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

仅在美国，每年就有超过32，000人自杀，据估计，每一次自杀死亡都有8-25次非致命性自杀企图。鉴于自杀的临床和公共卫生意义，有相当大的兴趣，在确定近端因素，增加自杀企图的风险，并确定自杀企图的时间在个人谁经常报告持续自杀意念。尽管一致的发现，酒精使用周围的自杀企图的患病率升高，很少有人知道急性酒精使用是否作为自杀企图的触发器，或急性酒精使用对自杀企图的影响是否不同的功能慢性酒精使用。根据个人的日常消费模式来区分急性饮酒的影响和受伤的风险是一个具有重大公共卫生利益的问题， 并且在心理特征上存在已知的差异（例如，情绪障碍，既往治疗史），以及在尝试自杀前饮酒（A+）和不饮酒（A-）的个体之间。然而，很少有人知道这些因素之间的差异与AUD+（谁不使用或不使用酒精之前，他们的企图），AUD-个人谁使用酒精之前，他们的企图，和AUD-个人谁不消耗酒精之前，他们的企图。在拟议的探索性/发展性研究（R21）中，我们将研究急性酒精使用对自杀企图的独特触发作用，作为个体基线AUD状态的函数，还将研究以急性和慢性酒精使用为特征的不同自杀者群体的远端心理特征。为此，我们将采用病例交叉设计，进行受试者间比较，招募150名自杀未遂后接受医学评估的个体。单次评估将包括AUD的诊断测量，评估心理特征的一组问卷，以及在自杀企图前6小时内以及在两个匹配的对照期间评估物质使用和其他随时间变化的近端风险因素的标准访谈。这项探索性/发展性研究将提供关于有和没有AUD的个体之间急性酒精使用和尝试之间独特的受试者内关系的程度的初步数据，并将有助于识别以不同急性酒精使用模式为特征的饮酒者群体的区别特征。 和长期酗酒这些初步数据和效应量将用于为更大规模研究的开发提供信息。更好地了解急性酒精使用对有和没有AUD的自杀企图的触发作用，并确定具有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酒精相关的自杀企图。

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.