percent) of suicides by alcoholics as compared to 22 and 59 percent, respectively, among suicides by persons with mood or anxiety disorders.

Hopelessness significantly predicted suicidal ideation more accurately than depression in alcoholics, as well as non-alcoholics (Beck et al., 1982). Alcohol has an effect on depression as well. Large doses of alcohol over time are associated with depressive activity (Mirin and Weiss, 1986; Tamerin and Mendelson, 1969). Some suggest that depression is secondary to the effects of heavy and chronic alcohol consumption, since depression wanes with withdrawal (Flavin et al., 1990; Nakamura et al., 1983). However, drinking can also begin as a reaction to depression.

Alcohol Use Disorders

Estimating the prevalence of suicide among those with alcohol use disorders is difficult because the data come from studies using varying approaches (retro- and prospective, and population studies) as well as highly variable follow-up periods. Harris and Barraclough (1997) found in their meta-analysis of 32 studies that alcohol-dependence and abuse increased suicide risk almost 6-fold. Murphy (1992) estimates that in a year, 25 percent of all suicides (approximately 7600 of 30,400) in the United States are of individuals with alcohol use disorders, and that these individuals have 115 times the risk of suicide compared to a psychiatrically healthy population. Lifetime risk of suicide has been estimated at 3.4 percent for those with severe alcohol abuse disorders requiring hospitalization (Murphy, 1992). Alcohol dependent individuals who complete suicide are most frequently male, white, middle-aged, unmarried, with hospitalization in the past year, and with a history of previous attempts (Roy and Linnoila, 1986). Yet alcohol-dependent females have a 20- to 30-fold greater risk of completing suicide than non-clinical female populations (Harris and Barraclough, 1997; Medhus, 1975).

Severity and time-course of the alcohol use disorder are associated with suicide risk. In a mortality study of 8060 individuals matched for age, sex, race, and cigarette smoking, the effects of alcohol intake were examined on a variety of causes of death over 10 years (Klatsky et al., 1981). Suicide accounted for 3.5 percent of all the deaths, and the heaviest drinkers, those consuming 6+ drinks daily, accounted for almost half of the suicides. Merrill and colleagues (1992) in England found increased alcohol consumption associated with increased rates of suicide attempt for males and females. The risk of suicide is highest in the late stages of chronic alcohol abuse, and is associated with similar high risk events and psychiatric symptoms found among non-alcoholic individuals (Kendall, 1983).

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