Alcohol misuse and alcohol consumption are significant risk factors for suicidal behaviour. Persons diagnosed with alcohol use disorder have been shown to be at increased risk of suicide in a meta-analysis of cohort studies,1 and the lifetime risk of suicide among those with alcohol use disorder has been estimated at 7%.2 In addition, subjects admitted with alcohol use disorder are more likely to present with self-harm during a 12-month follow-up period.3 However, although numerous studies have demonstrated an association between alcohol consumption and suicidal behaviour, very little attention has been paid to the factors associated with alcohol involvement in suicide and self-harm. A recent study conducted in Ireland sought to identify factors associated with alcohol consumption in cases of suicide and non-fatal self-harm presentations.4

In this research, published in the journal Crisis, suicide cases in Cork, from September 2008 to June 2012, were identified through the Suicide Support and Information System. Emergency department presentations of self-harm for the years 2007–2013 were obtained from the National Self-Harm Registry Ireland. Logistic regression analysis was used to estimate independent variable associations with alcohol use prior to or during a suicide or self-harm act.

Key findings included the following:

• Alcohol consumption was detected in the toxicology of 44% of 307 suicide cases.
• Only younger age was significantly associated with having consumed alcohol among suicides.
• Alcohol consumption was noted in 21% of 8,145 self-harm presentations.
• Variables associated with having consumed alcohol in a self-harm presentation included male gender, older age, overdose as a method, not being admitted to a psychiatric ward, and presenting out-of-hours.

The study authors concluded that public health measures to restrict access to alcohol may be used to enhance suicide prevention, as population-based studies show reduced suicide rates following measures to restrict access to alcohol.5 In addition, as it was found that alcohol involvement was associated with different characteristics in self-harm presentations, but not in suicide cases, this may require a tailored clinical approach to minimise risk of further non-fatal or fatal self-harm.

1    Wilcox HC, Conner KR and Caine ED (2004) Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug and Alcohol Dependence, 76 (Suppl): S11–S19.

2    Inskip HM, Harris EC and Barraclough B (1998) Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. British Journal of Psychiatry, 172: 35–37.

3    Singhal A, Ross J, Seminog O, Hawton K and Goldacre MJ (2014) Risk of self-harm and suicide in people with specific psychiatric and physical disorders: comparisons between disorders using English national record linkage. Journal of the Royal Society of Medicine, 107(5): 194–204.

4    Larkin C, Griffin E, Corcoran P, McAuliffe C, Perry IJ and Arensman E (2017) Alcohol involvement in suicide and self-harm: findings from two innovative surveillance systems. Crisis, 38: 413–22. https://www.drugsandalcohol.ie/28375/

5    Värnik A, Kõlves K, Väli M, Tooding L and Wasserman D (2007) Do alcohol restrictions reduce suicide mortality? Addiction, 102(6): 251–56.