Attempted Suicide and Alcohol Dependence

描述(由申请人提供)：本申请是对NIH项目公告03 161“关于减少和预防自杀的研究”的回应，该项目由NIAAA共同发起。酒精依赖者自杀未遂和完全自杀的风险都很高。接受酒精中毒强化治疗的患者风险特别高。这个项目的目的是通过阐明自杀和非自杀个体之间的主要差异以及通过检查企图自杀的人的异质性来源来加强对寻求酒精依赖治疗的患者的自杀行为的理解。在目标1中，研究了反应性和主动性攻击在自杀未遂中的作用，在目标2中，重点放在孤独的体验上，客观地评估为独居，主观评估为“孤独”。在目标3中，结合了这些变量的自杀计划模型被评估，该模型假设反应性攻击性和严重的人际关系困难(例如，伴侣关系破裂)导致该人群低计划(冲动性)的自杀企图，而抑郁和孤独创造了高计划企图的条件。研究目的采用回溯性病例对照研究设计。在酒精依赖住院治疗中，在治疗90天内有自杀企图的受试者使用统一的筛查进行识别，并对自杀行为、其情况和假设的风险因素(例如反应性攻击)进行详细的研究访谈。非预谋控制者被招募进行比较。调查对象包括40%的女性，39%的黑人个人，大多数是经济上处于不利地位的人。关于酒精依赖和其他药物使用的严重程度的数据被获得，并在所有分析中被考虑在内。在目标1和目标2中，多因素Logistic回归分析用于比较病例和对照，在目标3中，对在尝试计划水平上评估的病例进行多元线性回归分析。还探讨了与年龄、性别和种族相关的模式。研究结果可能会推动对自杀和酒精中毒的研究，重点放在反应性攻击表型上，强调迫切需要考虑寻求酒精中毒治疗的个人的人际生活，这些人可能有自杀的风险，并为寻求识别和影响这一人群中低计划和高计划自杀行为过程的治疗提供信息。

DESCRIPTION (provided by applicant): This application is in response to NIH Program Announcement 03 161 "Research on the reduction and prevention of suicidality" that was co-sponsored by NIAAA. Individuals with alcohol dependence are at high risk for both attempted and completed suicide. Patients in intensive treatment for alcoholism are at especially high risk. The purpose of this project is to enhance understanding of suicidal behavior among patients seeking treatment for alcohol dependence both by illuminating major differences between suicidal and non-suicidal individuals as well as by examining sources of heterogeneity within attempters. In Aim 1, the roles of reactive and proactive aggression in attempted suicide are examined, and in Aim 2, the focus is on the experience of aloneness, assessed objectively as living alone and subjectively as "loneliness." In Aim 3, a model of suicide planning that incorporates these variables is evaluated that posits reactive aggression and acute interpersonal difficulties (e.g., partner relationship break-ups) lead to low-planned (impulsive) suicide attempts in this population whereas depression and aloneness create the conditions for high-planned attempts. The aims are carried out using a retrospective case-control study design. Subjects in inpatient treatment for alcohol dependence who have made a suicide attempt within 90 days of treatment are identified using a uniform screen and followed up with a detailed research interview about the act of suicide, its circumstances, and hypothesized risk factors (e.g., reactive aggression). Non-attempter controls are recruited for comparison. Subjects include 40% women, 39% black individuals, and most are economically disadvantaged. Data on severity of alcohol dependence and other drug use are obtained, and accounted for in all analyses. Multivariate logistic regression analyses are used to compare cases and controls in Aims 1 and 2, and multivariate linear regression analyses of cases assessed on a continuum of level of planning of the attempt are used in Aim 3. Patterns related to age, gender, and race are also explored. Results may advance research on suicide and alcoholism focused on the reactive aggression phenotype, underscore the critical need to consider the interpersonal life of individuals seeking treatment for alcoholism who may be at risk for suicide, and inform treatments that seek to identify and affect the course of low-planned and high-planned suicidal behavior in this population.