Skip to main content Accessibility help
Hostname: page-component-684bc48f8b-n95np Total loading time: 0.393 Render date: 2021-04-13T01:01:31.021Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": false, "newCiteModal": false, "newCitedByModal": true }

A meta-analysis of acute use of alcohol and the risk of suicide attempt

Published online by Cambridge University Press:  08 December 2016

G. Borges
Instituto Nacional de Psiquiatría, Mexico City, Mexico
C. L. Bagge
Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS, USA
C. J. Cherpitel
Alcohol Research Group, Emeryville, CA, USA
K. R. Conner
University of Rochester Medical Center, Rochester, NY, USA
R. Orozco
Instituto Nacional de Psiquiatría, Mexico City, Mexico
I. Rossow
National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway



No review has used a meta-analytic approach to estimate common odds ratios (ORs) for the effect of acute use of alcohol (AUA) on suicide attempts. We aim to report the results of the first meta-analysis of controlled epidemiological studies on AUA and suicide attempt.


The English-language literature on Medline, PsycINFO and Google Scholar was searched for original articles and critical review on AUA and suicide attempt (period 1996–2015). Studies had to report an OR estimate for this association. Common ORs and 95% confidence intervals (CIs) from random effects in meta-analyses for any AUA and two levels of alcohol use on suicide attempt were calculated.


In all, seven studies provided OR estimates for the likelihood of suicide attempt by AUA, compared with those who did not drink alcohol. Studies used case–control (n 3) and case–crossover designs (n 4). Meta-analysis revealed a common OR of 6.97 (95% CI 4.77–10.17) for any AUA. Using four studies, ‘low levels of acute drinking’ resulted in an OR of 2.71 (95% CI 1.56–4.71) and ‘high levels’ had an OR of 37.18 (95% CI 17.38–79.53).


AUA is associated with increased likelihood of a suicide attempt, particularly at high doses. Such data should be incorporated into estimates of the burden of disease associated with alcohol use, which are currently limited by a consideration of only alcohol's chronic effects. Future research should focus on the mechanisms through which AUA confers risk for attempt.

Original Articles
Copyright © Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below.


A presentation of an initial version of this manuscript was made at the World Health Organization (WHO) meeting ‘Substance Use and Suicide in the International Context’, Geneva, Switzerland, WHO Headquarters, 19–21 October 2015.


Bagge, CL, Borges, G (in press). Acute substance use as a warning sign for suicide attempts: a case–crossover examination of the 48 h prior to a recent suicide attempt. Journal of Clinical Psychiatry.Google Scholar
Bagge, CL, Conner, KR, Reed, L, Dawkins, M, Murray, K (2015). Alcohol use to facilitate a suicide attempt: an event-based examination. Journal of Studies on Alcohol and Drugs 76, 481.CrossRefGoogle ScholarPubMed
Bagge, CL, Lee, HJ, Schumacher, J, Gratz, K, Krull, J, Holloman, G (2013). Alcohol as an acute risk factor for recent suicide attempts: a case–crossover analysis. Journal of Studies on Alcohol and Drugs 74, 552558.CrossRefGoogle ScholarPubMed
Bagge, CL, Littefield, AK, Conner, KR, Schumacher, J, Lee, HJ (2014). Near-term predictors of the intensity of suicidal ideation: an examination of the 24 h prior to a recent suicide attempt. Journal of Affective Disorders 165, 5358.CrossRefGoogle ScholarPubMed
Bagge, CL, Sher, KJ (2008). Adolescent alcohol involvement and suicide attempts: toward the development of a conceptual framework. Clinical Psychology Review 28, 12831296.CrossRefGoogle ScholarPubMed
Berglund, M, Ojehagen, A (1998). The influence of alcohol drinking and alcohol use disorders on psychiatric disorders and suicidal behavior. Alcoholism: Clinical and Experimental Research 22, 333S345S.CrossRefGoogle ScholarPubMed
Boenisch, S, Bramesfeld, A, Mergl, R, Havers, I, Althaus, D, Lehfeld, H, Niklewski, G, Hegerl, U (2010). The role of alcohol use disorder and alcohol consumption in suicide attempts – a secondary analysis of 1921 suicide attempts. European Psychiatry 25, 414420.CrossRefGoogle ScholarPubMed
Borges, G, Cherpitel, C, MacDonald, S, Giesbrecht, N, Stockwell, T, Wilcox, HC (2004). A case–crossover study of acute alcohol use and suicide attempt. Journal of Studies on Alcohol and Drugs 65, 708714.CrossRefGoogle ScholarPubMed
Borges, G, Cherpitel, C, Orozco, R, Bond, J, Ye, Y, MacDonald, S, Rehm, J, Poznyak, V (2006). Multicentre study of acute alcohol use and non-fatal injuries: data from the WHO collaborative study on alcohol and injuries. Bulletin of the World Health Organization 84, 453460.CrossRefGoogle ScholarPubMed
Borges, G, Cherpitel, C, Orozco, R, Ye, Y, Monteiro, M, Hao, W, Benegal, V (2016). A dose–response estimate for acute alcohol use and risk of suicide attempt. Addiction Biology. Published online 10 August 2016. doi:10.1111/adb.12439.CrossRefGoogle ScholarPubMed
Borges, G, Loera, CR (2010). Alcohol and drug use in suicidal behaviour. Current Opinion in Psychiatry 23, 195204.CrossRefGoogle ScholarPubMed
Borges, G, Rosovsky, H (1996). Suicide attempts and alcohol consumption in an emergency room sample. Journal of Studies on Alcohol and Drugs 57, 543548.CrossRefGoogle Scholar
Branas, CC, Richmond, TS, Ten Have, TR, Wiebe, DJ (2011). Acute alcohol consumption, alcohol outlets, and gun suicide. Substance Use and Misuse 46, 15921603.CrossRefGoogle ScholarPubMed
Caswell, AJ, Morgan, MJ, Duka, T (2013). Acute alcohol effects on subtypes of impulsivity and the role of alcohol-outcome expectancies. Psychopharmacology 229, 2130.CrossRefGoogle ScholarPubMed
Cherpitel, C, Borges, G, Wilcox, HC (2004). Acute alcohol use and suicidal behavior: a review of the literature. Alcoholism: Clinical and Experimental Research 28, 18S28S.CrossRefGoogle ScholarPubMed
Cherpitel, C, Ye, Y, Bond, J, Borges, G, Monteiro, M (2015). Relative risk of injury from acute alcohol consumption: modeling the dose–response relationship in emergency department data from 18 countries. Addiction 110, 279288.CrossRefGoogle ScholarPubMed
Conner, KR (2015). Commentary on ‘The modal suicide decedent did not consume alcohol just prior to the time of death: an analysis with implications for understanding suicidal behavior’. Journal of Abnormal Psychology 124, 457459.CrossRefGoogle ScholarPubMed
Conner, KR, Bagge, CL, Goldston, DB, Ilgen, MA (2014). Alcohol and suicidal behavior: what is known and what can be done. American Journal of Preventive Medicine 47, S204S208.CrossRefGoogle Scholar
Conner, KR, Duberstein, PR (2004). Predisposing and precipitating factors for suicide among alcoholics: empirial review and conceptual integration. Alcoholism: Clinical and Experimental Research 28, 6S17S.CrossRefGoogle Scholar
Conner, KR, McCloskey, MS, Duberstein, PR (2008). Psychiatric risk factors for suicide in the alcohol-dependent patient. Psychiatric Annals 38, 742748.CrossRefGoogle Scholar
Darvishi, N, Farhadi, M, Haghtalab, T, Poorolajal, J (2015). Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLOS ONE 10, e0126870.CrossRefGoogle ScholarPubMed
Dougherty, DM, Marsh-Richard, DM, Hatzis, ES, Nouvion, SO, Mathias, CW (2008). A test of alcohol dose effects on multiple behavioral measures of impulsivity. Drug and Alcohol Dependence 96, 111120.CrossRefGoogle ScholarPubMed
Durkheim, E (1897). Suicide, 1951 edn. Free Press: New York.Google ScholarPubMed
Egger, M, Davey, S, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.CrossRefGoogle ScholarPubMed
Ferrari, AJ, Norman, RE, Freedman, GD, Baxter, AJ, Pirkis, J, Harris, MG, Page, A, Carnahan, E, Degenhardt, L, Vos, T, Whiteford, H (2014). The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLOS ONE 9, e91936.CrossRefGoogle ScholarPubMed
Ghanbari, B, Malakouti, SK, Nojomi, M, De Leo, D, Saeed, K (2015). Alcohol abuse and suicide attempt in Iran: a case–crossover study. Global Journal of Health Science 8, 53092.CrossRefGoogle ScholarPubMed
Gustafson, R (1993). What do experimental paradigms tell us about alcohol-related aggressive responding? Journal of Studies on Alcohol. Supplement 11, 2029.CrossRefGoogle ScholarPubMed
Harris, RJ, Bradburn, MJ, Deeks, JJ, Harbord, RM, Altman, DG, Sterne, JAC (2008). metan: Fixed- and random-effects meta-analysis. Stata Journal 8, 328.Google Scholar
Heinz, A, Mann, K, Weinberger, DR, Goldman, D (2001). Serotonergic dysfunction, negative mood states, and response to alcohol. Alcoholism: Clinical and Experimental Research 25, 487495.CrossRefGoogle ScholarPubMed
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. BMJ 327, 557560.CrossRefGoogle ScholarPubMed
Hufford, MR (2001). Alcohol and suicidal behavior. Clinical Psychology Review 21, 797811.CrossRefGoogle ScholarPubMed
Kaplan, MS, Huguet, N, McFarland, BH, Caetano, R, Conner, KR, Nolte, KB, Giesbrecht, N (2016). Heavy alcohol use among suicide decedents and a population-based living comparison sample: differences in risk across racial/ethnic groups. Psychiatric Services 67, 258.CrossRefGoogle Scholar
Mann, JJ, Waternaux, C, Haas, GL, Malone, KM (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry 156, 181189.Google Scholar
Norström, T, Rossow, I (2016). Alcohol consumption as a risk factor for suicidal behaviour: a systematic review of associations at the individual and at the population level. Archives of Suicide Research 20, 489506.CrossRefGoogle ScholarPubMed
Oquendo, MA, Mann, JJ (2000). The biology of impulsivity and suicidality. Psychiatric Clinics of North America 23, 1125.CrossRefGoogle ScholarPubMed
Peterson, JB, Rothfleisch, JM, Zelazo, PD, Pihl, RO (1990). Acute alcohol intoxication and cognitive functioning. Journal of Studies on Alcohol 51, 114122.CrossRefGoogle ScholarPubMed
Popke, EJ, Allen, SR, Aule, MG (2000). Effects of acute ethanol on indices of cognitive–behavioral performance in rats. Alcohol 20, 187192.CrossRefGoogle ScholarPubMed
Powell, KE, Kresnow, M, Mercy, JA, Potter, LB, Swann, AC, Frankowski, RF, Lee, RK, Bayer, TL (2001). Alcohol consumption and nearly lethal suicide attempts. Suicide and Life-Threatening Behavior 32, 3041.CrossRefGoogle ScholarPubMed
Rehm, J, Monteiro, M, Room, R, Gmel, G, Jernigan, D, Frick, U, Graham, K (2001). Steps towards constructing a global comparative risk analysis for alcohol consumption: determining indicators and empirical weights for patterns of drinking, deciding about theoretical minimum, and dealing with different consequences. European Addiction Research 7, 138147.CrossRefGoogle ScholarPubMed
Roerecke, M, Rehm, J (2014). Cause-specific mortality risk in alcohol use disorder treatment patients: a systematic review and meta-analysis. International Journal of Epidemiology 43, 906919.CrossRefGoogle ScholarPubMed
Room, R (2001). Intoxication and bad behaviour: understanding cultural differences in the link. Social Science and Medicine 53, 189198.CrossRefGoogle ScholarPubMed
Simon, TR, Swann, AC, Powell, KE, Potter, LB, Kresnow, M, O'Carroll, PW (2002). Characteristics of impulsive suicide attempts and attempters. Suicide and Life-Threatening Behavior 32, 4959.CrossRefGoogle ScholarPubMed
Skog, O (1991). Alcohol and suicide – Durkheim revisited. Acta Sociologica 34, 193206.CrossRefGoogle Scholar
Stata Statistical Sofware (2013). Release 13. StataCorp LP: College Station, TX.Google ScholarPubMed
Wojnar, M, Ilgen, MA, Jakubczyk, A, Wnorowskaa, A, Klimkiewicz, A, Brower, KJ (2008). Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients. Drug and Alcohol Dependence 97, 268275.CrossRefGoogle ScholarPubMed
World Health Organization (2014 a). Global Status Report on Alcohol and Health 2014. World Health Organization: Geneva, Switzerland.Google Scholar
World Health Organization (2014 b). Preventing Suicide: A Global Imperative. World Health Organization: Geneva, Switzerland.Google Scholar

Altmetric attention score

Full text views

Full text views reflects PDF downloads, PDFs sent to Google Drive, Dropbox and Kindle and HTML full text views.

Total number of HTML views: 121
Total number of PDF views: 660 *
View data table for this chart

* Views captured on Cambridge Core between 08th December 2016 - 13th April 2021. This data will be updated every 24 hours.

Send article to Kindle

To send this article to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the or variations. ‘’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

A meta-analysis of acute use of alcohol and the risk of suicide attempt
Available formats

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

A meta-analysis of acute use of alcohol and the risk of suicide attempt
Available formats

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

A meta-analysis of acute use of alcohol and the risk of suicide attempt
Available formats

Reply to: Submit a response

Your details

Conflicting interests

Do you have any conflicting interests? *