Norström, 2014 ). A longitudinal study of a database of sentinel surveillance of self-harm in England showed that the role of alcohol use in self-harm appears to have increased over the last few decades ( Ness et al, 2015 ).…”