The impact of acute alcohol use and usual drinking frequency on the clinical characteristics and medical severity of suicide attempts

Background

The relationship between alcohol consumption and suicidal behavior is well-established in psychiatric literature, representing a major public health challenge. However, the distinct roles of acute alcohol consumption prior to an attempt versus chronic drinking habits remain complex. While acute intoxication is often linked to transient impulsivity, chronic use is frequently associated with accumulating psychosocial decline. This comprehensive study aimed to investigate the demographic and clinical characteristics of suicide attempters based on acute alcohol use (AAU) immediately before the attempt. Furthermore, we sought to examine how an individual’s usual drinking frequency independently influences the ultimate medical severity of suicide attempts.

Methods

A large-scale retrospective observational study was conducted, encompassing a total of 5,367 suicide attempters who presented to the emergency department. To facilitate comparative analysis, the cohort was systematically divided into two distinct groups: an acute alcohol use (AAU) group (n=2,643) and a non-AAU group (n=2,724). Comprehensive demographic variables and clinical characteristics were compared between the two cohorts. Furthermore, to determine the independent impact of alcohol consumption on lethality, a multiple linear regression analysis was conducted. This approach identified significant predictors of medical severity while rigorously controlling for underlying psychopathology.

Results

In the univariate analysis, the AAU group exhibited significantly higher proportions of males (41.3% vs. 34.8%), married individuals (44.8% vs. 38.2%), employed individuals (50.7% vs. 42.5%), and those with low socioeconomic status (31.8% vs. 23.9%) compared to the non-AAU group (all p < 0.001). Clinically, the AAU group demonstrated a higher rate of nonpsychotic states (98.1% vs. 93.5%, p < 0.001), a lower rate of severe depression (51.0% vs. 54.3%, p = 0.034), and a higher rate of absent hopelessness (36.8% vs. 32.5%, p < 0.001). In the multiple linear regression model (F = 31.99, p < 0.001, Adjusted R-squared = 12.7%), usual drinking frequency demonstrated a significant negative association with the medical severity of the attempt (B = -0.0066, p = 0.002). Additionally, older age (B = 0.0065, p < 0.001), psychotic states (B = 0.3460, p = 0.007), moderate (B = 0.1957, p = 0.010) and severe depression (B = 0.3885, p < 0.001), planned attempts (B = 0.2850, p = 0.001), and a definite suicide goal (B = 0.4832, p < 0.001) significantly increased medical severity. Conversely, being female, being single, and making prior contact before the attempt were significantly associated with lower medical severity (all p < 0.01).

Conclusions

Suicide attempters who engage in acute alcohol use prior to their attempt tend to experience more practical socioeconomic stressors rather than severe underlying psychopathologies, such as severe depression, compared to non-users. Interestingly, when controlling for clinical variables, a higher frequency of usual drinking was independently associated with a lower medical severity of the attempt. These findings suggest that suicide attempts among habitual drinkers may be driven more by impulsive, communicative motives or an urgent “cry for help” rather than high lethality. This highlights the importance of evaluating both acute and chronic alcohol exposure separately in clinical suicide risk assessments.

References

Sher L, Oquendo MA, Richardson-Vejlgaard R, Makhija NM, Posner K, Mann JJ, Stanley BH. Effect of acute alcohol use on the lethality of suicide attempts in patients with mood disorders. J Psychiatr Res. 2009 Jul;43(10):901-5. doi: 10.1016/j.jpsychires.2009.01.005. Epub 2009 Feb 25. PMID: 19246050; PMCID: PMC3767468. Yim M, Kim H, Kim G, Hur J. Acute Alcohol Use and Suicide. JAMA Netw Open. 2025;8(2):e2461409. doi:10.1001/jamanetworkopen.2024.61409