Attempted Suicide and Alcohol Dependence

描述（由申请人提供）：本申请是为了响应NIH项目公告03 161“减少和预防自杀的研究”，该项目由NIAAA共同发起。酒精依赖者自杀未遂和自杀未遂的风险都很高。接受酒精中毒强化治疗的患者风险尤其高。该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，以及通过检查企图者内部的异质性来源，加强对寻求酒精依赖治疗的患者自杀行为的理解。在目标1中，研究了自杀未遂中反应性攻击和主动攻击的作用，而在目标2中，重点是孤独的体验，客观地评估为独自生活，主观地评估为“孤独”。在目标3中，评估了一个包含这些变量的自杀计划模型，该模型假设反应性攻击和急性人际关系困难（例如，伴侣关系破裂）导致该人群中低计划（冲动）自杀企图，而抑郁和孤独为高计划自杀企图创造了条件。目的是采用回顾性病例对照研究设计。接受酒精依赖住院治疗的受试者在治疗90天内有自杀企图，使用统一的筛查方法进行识别，并对自杀行为、其环境和假设的风险因素（例如，反应性攻击）进行详细的研究访谈。采用非尝试者对照进行比较。研究对象包括40%的女性，39%的黑人，大多数是经济上处于不利地位的人。获得了酒精依赖和其他药物使用严重程度的数据，并在所有分析中加以说明。在目标1和目标2中，使用多变量逻辑回归分析来比较病例和对照，在目标3中，使用多变量线性回归分析来评估在尝试计划水平连续体上评估的病例。还探讨了与年龄、性别和种族有关的模式。研究结果可能会推动对自杀和酒精中毒的研究，重点关注反应性攻击表型，强调有必要考虑寻求酒精中毒治疗的个体的人际生活，这些个体可能有自杀风险，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.