Kõlves Kairi, Värnik Airi, Tooding Liina-Mai, Wasserman Danuta
Estonian-Swedish Mental Health & Suicidology Institute, Estonian Centre of Behavioural and Health Sciences, Tallinn, EstoniaTartu University, Faculty of Social Sciences, Tartu, Estonia.
Psychol Med. 2006 Jul;36(7):923-30. doi: 10.1017/S0033291706007707. Epub 2006 May 2.
The purpose of the study was to estimate the proportion of alcohol abuse and dependence (AAD) among suicides and controls, and to compare the incidence of AAD documented by clinicians with diagnoses derived from a research protocol.
AAD according to DSM-IV was diagnosed on the basis of interviews with relatives of people who committed suicide and with controls. A total of 427 people who committed suicide during one year were paired by region, gender, age and nationality with controls randomly selected from general practitioners' lists.
Alcohol abuse was found in 10% and alcohol dependence in 51% of suicide cases. The corresponding figures for controls were 7% and 14% respectively. AAD was a statistically significant predictor of completed suicides, while abstinence was a significant predictor for female suicides and former use a significant predictor for older male suicides. AAD was diagnosed in 68% of male and 29% of female suicides. Middle-aged (35-59 years) males who committed suicide had the highest risk of alcohol dependence. Among suicide cases only 29% had received a lifetime diagnosis of AAD, against 23% of controls.
AAD was significantly more prevalent among suicides than controls. Overall, the proportion of male suicides affected by alcohol was the same in the present psychological autopsy study as in our previous findings for Estonia on the aggregate level, while the share of female suicides with an AAD diagnosis was dramatically higher on the individual level. AAD is markedly underdiagnosed by general practitioners and clinicians.
本研究旨在估计自杀者与对照组中酒精滥用及依赖（AAD）的比例，并比较临床医生记录的AAD发病率与研究方案得出的诊断结果。
根据《精神疾病诊断与统计手册》第四版（DSM-IV），通过对自杀者亲属及对照组进行访谈来诊断AAD。在一年内自杀的427人按地区、性别、年龄和国籍与从全科医生名单中随机选取的对照组进行配对。
在自杀案例中，发现10%存在酒精滥用，51%存在酒精依赖。对照组的相应数字分别为7%和14%。AAD是自杀完成的统计学显著预测因素，而戒酒是女性自杀的显著预测因素，既往饮酒是老年男性自杀的显著预测因素。在68%的男性自杀者和29%的女性自杀者中诊断出AAD。自杀的中年（35 - 59岁）男性酒精依赖风险最高。在自杀案例中，只有29%曾被终生诊断为AAD，而对照组为23%。
自杀者中AAD的患病率显著高于对照组。总体而言，在本次心理解剖学研究中，受酒精影响的男性自杀比例与我们之前对爱沙尼亚总体水平的研究结果相同，而在个体层面，被诊断为AAD的女性自杀比例显著更高。全科医生和临床医生对AAD的诊断明显不足。
