The Acute Alcohol-Suicide Attempt Relation as a Function of Alcohol Use Disorders

描述(申请人提供)：仅在美国，每年就有超过32,000人自杀，据估计，每一次自杀死亡中就有8-25次非致命的自杀未遂。鉴于自杀的临床和公共卫生意义，在经常报告持续自杀意念的个人中，确定增加自杀企图风险和决定自杀企图时机的近端因素引起了相当大的兴趣。尽管一致的研究结果表明，自杀企图周围的酒精使用率上升，但关于急性饮酒是否会触发自杀企图，或者急性饮酒对自杀企图的影响是否随着长期饮酒而有所不同，人们知之甚少。根据个人通常的消费模式，将急性饮酒的影响和伤害风险分开，这是一件极具公共卫生利益的事情， 在有和没有酒精使用障碍(AUD)的自杀未遂者之间，以及在企图自杀之前饮酒(A+)和不饮酒(A-)的人之间，在心理特征(例如，情绪障碍、既往治疗史)方面存在已知的差异。然而，人们对AUD+自杀未遂者(在自杀前立即饮酒或不饮酒)、AUD-企图前饮酒的人以及AUD-企图前不饮酒的人之间的这些因素的差异知之甚少。在拟议的探索性/发育研究(R21)中，我们将研究急性饮酒对自杀企图的独特触发作用，作为个人基线和发育状态的函数，并将研究以急性和慢性饮酒为特征的不同组未遂者的远端心理特征。为此，我们将采用病例交叉设计和受试者之间的比较，招募150名自杀未遂后提交医学评估的人。这项为期一次的评估将包括对AUD的诊断性测量，一系列评估心理特征的问卷，以及一次标准访谈，评估自杀未遂前六个小时内以及两个匹配的控制期内物质使用和其他随时间变化的近端风险因素。这项探索性/发育性研究将提供初步数据，说明急性饮酒和尝试饮酒在患有和不患有AUD的个体之间的独特的受试者内部关系的大小，并将有助于识别以不同急性酒精中毒模式为特征的尝试者群体的区别特征。 以及长期饮酒。这些初步数据和效应大小将被用来为更大规模研究的发展提供信息。更好地了解急性饮酒对AUD患者和非AUD患者自杀企图的触发作用，并识别不同急性和慢性酒精使用模式的个体的心理特征，将有助于未来识别和治疗与酒精相关的自杀企图。 公共卫生相关性：鉴于自杀未遂和有问题的饮酒对临床和公共卫生的重要意义，人们对它们之间的关系很感兴趣。最终， 识别不同急性和慢性酒精使用模式的自杀未遂者的心理特征的差异，并更好地了解急性酒精使用对有和没有酒精使用障碍(AUD)的自杀企图的触发效应，将有助于未来识别和治疗与酒精相关的自杀企图。这一点尤其重要，因为许多企图自杀的人报告说他们有持续的自杀念头，因此很难预测这些企图的时间。

DESCRIPTION (provided by applicant): In the United States alone, more than 32,000 people commit suicide each year and it is estimated that for every death by suicide there are 8-25 nonfatal suicide attempts. Given the clinical and public health significance of suicide, there is considerable interest in identifying proximal factors that increase the risk for suicide attempts and that determine the timing of suicide attempts among individuals who often report persistent suicidal ideation. Despite consistent findings of an elevated prevalence of alcohol use surrounding suicide attempts, little is known about whether acute alcohol use serves as a trigger to suicide attempts, or whether the effect of acute alcohol use on suicide attempt differs as a function of chronic alcohol use. Disentangling the effects of acute alcohol use and risk of injury according to an individual's usual consumption pattern is a matter of great public health interest, and there are known differences in psychological characteristics (e.g., mood disorders, previous treatment history) between those who attempt suicide with and without alcohol use disorders (AUD), as well as between individuals who drink alcohol (A+) and who do not drink alcohol (A-) prior to their attempt. However, little is known about differences on such factors between suicide attempters with AUD+ (who do or do not use alcohol immediately prior to their attempt), AUD- individuals who use alcohol before their attempt, and AUD- individuals who do not consume alcohol prior to their attempt. In the proposed exploratory/ developmental study (R21), we will examine the unique triggering role of acute alcohol use on suicide attempts as a function of an individual's baseline AUD status, and will also examine distal psychological characteristics of distinct groups of attempters characterized by acute and chronic alcohol use. To this end, we will employ a case-crossover design with a between-subject comparison, recruiting 150 individuals presenting for medical evaluation after a suicide attempt. The one-session assessment will comprise a diagnostic measure of AUD, a battery of questionnaires assessing psychological characteristics, and a standard interview assessing substance use and other time-varying proximal risk factors during the six hours prior to the suicide attempt, as well as during two matched controls periods. This exploratory/developmental study will provide preliminary data on the magnitude of the unique within-subject relation between acute alcohol use and attempt among individuals with and without AUD, and will aid in identifying distinguishing characteristics of groups of attempters characterized by different patterns of acute and chronic alcohol use. These preliminary data and effect sizes will be used to inform the development of a larger study. Gaining a better understanding of the triggering effects of acute alcohol use on suicide attempts among those with and without AUD, and identifying psychological characteristics of individuals with different acute and chronic alcohol use patterns will facilitate future identification and treatment of alcohol-related suicide attempts. PUBLIC HEALTH RELEVANCE: Given the clinical and public health significance of suicide attempts and problematic alcohol use, there is considerable interest in their relation. Ultimately, identifying differences in the psychological characteristics of suicide attempters with different patterns of acute and chronic alcohol use, and gaining a better understanding of the triggering effects of acute alcohol use on suicide attempts among those with and without Alcohol Use Disorders (AUD), will facilitate future identification and treatment of alcohol-related suicide attempts. This is particularly important given that many who attempt suicide report persistent suicidal ideation, and thus the timing of these attempts is difficult to predict.