There is an association between alcohol use disorder (AUD) and suicide mortality across sexes, according to a recent study published in JAMA Network Open.
Takeaways
- The study establishes an association between alcohol use disorder (AUD) and suicide mortality across both sexes, emphasizing the importance of understanding this link for effective suicide prevention strategies.
- While previous research hinted at an increased suicide mortality risk among individuals with AUD, this study delves deeper into sex-specific differences. Female individuals with AUD appear to have a non-significantly higher risk compared to their male counterparts.
- The study employed a systematic review and meta-analysis approach, indicating a rigorous methodology. This involved screening numerous studies and considering various potential sources of bias, enhancing the reliability of the findings.
- The analysis revealed differences in the association between AUD and suicide mortality based on study design. Longitudinal studies showed a more modest association compared to cross-sectional studies, highlighting the importance of study design in understanding complex associations.
- Given the identified association between AUD and suicide mortality, the study underscores the importance of integrating AUD treatment into suicide prevention strategies.
The World Health Organization reported over 700,000 suicide mortalities worldwide in 2019, indicating a rate of 9 per 100,000 people. Suicide is an indicator for mental health disorders in the Sustainable Development Goals, making it vital to understand its link to specific psychiatric conditions such as AUD.
In 2015, a study found a 2.6-fold increase in suicide mortality risk among patients with AUD vs those without AUD. Additionally, data has indicated this association may be stronger among female individuals. However, most available data on the association has ignored sex-related differences.
To determine sex-specific suicide mortality risks among patients with AUD, investigators conducted a systematic review. Literature was found through systematic searches of the MEDLINE, Embase, Pubmed, PsycINFO, and Web of Science databases from inception to April 27, 2022. Keywords were related to alcohol use and suicide.
Titles and abstracts were screened by 2 independent reviewers, with discrepancies solved by discussion until high agreement was reached. Afterward, a single reviewer screened the remaining titles and abstracts.
This process was repeated during full-text screening. A third party was consulted if a disagreement could not be reached. Original, quantitative studies including a measure of association and corresponding measure of variability that stratified results based on sex were eligible for the analysis.
Alcohol abuse and dependence were determined using Diagnostic and Statistical Manual of Mental Disorders Third and Fourth Editions. Harmful alcohol use and alcohol dependence syndrome were determined using International Classification of Diseases, Ninth Revision (ICD-9) codes, and suicide by ICD-9, ICD-10, or ICD-11 codes.
There were 37,870,699 participants across 24 studies included in the analysis, aged between 15 and 65 years. Of studies, 11 were cohort studies, 4 were longitudinal case-control studies, 8 were cross-sectional case-control studies, and 1 was a cross-sectional prevalence study.
Participants were limited to adolescents and young adults in 4 studies, middle-aged adults in 2 studies, and older adults in 1 study. The remaining studies included patients from 2 or 3 of these groups. Potential cofounding was considered a potential source of bias in the studies.
Among male patients, the pooled odds ratio (OR) for the association between AUD and suicide mortality was 3.03, vs 3.41 for female patients. Publication bias was not identified when using sex-specific Egger tests and funnel plots. A significant effect of study design type was reported, with a log OR of 0.68 for male patients and 1.41 for female patients.
In longitudinal studies, the pooled OR was 2.68 among male patients and 2.39 among female patients. In cross-sectional studies, the ORs were 3.67 and 6.88, respectively. The difference between sexes was not significantly different in longitudinal studies, but was significantly different in cross-sectional studies, with a differing OR of 3.21.
These results indicated a similar association between AUD and suicide mortality risk between sexes. Investigators concluded AUD treatment should be considered an important component of a suicide prevention strategy.
Reference
Lange S, Kim KV, Lasserre AM, et al. Sex-specific association of alcohol use disorder with suicide mortality: A systematic review and meta-analysis. JAMA Netw Open. 2024;7(3):e241941. doi:10.1001/jamanetworkopen.2024.1941
