Olsson Petter, Wiktorsson Stefan, Strömsten Lotta M J, Salander Renberg Ellinor, Runeson Bo, Waern Margda
Department of Psychiatry and Neurochemistry, University of Gothenburg, Gothenburg, Sweden.
Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Mölndal, Sweden.
Front Psychiatry. 2024 Aug 2;15:1396855. doi: 10.3389/fpsyt.2024.1396855. eCollection 2024.
Alcohol use disorder (AUD) is associated with suicidal behavior, but prospective clinical studies are lacking.
To compare clinical characteristics and 6-month outcomes in persons with and without AUD who self-harm.
804 adults (mean age 33, age range 18-95, 541 women and 263 men, 666 with suicide attempts and 138 with non-suicidal self-injuries at index) at three Swedish university hospitals took part in a research interview that included the Mini International Neuropsychiatric Interview (MINI). Subsequent non-fatal suicidal behavior within six months was identified by record review; suicides were identified by national register.
At index, 39% of the men and 29% of the women had AUD. Over two thirds of these cases (69%) were identified by the MINI, but not by clinical AUD diagnosis. While trait impulsivity was more common among persons with AUD than those without (56% vs 36%, <.001), impulsivity in connection with the index attempt was noted in half of the participants in each group (48% vs 52%, 1). Subsequent suicidal behavior (fatal/non-fatal) occurred in 67 persons with AUD (26%) and in 98 without AUD (18%), a 60% higher risk among persons with AUD (OR = 1.60, 95% [ 1.13-2.28], 009). Four persons with AUD (2%) and six without (1%) died by suicide within 6 months.
Almost a third of patients presenting at psychiatric emergency settings after self-harm fulfilled criteria for AUD, but clinicians often missed this diagnosis. Risk for subsequent suicidal behavior was elevated in patients with AUD. Educational interventions to improve recognition of alcohol use disorder may aid clinicians in the assessment and management of patients who present with self-harm.
酒精使用障碍（AUD）与自杀行为相关，但前瞻性临床研究尚缺。
比较有和无酒精使用障碍的自伤患者的临床特征及6个月的结局。
瑞典3家大学医院的804名成年人（平均年龄33岁，年龄范围18 - 95岁，541名女性和263名男性，666名有自杀未遂史，138名在索引期有非自杀性自伤史）参与了一项研究访谈，其中包括迷你国际神经精神访谈（MINI）。通过记录审查确定6个月内随后发生的非致命性自杀行为；通过国家登记册确定自杀情况。
在索引期，39%的男性和29%的女性有酒精使用障碍。这些病例中超过三分之二（69%）通过MINI确定，但未通过临床酒精使用障碍诊断确定。虽然特质冲动在有酒精使用障碍的人群中比无酒精使用障碍的人群更常见（56%对36%，P <.001），但每组中均有一半的参与者（48%对52%，P = 1）在索引期自杀未遂时存在冲动行为。随后有67名有酒精使用障碍者（26%）和98名无酒精使用障碍者（18%）出现自杀行为（致命/非致命），有酒精使用障碍者的风险高60%（比值比 = 1.60，95%可信区间[1.13 - 2.28]，P = 0.009）。4名有酒精使用障碍者（2%）和6名无酒精使用障碍者（1%）在6个月内自杀死亡。
近三分之一在自伤后到精神科急诊就诊的患者符合酒精使用障碍标准，但临床医生常漏诊。有酒精使用障碍的患者随后发生自杀行为的风险升高。改善对酒精使用障碍识别的教育干预可能有助于临床医生对自伤患者进行评估和管理。
