Courtney Bagge, Ph.D. made use of her AFSP Pilot Research Grant to study alcohol use, drug use and negative life events in the hours before a suicide attempt. Her study goals were to 1) examine the timing of alcohol intake in relation to recent suicide attempts; 2) determine if the amount of alcohol consumed makes a difference in risk for a suicide attempt; and 3) learn if drinking itself increases the risk after accounting for other factors such as negative life events and drug use. The findings of her study have been accepted for publication in Journal of Studies on Alcohol and Drugs.
In order to reach her goals, Dr. Bagge recruited 192 men and women between the ages of 18 and 64 who were seen in the hospital for a recent suicide attempt. They were seen in the hospital’s emergency department, inpatient psychiatry unit or on a medical unit. Within the 48 hours of their presentation to the hospital and no more than seven days from their suicide attempt, participants were interviewed by trained interviewers using the Timeline Follow-Back Interview for Suicide Attempts (TLFB-SA). This interview reviews each of the 48 hours before the suicide attempt and the presence of factors, such as substance use and negative life events, are noted. The presence of behaviors and events during two time periods are compared: the day before the attempt (a day when a suicide attempt did not occur) and the day of the attempt. This is an improvement over other studies that compare drinking and life events on the day of the attempt to those from longer time periods (e.g. the year prior). The design used by Dr. Bagge may help us to understand what increases the risk for a suicide attempt for some people at a particular moment in time.
Participants were mostly female (62%) with an average age of 36.7 years. Regarding race, most were white (64%), many were African American (30.2%) and the rest of the participants Native American (1.5%) or of mixed race/ethnicity (4.5%). Almost one quarter of the suicide attempters (24.48%) had consumed alcohol during the six hours before the attempt—more than twice as many as the same time period on the day before (11.98%). Of those who drank before their attempt, almost 66% had drunk within the hour before their attempt. Forty-four percent reported negative life events during the six hours before their attempt and only 12.5% reported an event the day before their attempt. Drug use was less common (15.10%) during the six hours before and was not found to independently increase the risk for an attempt. Dr. Bagge found that drinking any alcohol was associated with a 6-fold increase in the risk for a suicide attempt and that experiencing a negative life event posed a similar risk for attempt. Notably, heavy drinking (4 or more drinks for females and 5 or more drinks for males) was associated with a 16-fold increase in risk for an attempt.
In sum, Dr. Bagge demonstrated that people are at increased risk for a suicide attempt while they are drinking (especially when drinking heavily) and soon after experiencing a negative life event. Given these findings, clinicians may choose to educate patients on the increased risk for suicide attempt while drinking and to help patients develop effective strategies for coping with negative events.
Dr. Courtney Bagge is an Assistant Professor of Psychiatry and the Director of Suicide Research at the University of Mississippi Medical Center.