Levels of aggressiveness are higher among alcohol-related suicides: Results from a psychological autopsy study

Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR = 3.32). Cases were more likely to have family history of alcohol (OR = 1.73) and drug abuse (OR = 3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR = 6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR = 4.68), and were less likely to meet criteria for Avoidant (OR = 0.26) and Obsessive-Compulsive Personality Disorders (OR = 0.35). Impulsivity scores were higher in AUD suicides (p = 0.18), as well as aggression scores (p < 0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR = 4.20) and Antisocial Personality Disorder (OR = 6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR = 1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.