RGUHS Nat. J. Pub. Heal. Sci Vol: 15 Issue: 4 eISSN: pISSN
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1Aishwarya Jog, Basaveshwara Medical College Hospital and Research Centre, Chitradurga, Karnataka, India.
2Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
3Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
4Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
5Basaveshwara Medical College and Hospital, Chitradurga, Karnataka, India
*Corresponding Author:
Aishwarya Jog, Basaveshwara Medical College Hospital and Research Centre, Chitradurga, Karnataka, India., Email: aishwarya.jog@gmail.com
Abstract
Background: Suicide is one of the leading causes of death both globally and nationally, yet it remains one of the most preventable causes. Substance use is among the most common risk factors for suicide attempts, but it is also a modifiable one. Individuals with substance use disorders present particular challenges to suicide prevention, including the possibility of developing a suicidal urge during alcohol intoxication and substance induced depression.
Aim: The aim of this study was to determine the prevalence of alcohol use and suicide attempts made under the influence of alcohol, as well as to assess the intent of such attempts.
Methods: This was a cross-sectional study conducted at a tertiary care hospital in Chitradurga, Karnataka. A total of 80 patients who had attempted suicide were included. Each participant was evaluated for alcohol use disorder (harmful use or dependence) according to the ICD-11 criteria. The intent of the suicide attempt was also assessed. Data were analyzed to evaluate the role of alcohol in suicide attempts.
Results: Of the 80 participants, 35 (41.25%) reported a history of alcohol use, 27 (33.75%) met criteria for alcohol dependence. Among those with alcohol dependence, 9 (11.25% of the total sample; 33.33% of those with dependence) attempted suicide under the influence of alcohol. Regarding the level of suicidal intent among patients with alcohol use disorder, 14 had severe intent, 14 had moderate intent, and 7 had low intent.
Conclusion: Alcohol use emerged as a risk factor for suicide attempts. Targeted strategies are therefore required to minimize this risk.
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Introduction
Suicide is defined as death caused by intentional self-injury. A suicide attempt refers to intentional self-inflicted poisoning or injury, which may or may not have a fatal purpose or effect.1 Suicide is a leading cause of death worldwide and nationally, yet it remains one of the most preventable causes. Risk factors for suicide include previous attempts, family history of suicide, history of childhood abuse, psychiatric disorders, substance use disorders, chronic medical conditions, interpersonal diffi-culties, and access to lethal means. A prior suicide attempt is the single most important risk factor in the general population, followed by the presence of psychiatric disorders.2 Among individuals presenting to emergency repetition is up to 16.3%, while the 5-year risk is 3.9%.3
Substance use is one of the most common risk factors for suicide attempts, but it is also a modifiable one. Patients with substance use disorder present unique challenges to suicide prevention, including the potential emergence of suicidal urges during alcohol intoxication and substance-induced depression.4,5
Bhattacharjee S (2012) studied the putative effect of alcohol on suicide attempters and found that alcohol use was associated with an increased rate of suicide in a specific rural Indian population.6 In a study on alcohol, tobacco, and caffeine use, Myong Sun Cho (2020) found that, compared with non-use, daily alcohol consumption was associated with a significantly higher likelihood of suicide attempts (odds ratio [OR]= 8.00).7 Ledden S (2022) studied the relationship between alcohol use and suicide attempts, suicidal thoughts and non-suicidal self-harm, and found that alcohol use significantly disrupts day-to-day functioning.8 This disruption may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than overall levels of alcohol consumption.
Aims and Objectives
To determine the prevalence of alcohol use and suicide attempts made under the influence of alcohol among individuals presenting with suicide attempts.
To assess the intent of suicide attempts occurring under the influence of alcohol.
Materials and Methods
This cross-sectional study was conducted at Basaves-hwara Medical College and Hospital, Chitradurga, Karnataka, over a period of six months. The study population included individuals above 18 years of age who were re-ferred for psychiatric evaluation following a suicide attempt. A convenience sampling method was employed, and the final sample consisted of 80 participants.
Basic clinical details were documented at the time of admission and during psychiatric evaluation. A semi-structured proforma was used to record information on the suicidal attempt, findings from psychiatric evaluation, provisional psychiatric diagnosis, recommended treatment and scheduled follow-up. All 80 patients who had attempted suicide were evaluated for alcohol use disorder (harmful use or dependence) according to the International Classification of Diseases (ICD) -11 criteria. The intent of the suicide attempt was measured using Beck’s Suicide Intent Scale.
Statistical analysis
Fishers exact test was used to determine statistical significance. A P-value of <0.05 was considered statis-tically significant. Data were analyzed using SPSS software v. 23.0. and Microsoft office 2021.
Results
People often consume alcohol prior to a suicide attempt, to ease the process.9 In the present study, 33% of individuals who attempted suicide had reported alcohol use, either in the harmful use or dependence pattern (Table 1).
Among these, a significant proportion attempted suicide under the influence of alcohol (11.25% overall and 33% among alcohol users) (Table 2).
Comorbid alcohol use was observed in 33.75% of cases (n=27), of which 11.25% (n=9) had attempted suicide under the influence of alcohol.
This establishes alcohol use as a significant risk factor for suicide attempts (Table 3), consistent with findings from studies by Bharati S et al., Vijaykumar L et al., and Soukas J et al.10,11,12
A statistically significant association was observed between alcohol use and suicide risk (P-value <0.001), demonstrating alcohol as a prominent risk factor for suicide attempt.
This study also aimed to examine whether suicide attempts made under the influence of alcohol were more impulsive and associated with lower intent and severity. However, no significant association was found in this context in the present study (Table 4).
No significant association was observed between the intent of suicide and attempts made under the influence of alcohol (P-value=0.76). Consistent with previous studies, alcohol intake prior to a suicide attempt was not associated with the level of intent.
Discussion
Suicide is an important cause of death with a substantial global health burden, yet it remains one of the most preventable causes with timely intervention.This underscores the need to analyze common risk factors, patient profiles, and the potential impact of simple interventions in preventing future suicide attempts.
In contrast, Salles J et al., reported that patients with alcohol use demonstrated lower suicide intent, although this was based on self-reported scores, with no differences observed in objective circumstances.13 Conversely, Sher L et al., demonstrated that both lethality and intent of suicide attempts were more severe among individuals who consumed alcohol prior to the attempt compared to those who had not.14
Limitations
This study was conducted in a tertiary care center, and the sample primarily included patients brought directly to the emergency department or critically ill cases referred from outside facilities. Therefore, it may not represent the full spectrum of cases, including those admitted to government hospitals. Additionally, the relationship between other potential variables and suicide was not examined, which limits the scope for identifying necessary preventive measures. Follow-up data were also not collected, which is required to understand the relation between continued alcohol use and the risk of repeated suicide attempts.
Conclusion
Suicide and alcohol use disorder are both major public health burdens. This study demonstrated a significant association between alcohol use and suicide attempts; however, no association was found between the intent of suicide and attempts under the influence of alcohol. Given that alcohol use is a major risk factor for suicide attempts, additional strategies are required to minimize this risk. Future research with a larger sample size and a prospective design would provide deeper insights into the influence of alcohol on suicidal behaviour and the risk of reattempts.
Conflict of Interest
Nil
Supporting File
References
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