S17 * ALCOHOL DEPENDENCE AND SUICIDAL BEHAVIOR - AN INTERNATIONAL PERSPECTIVE

Abstract

# S17.1 CO-MORBID ALCOHOL DEPENDENCE AND ANXIETY DISORDER INCREASE THE RISK OF SUICIDAL BEHAVIOR {#article-title-2} Background. Alcohol disorders, anxiety disorders and suicidal behavior are common, frequently co-occur and are found in most industrialized countries. Alcohol use problems are quite prevalent, with a point prevalence rate of ∼17% in the US general population. DSM-IV Anxiety disorders include panic disorder, agoraphobia, specific phobias, social phobia, post-traumatic stress disorder, obsessive – compulsive disorder, and generalized anxiety disorder. This family of anxiety disorders lifetime prevalence rates range from ∼9-14%. Suicidal behavior is also common among alcoholics with a lifetime rate of 40% for suicidal attempts. Methods. Data will be drawn from the Collaborative Study on the Genetics (COGA), a multisite extended family study of alcoholism being conducted in the US. COGA has collected information on more than 2255 families containing more than 17,682 individuals. Participants were individually interviewed using a lifetime structured psychiatric interview covering Axis I diagnoses and also included Antisocial Personality Disorder (ASPD). Results. Persons with an alcohol use disorder plus anxiety reported a higher prevalence of suicidal thoughts and attempts, an earlier use of tobacco and marijuana, and a slight increase in prevalence of depression and PTSD compared to nonalcoholic persons. Interestingly, nonalcoholic COGA subjects reported an earlier age of onset of suicide attempts, more PTSD symptoms an earlier onset of OCD and social phobia but a later onset of panic and agoraphobia than alcoholic subjects. Conclusions. As expected, both males and females with alcohol use disorders with comorbid anxiety and depression reported the highest rates of suicidal behavior and are at risk for severe alcoholism. # S17.2 HISTORY OF SUICIDE ATTEMPT AS A PROGNOSIC FACTOR FOR TREATMENT OUTCOME IN ALCOHOL-DEPENDENT INDIVIDUALS {#article-title-3} Suicidal behavior is a risk factor for a more severe course of alcohol dependence and a higher rate of psychopathology. Some, but not all research indicated that a history of suicide attempts is related to worse treatment outcome. The aim of this analysis of in- and outpatients in alcohol dependence rehabilitation in Germany is to determine if a history of suicide attempts is related to a higher rate of treatment noncompletion and relapse during a one-year follow-up period. Methods. A total of 92 individuals from an outpatient program and 303 individuals from two inpatient rehabilitation treatment units in three different locations in Germany were recruited and assessed with a structured interview and several measures of psychopathology (including suicidal behavior, personality disorders, anxiety, depression, and impulsivity) at treatment admission, with termination at 12 months follow-up. Participants were further subdivided into subjects with and without suicide attempt history and treatment completers and noncompleters for any reason. A total of 15.4% of inpatients and 17.4% of outpatients reported a lifetime history of suicide attempts. In treatment settings, both groups of subjects with suicide attempt history had a significantly higher rate of relapses during one-year follow-up after rehabilitation treatment. Rate of treatment discontinuation was significantly higher in inpatient subjects with suicide attempts. As with some but not all previous studies, suicide attempt history in alcohol-dependent subjects is significantly related to treatment continuation and outcome one year later and may serve as a marker for severity of alcohol dependence and unfavorable prognosis. # S17.3 HISTORY OF CHILD ABUSE AND SUICIDE ATTEMPTS IN ALCOHOL DEPENDENT PATIENTS {#article-title-4} Background. History of child abuse is considered as one of the important risk factors of a suicide attempt in general population. Also, it has been shown that suicide attempts appear significantly more frequent in alcoholics than in healthy individuals. The objective of our study was to investigate relationship between history of child abuse and suicide attempts in alcohol dependent patients. Material and methods. A sample of 364 alcohol dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information about demographics, psychopathological symptoms, history of suicide attempts and alcohol problems was collected. Stop signal task and Barratt Impulsiveness Scale (BIS) were performed to assess levels of impulsivity. Results. About 30% of women (about 10% of the whole study sample) experienced sexual abuse during the lifetime, and 20% - in childhood. In the group of patients with a history of suicide attempts, the experience of sexual abuse during childhood was significantly more frequent (p = 0.008). When entered into linear regression analysis with other dependent variables, history of child abuse remained a significant predictor of a suicide attempt (OR = 2.741; p = 0.015). In addition, patients with a history of suicide attempt were significantly more impulsive in stop signal task (p = 0,002) and in BIS (p = 0,000004) than subjects with no suicidal behavior. Moreover, we observed a significant association between history of sexual abuse before 18 years of age and suicide attempts (p = 0,009). Conclusions. Impulsivity may be treated as a link between child abuse and suicide attempt in alcohol dependent patients. # S17.4 SUICIDAL IDEATION AND BEHAVIOR IN JAPANESE PATIENTS WITH ALCOHOL DEPENDENCE {#article-title-5} Background. Suicide is a global public health problem, particularly in Asia where it accounts for 60% of suicides worldwide. Both acute and chronic alcohol use are well known to be associated with suicidal behavior. However, little is known about the risk factors of suicidal behavior in patients with alcohol dependence (AD) in Japan. Since elucidating the risk factors of suicidal behavior in AD patients should facilitate preventive measures, we examined the association between various clinical factors and suicidal behavior in Japanese AD patients using data from the Japan Collaborative Clinical Study on Alcohol Dependence (JCSA). Methods. The subjects were 853 Japanese patients with AD who were consecutively hospitalized in 54 hospitals participating in the JCSA. The clinical symptoms, including the addiction severity index (ASI), of each patient were assessed and the 6-month outcomes after hospital discharge were obtained by monitoring each patient. Results. Approximately 16% of the AD patients reported lifetime suicidal ideation and 9% reported an attempted suicide. A female gender, younger age, depression, other substance abuse, marital status, violent behavior when intoxicated, and unemployment were associated with a history of suicidal ideation. Female gender, depression, anxiety, violent behavior when intoxicated, other substance abuse, and unemployment were associated with suicidal attempts. Overall, 9% of male and 13% of female AD patients experienced depressive episodes after hospital discharge, and depressive episodes after discharge, but not before discharge, were associated with lower abstinence rates. Conclusions. These findings should contribute to the development of preventive measures against suicidal behavior in AD patients.