Corporal Michael J. Crescenz VA Medical Center, Perelman School of Medicine, MIRECC, 2nd Fl, Postal Code 116, 3900 Woodland Ave, Philadelphia, PA 19104.
Corporal Michael J. Crescenz VA Medical Center, Philadelphia, Pennsylvania, USA.
J Clin Psychiatry. 2018 Oct 23;79(6):17m11800. doi: 10.4088/JCP.17m11800.
Alcohol intoxication and dependence are risk factors for suicide, a leading cause of death in the United States. We examined the hours of peak and nadir in completed suicides over a 24-hour period among intoxicated, alcohol-dependent individuals. We also evaluated suicide-related factors associated with intoxication at different times of the day.
We analyzed cross-sectional data from the 2003-2010 National Violent Death Reporting System provided by 16 US states. In the primary database, the deceased individuals' alcohol-dependent status was classified as "yes" or "no or unknown." We restricted the analysis to alcohol-dependent individuals with alcohol level data available (N = 3,661). The primary outcome measure was the reported time of death. Secondary outcome measures were predisposing and injury-related factors. Individuals were classified on the basis of their blood alcohol level (BAL) as heavy drinking (BALH [≥ 80 mg/dL]) or non-heavy drinking (BALO [< 80 mg/dL]). The time of injury was divided into 1-hour bins, which were used to compute the incidence of suicide over 24 hours. We also evaluated the association between clinical factors and BALH for each of six 4-hour time periods beginning at 00:01 hours.
The majority (73.4%) of individuals showed evidence of alcohol consumption prior to committing suicide. BALH was observed in 60.7% of all individuals. Peak incidences in suicide were identified at 21:00 for BALH and 12:00 for BALO, with nadirs at 05:00 and 03:00 hours, respectively. In a multivariable analysis, between 20:01 and 00:00 hours, BALH was associated with more risk and protective factors than BALO.
Identifying critical times and associated risk factors for suicidal behavior may contribute to suicide prevention efforts in intoxicated alcohol-dependent individuals.
酒精中毒和依赖是自杀的危险因素，而自杀是美国的主要死亡原因之一。我们研究了在 24 小时内醉酒且酒精依赖个体自杀的高峰和低谷时间。我们还评估了与一天中不同时间点醉酒相关的自杀相关因素。
我们分析了 2003-2010 年来自美国 16 个州的国家暴力死亡报告系统的横断面数据。在原始数据库中，将死亡个体的酒精依赖状态分为“是”或“否或未知”。我们将分析仅限于有酒精水平数据的酒精依赖个体（N=3661）。主要结局指标是报告的死亡时间。次要结局指标是易感性和损伤相关因素。根据血液酒精水平（BAL）将个体分为重度饮酒（BALH [≥80mg/dL]）或非重度饮酒（BALO [<80mg/dL]）。将损伤时间分为 1 小时区间，用于计算 24 小时内自杀的发生率。我们还评估了 00:01 小时开始的六个 4 小时时间段内，临床因素与 BALH 之间的关联。
大多数（73.4%）个体在自杀前表现出饮酒的证据。所有个体中有 60.7%观察到 BALH。BALH 的自杀高峰发生在 21:00，BALO 的自杀高峰发生在 12:00，低谷分别发生在 05:00 和 03:00。在多变量分析中，20:01 至 00:00 小时期间，BALH 与更多的风险和保护因素相关，而 BALO 则较少。
确定与醉酒和酒精依赖个体自杀行为相关的关键时间和相关风险因素，可能有助于自杀预防工作。
