Alcohol abuse and suicidal behaviour in young and middle aged men: differentiating between attempted and completed suicide

AIMS: To establish whether alcohol abuse as a risk factor in suicidal behaviour would be different in parasuicide compared to completed suicide, and to explore the relative impact of alcohol abuse on completed suicide among parasuicides. DESIGN: A 25-year follow-up study by linking data from military conscription, inpatient treatment and death register. PARTICIPANTS: A cohort of 46,490 Swedish male conscripts born in 1950-51. MEASUREMENTS: Psychiatric diagnosis was recorded at conscription, diagnoses related to alcohol abuse and suicidal behaviour were recorded at any inpatient treatment during follow-up, and underlying cause of death was recorded for those who died during follow-up. FINDINGS: Bivariate analyses showed alcohol abusers to have an elevated risk of attempted suicide (OR = 27.1) as well as completed suicide (OR = 4.7), but in the latter case to a significantly lesser extent. Correspondingly, alcohol abusers constituted a significantly larger proportion of the parasuicides (33.3%) than of the completed suicides (10.0%). A relatively stronger impact of alcohol abuse on parasuicide than on completed suicide remained after controlling for psychiatric co-morbidity, the adjusted odds ratios for attempted suicide and completed suicide being 8.8 and 2.4, respectively. Attempted suicide was a highly significant risk factor for completed suicide (OR = 13.5). Among those who attempted suicide, alcohol abusers were found to have a significantly lower risk of completed suicide than other suicide attempters (OR = 0.46). CONCLUSION: The significantly stronger association between alcohol abuse and attempted suicide compared to completed suicide may be viewed in the light of possible impact of intoxication and impulsiveness on non-fatal suicidal behaviour in alcohol abusers.