Association between alcohol consumption and severity of self-harm behaviors based on suicidal intent in patients admitted to the emergency department for self-harm

This study aimed to investigate the association between alcohol consumption and the severity of self-harm behaviors based on the suicidal intents of patients admitted to the emergency department (ED) for self-harm. This was a retrospective study on patients admitted to the ED between March 2017 and December 2020 owing to self-harm behaviors and were grouped into a suicide attempt (SA) and non-suicidal self-harm (NSSH) group. A total of 642 (73.5%) and 232 (26.5%) patients were classified into SA and NSSH groups, respectively. In the SA group, 270 (42.1%) patients reported consuming alcohol, which was independently associated with ≥12 years of formal education and no history of psychiatric hospitalization. In the NSSH group, 87 (37.5%) patients reported consuming alcohol, which was associated with male sex, being married or unmarried but living together, ≥12 years of formal education, and no history of depression. Alcohol consumption could predict ED disposition in the SA group but not in the NSSH group. The impact of alcohol consumption varied according to suicidal intents among patients admitted to the ED for self-harm behavior. Regardless of suicidal intent, patients with a higher education level tended to drink alcohol when engaging in self-harm behaviors.

Alcohol drinking; Emergency department; Self-harm behavior

[1] Development OfEC-oa. Health status, Suicide rate 2018. Available at: https://data.oecd.org/healthstat/suicide-rates.htm (Accessed: 3 December 2021).

[2] Korea S. Cause of death statistics in 2018 Daejeon: Statistics Korea. 2019. Available at: https://kostat.go.kr/portal/korea/kor_nw/1/1/index.board?bmode=read&bSeq=&aSeq=377606& pageNo=18&rowNum=10&navCount=10&currPg=&searchInfo=&sTarget=title&sTxt= (Accessed: 25 May 2019).

[3] Conner KR, Bagge CL, Goldston DB, Ilgen MA. Alcohol and suicidal behavior. American Journal of Preventive Medicine. 2014; 47: S204–S208.

[4] Cherpitel CJ, Borges GLG, Wilcox HC. Acute alcohol use and suicidal behavior: a review of the literature. Alcoholism: Clinical and Experimental Research. 2004; 28: 18S–28S.

[5] Borges G, Rosovsky H. Suicide attempts and alcohol consumption in an emergency room sample. Journal of Studies on Alcohol. 1996; 57: 543–548.

[6] Branas CC, Richmond TS, Ten Have TR, Wiebe DJ. Acute alcohol consumption, alcohol outlets, and gun suicide. Substance Use & Misuse. 2011; 46: 1592–1603.

[7] Powell KE, Kresnow M, Mercy JA, Potter LB, Swann AC, Frankowski RF, et al. Alcohol consumption and nearly lethal suicide attempts. Suicide and Life-Threatening Behavior. 2002; 32: 30–41.

[8] Conner KR, Huguet N, Caetano R, Giesbrecht N, McFarland BH, Nolte KB, et al. Acute use of alcohol and methods of suicide in a us national sample. American Journal of Public Health. 2014; 104: 171–178.

[9] Suokas J, Lönnqvist J. Suicide attempts in which alcohol is involved: a special group in general hospital emergency rooms. Acta Psychiatrica Scandinavica. 1995; 91: 36–40.

[10] Suominen K, Lönnqvist J. Determinants of psychiatric hospitalization after attempted suicide. General Hospital Psychiatry. 2006; 28: 424–430.

[11] Lejoyeux M, Huet F, Claudon M, Fichelle A, Casalino E, Lequen V. Characteristics of suicide attempts preceded by alcohol consumption. Archives of suicide research: official journal of the International Academy for Suicide Research. 2008; 12: 30–38.

[12] Bagge CL, Conner KR, Reed L, Dawkins M, Murray K. Alcohol use to facilitate a suicide attempt: an event-based examination. Journal of Studies on Alcohol and Drugs. 2015; 76: 474–481.

[13] Hawton K, Hall S, Simkin S, Bale L, Bond A, Codd S, et al. Deliberate self-harm in adolescents: a study of characteristics and trends in Oxford, 1990–2000. Journal of Child Psychology and Psychiatry. 2003; 44: 1191–1198.

[14] Salles J, Tiret B, Gallini A, Gandia P, Arbus C, Mathur A, et al. Suicide attempts: how does the acute use of alcohol affect suicide intent? Suicide and Life-Threatening Behavior. 2020; 50: 315–328.

[15] Greene D, Boyes M, Hasking P. The associations between alexithymia and both non-suicidal self-injury and risky drinking: a systematic review and meta-analysis. Journal of Affective Disorders. 2020; 260: 140–166.

[16] Kuntsche E, Wiers RW, Janssen T, Gmel G. Same wording, distinct concepts? Testing differences between expectancies and motives in a mediation model of alcohol outcomes. Experimental and Clinical Psychopharmacology. 2010; 18: 436–444.

[17] Urban C, Arias SA, Segal DL, Camargo CA, Boudreaux ED, Miller I, et al. Emergency department patients with suicide risk: differences in care by acute alcohol use. General Hospital Psychiatry. 2020; 63: 83–88.

[18] Dambrauskiene K, Adomaitiene V, Zalinkevicius R, Jariene G, Vilkas V, Rybakova I, et al. Can suicide attempt be related to problem drinking: cohort study. Alcohol and Alcoholism. 2019; 54: 104–111.

[19] Crombie IK, Pounder DJ, Dick PH. Who takes alcohol prior to suicide? Journal of Clinical Forensic Medicine. 1998; 5: 65–68.

[20] Mendelson WB, Rich CL. Sedatives and suicide: the san diego study. Acta Psychiatrica Scandinavica. 1993; 88: 337–341.

[21] Whitlock J, Muehlenkamp J, Purington A, Eckenrode J, Barreira P, Baral Abrams G, et al. Nonsuicidal self-injury in a college population: general trends and sex differences. Journal of American College Health. 2011; 59: 691–698.

[22] Haw C, Hawton K, Casey D, Bale E, Shepherd A. Alcohol dependence, excessive drinking and deliberate self-harm. Social Psychiatry and Psychiatric Epidemiology. 2005; 40: 964–971.

[23] Oreskovich MR, Shanafelt T, Dyrbye LN, Tan L, Sotile W, Satele D, et al. The prevalence of substance use disorders in American physicians. The American Journal on Addictions. 2015; 24: 30–38.