Mês: outubro 2021

In almost all industrialized countries, the highest suicide rate is found among men aged 75 years and older 207. Whereas suicidal behavior in youngsters is often impulsive and communicative, in older people it is often long-planned and involves highly lethal methods. Its lethality increases also as a result of the structural frailty and loneliness that are often present in the elderly. Psychiatric disorders, especially depression, are common in suicides in Western 208, as well as in Eastern countries 209. Depression on the other hand, is frequently comorbid with alcohol abuse/dependence in the aged 210–212. The association between OUD and increased suicide risk may be attributed to several factors.

The CDC reports that more than half of U.S. adults drink alcohol, 17% binge drink, and 6% drink heavily. The conclusion that alcohol consumption carries significant health risks is backed by systematic reviews as well as meta-analyses focused on the association between alcohol consumption and the risk of death from any cause. Reduced serotonergic functioning, implicated in the pathophysiology of depression and suicidality 62, 63, may also play a role in OUD 231. Serotonin availability at postsynaptic 5-HT1 A receptors modulates pain levels by inhibiting firing of sensory neurons. Opioid drugs enhance this effect by overriding GABA-mediated inhibitory control of serotonergic neurons, causing increased serotonin release that contributes to the drug’s analgesic effects.

Survivor reactions to suicide are strongly influenced by the nature of the relationship between survivors and the suicide. Bereavement counsellors should be alert for complex grief and mourning responses among this group of suicide survivors. Research on na vs aa the link between alcohol and substances in suicide has been driven by the prevalent involvement of alcohol and substance abuse in suicide cases.

Treatment Interventions for Co-occurring Suicidality and OUD

About 40% of all patients seeking treatment for alcohol dependence report at least one suicide attempt at some point in their lives 64–66. Impulsive suicide attempts are common in patients with an alcohol use disorder 67,68. However, whether a history of suicide attempts is related to the risk for relapse in alcohol-dependent patients is still a matter of debate. In 2016 alone, 11.8 million people misused opioids and 42,000 died by opioid-overdose 139. Recent research suggests that a suicidal element may play a significant role in opioid overdose deaths 140, 141. People who use opioids are 14 times more likely to die by suicide compared to the general population 10, 142, perhaps the highest odds of all substances.

People with psychiatric disorders, alcohol and/or drug abuse, newly diagnosed severe physical illness, past suicide attempts, homelessness, institutionalization, and other types of social exclusion are the object of selective interventions. Additionally, suicide decedents with AUD tended to drink chronically until their deaths and had a recent alcohol binge in close proximity to, or as part of, a suicide attempt 104. Alcohol and opioid use disorders (AUD/OUD) significantly increase risk for suicidal ideation, attempts, and death, and are the two most frequently implicated substances in suicide risk. We provide a brief overview of shared risk factors and pathways in the pathogenesis of AUD/OUD and suicidal thoughts and behaviors. We also review clinical recommendations on inpatient care, pharmacotherapy, and psychotherapeutic interventions for people with AUD/OUD and co-occurring suicidal ideation and behavior.

Criteria for including studies

1. Several case-control studies at the individual level have shown a high prevalence of alcohol abuse and dependence among suicide victims 89,90.
2. People with problematic alcohol use are also a vulnerable population and we owe them a special duty of care; that should also inform public policies.
3. This group difference disappeared after fenfluramine administration which suggests that serotonergic mechanisms play a role in the observed differences between the groups.
4. The high rate of suicide among adolescents and young adults is a challenge for prevention.
5. However, 5-HT3 receptors were not found to be altered postmortem in suicides 147.

Their anger is directed to the lost person significantly more than that of spouses whose suicidal partner had no alcohol problems 225. Alcoholism in any close relationship causes tension and conflicts and complicates bereavement. Regarding other receptors involved in the action of ethanol, genetic polymorphisms have been found in suicidal persons for both the CRF1 165 and CRF2 receptors 166, but the latter is not apparently involved in the action of ethanol 127. However, mRNA for CRF1, but not CRF2 receptors, were found to be reduced in the frontal cortex of suicides, along with mRNA for the alpha1, alpha3, alpha4, and delta receptor subunits of the GABAA-benzodiazepine receptor cortex 167. It has to be mentioned, however, that CRF receptor numbers and affinity have been reported to be either reduced 168 or unchanged by different groups of investigators 169.

Study sample

Higher suicidality in depressed patients with alcohol dependence compared to depressed persons without comorbid alcohol dependence may also be related to the differences in dopaminergic regulation between the two groups. It has been observed that depressed subjects with a history of alcohol dependence had lower CSF HVA levels, compared with depressed subjects without a history of alcoholism 159. Clinical recommendations suggest inpatient care for individuals with alcohol misuse who present with suicidal plans or intent, preferably in a dual-diagnosis facility (i.e., treatment setting for AUD/SUD and comorbid mental illness) 104, 105. Evidence suggests that suicidal individuals with comorbid AUD significantly benefit from inpatient treatment relative to outpatient settings 106.

3. Suicidal Behavior and Alcohol Abuse in Affective Bonds and Social Relationships

In fact, for every death due to war, there are three deaths due to homicide and five deaths due to suicide 5. It is estimated that about one million people die annually from suicide, i.e., a global mortality rate of 16 per 100,000, or one death every 40 seconds 2. This section collects any data citations, data availability statements, or supplementary materials included in this article. This study is funded by the National Institute for Health Research (NIHR) School for Public Health Research (grant reference number PD-SPH-2015), of which all the authors are members. The authors are supported as described here but have not provided grant codes as these other funds did not directly contribute to this research. Are supported by the NIHR Biomedical Research Centre at University College London Hospitals.

However, there is insufficient evidence in regard to the dose-response relationship between alcohol drinking and risk of suicide. Further investigation based on observational studies are needed to expect the dose-response pattern of alcohol-related suicide. Suicide is one of the top 20 leading causes of death in the world for all ages 1, the third leading cause of death among people aged 15–44 years, and the second leading cause of death among people aged 10–24 years 2. These numbers underestimate the problem and do not include suicide attempts which are up to 20 times more frequent than completed suicide 2.