Objective: Alcohol intoxication and dependence are risk factors for suicide, a leading cause of death in the United States. We examined the hours of peak and nadir in completed suicides over a 24-hour period among intoxicated, alcohol-dependent individuals. We also evaluated suiciderelated factors associated with intoxication at different times of the day. Methods: We analyzed cross-sectional data from the 2003- 2010 National Violent Death Reporting System provided by 16 US states. In the primary database, the deceased individuals' alcohol-dependent status was classified as "yes" or "no or unknown." We restricted the analysis to alcohol-dependent individuals with alcohol level data available (N = 3,661). The primary outcome measure was the reported time of death. Secondary outcome measures were predisposing and injury-related factors. Individuals were classified on the basis of their blood alcohol level (BAL) as heavy drinking (BAL H [≥ 80 mg/dL]) or non-heavy drinking (BAL O [< 80 mg/dL]). The time of injury was divided into 1-hour bins, which were used to compute the incidence of suicide over 24 hours. We also evaluated the association between clinical factors and BAL H for each of six 4-hour time periods beginning at 00:01 hours. Results: The majority (73.4%) of individuals showed evidence of alcohol consumption prior to committing suicide. BAL H was observed in 60.7% of all individuals. Peak incidences in suicide were identified at 21:00 for BAL H and 12:00 for BAL O , with nadirs at 05:00 and 03:00 hours, respectively. In a multivariable analysis, between 20:01 and 00:00 hours, BALH was associated with more risk and protective factors than BAL O . Conclusions: Identifying critical times and associated risk factors for suicidal behavior may contribute to suicide prevention efforts in intoxicated alcohol-dependent individuals.
|Journal||Journal of Clinical Psychiatry|
|State||Published - Nov 1 2018|
Bibliographical noteFunding Information:
The study was not supported by any independent grant funding. Partial salary support was provided by the following grants: Department of Veterans Affairs grant IK2CX000855 (Dr Chakravorty), National Institutes of Health (NIH) grants K23 HL110216 and NIH R21 ES022931 (Dr Grandner); R01 AG041783 (Dr Perlis) and R56 AG050620 (Dr Perlis); R01 AA023192 (Dr Kranzler) and R01 AA021164 (Dr Kranzler).
Submitted: July 9, 2017; accepted April 24, 2018. Published online: October 23, 2018. Potential conflicts of interest: Dr Chakravorty has received research support from AstraZeneca and Teva. Dr Perlis has received research support from Nexalin Technology and Teva. Dr Grandner has received research support from Nexalin technology and Kemin Industries and serves as a consultant for Fitbit, Curaegis Technologies, and Natrol. Dr Kranzler has served as a consultant, advisory board member, or continuing medical education speaker for Alkermes, Indivior, and Lundbeck and is also a member of the American Society of Clinical Psychopharmacology Clinical Trials Initiative (ACTIVE) group, which was supported in the last 3 years by AbbVie, Alkermes, Amygdala Neurosciences, Arbor, Ethypharm, Indivior, Lilly, Lundbeck, Otsuka, and Pfizer. Dr Smith certifies that she has no actual or potential conflict of interest with this investigation. Funding/support: The study was not supported by any independent grant funding. Partial salary support was provided by the following grants: Department of Veterans Affairs grant IK2CX000855 (Dr Chakravorty), National Institutes of Health (NIH) grants K23 HL110216 and NIH R21 ES022931 (Dr Grandner); R01 AG041783 (Dr Perlis) and R56 AG050620 (Dr Perlis); R01 AA023192 (Dr Kranzler) and R01 AA021164 (Dr Kranzler). Role of sponsor: None. Disclaimer: The content of this publication does not represent the views of the University of Pennsylvania, Department of Veterans Affairs, the United States Government, or any other institution. Previous presentation: Some of the results from this study were presented at the SLEEP 2016 annual meeting; June 11–15, 2016; in Denver, Colorado. Acknowledgments: The authors thank the Centers for Disease Control and Prevention, Atlanta, Georgia, for providing access to the NVDRS dataset. They also express gratitude to the following individuals who helped with the data analysis and provided intellectual assistance with the draft: Ninad Chaudhary, MBBS, MPH, University of Alabama at Birmingham; and Kachina Allen, PhD, Princeton University. Neither Dr Chaudhary nor Dr Allen has any conflict of interest to report with the manuscript draft.
© Copyright 2018 Physicians Postgraduate Press, Inc.
ASJC Scopus subject areas
- Psychiatry and Mental health