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Multiple Risk Factors Predict Suicide in Alcoholism

George E. Murphy, MD; Richard D. Wetzel, PhD; Eli Robins, MD; Larry McEvoy, MA
Arch Gen Psychiatry. 1992;49(6):459-463. doi:10.1001/archpsyc.1992.01820060039006.
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• From a study of the lives of 50 alcoholics who committed suicide, seven nonacute clinical/historical features were identified post hoc that appear to be intimately linked to suicide. They included continued drinking, major depressive episode, suicidal communication, poor social support, serious medical illness, unemployment, and living alone. This study examined whether these features are common to alcoholics generally and/or to nonalcoholics who commit suicide or if they may be specifically predictive of suicide in alcoholics. The frequencies of these factors were compared with those in an earlier sample of 32 alcoholics who committed suicide, then with data from two St Louis studies of living alcoholics and a cohort of individuals with major depressive disorder who committed suicide. The frequency of the identified items was replicated among the 32 alcoholics in a larger community sample of individuals who committed suicide. The white men from those two samples of alcoholics who committed suicide were then combined for the advantage of sample size. Six of the seven factors could be compared with a population survey sample of 106 living alcoholics and five with a clinically identified sample of 142 living alcoholics. All compared factors were significantly more frequent among those who committed suicide than among controls. Any four of the six factors identified 46 (69%) of the 67 individuals who committed suicide with few false-positive results among the controls. Regarding all seven of the identified factors, 54 (81%) of the 67 men and 64 (83%) of the entire sample of 82 individuals who committed suicide had four or more risk factors. Alcoholic women and blacks showed the same pattern as white men. Major depression, found comorbidly in 58% of the alcoholics who committed suicide, did not account for the accumulation of other risk factors. Their distribution and frequency were significantly different from those of individuals with uncomplicated major depression who committed suicide. Seven subacute and chronic factors had a cumulative effect in identifying an increasing risk of suicide in alcoholics. Alcoholics can thus be easily monitored for increasing risk. Treatment of the accompanying depression will reduce the risk of suicide. Securing abstinence remains the goal of alcoholism treatment.

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