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

  • G. Borges (a1), C. L. Bagge (a2), C. J. Cherpitel (a3), K. R. Conner (a4), R. Orozco (a1) and I. Rossow (a5)...



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.


Corresponding author

*Address for correspondence: G. Borges, Instituto Nacional de Psiquiatría, Mexico City, Mexico. (Email:;


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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.



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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.
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.
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.
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.
Bagge, CL, Sher, KJ (2008). Adolescent alcohol involvement and suicide attempts: toward the development of a conceptual framework. Clinical Psychology Review 28, 12831296.
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.
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.
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.
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.
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.
Borges, G, Loera, CR (2010). Alcohol and drug use in suicidal behaviour. Current Opinion in Psychiatry 23, 195204.
Borges, G, Rosovsky, H (1996). Suicide attempts and alcohol consumption in an emergency room sample. Journal of Studies on Alcohol and Drugs 57, 543548.
Branas, CC, Richmond, TS, Ten Have, TR, Wiebe, DJ (2011). Acute alcohol consumption, alcohol outlets, and gun suicide. Substance Use and Misuse 46, 15921603.
Caswell, AJ, Morgan, MJ, Duka, T (2013). Acute alcohol effects on subtypes of impulsivity and the role of alcohol-outcome expectancies. Psychopharmacology 229, 2130.
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.
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.
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.
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.
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.
Conner, KR, McCloskey, MS, Duberstein, PR (2008). Psychiatric risk factors for suicide in the alcohol-dependent patient. Psychiatric Annals 38, 742748.
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.
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.
Durkheim, E (1897). Suicide, 1951 edn. Free Press: New York.
Egger, M, Davey, S, Schneider, M, Minder, C (1997). Bias in meta-analysis detected by a simple, graphical test. BMJ 315, 629634.
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.
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.
Gustafson, R (1993). What do experimental paradigms tell us about alcohol-related aggressive responding? Journal of Studies on Alcohol. Supplement 11, 2029.
Harris, RJ, Bradburn, MJ, Deeks, JJ, Harbord, RM, Altman, DG, Sterne, JAC (2008). metan: Fixed- and random-effects meta-analysis. Stata Journal 8, 328.
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.
Higgins, JP, Thompson, SG, Deeks, JJ, Altman, DG (2003). Measuring inconsistency in meta-analyses. BMJ 327, 557560.
Hufford, MR (2001). Alcohol and suicidal behavior. Clinical Psychology Review 21, 797811.
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.
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.
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.
Oquendo, MA, Mann, JJ (2000). The biology of impulsivity and suicidality. Psychiatric Clinics of North America 23, 1125.
Peterson, JB, Rothfleisch, JM, Zelazo, PD, Pihl, RO (1990). Acute alcohol intoxication and cognitive functioning. Journal of Studies on Alcohol 51, 114122.
Popke, EJ, Allen, SR, Aule, MG (2000). Effects of acute ethanol on indices of cognitive–behavioral performance in rats. Alcohol 20, 187192.
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.
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.
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.
Room, R (2001). Intoxication and bad behaviour: understanding cultural differences in the link. Social Science and Medicine 53, 189198.
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.
Skog, O (1991). Alcohol and suicide – Durkheim revisited. Acta Sociologica 34, 193206.
Stata Statistical Sofware (2013). Release 13. StataCorp LP: College Station, TX.
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.
World Health Organization (2014 a). Global Status Report on Alcohol and Health 2014. World Health Organization: Geneva, Switzerland.
World Health Organization (2014 b). Preventing Suicide: A Global Imperative. World Health Organization: Geneva, Switzerland.


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

  • G. Borges (a1), C. L. Bagge (a2), C. J. Cherpitel (a3), K. R. Conner (a4), R. Orozco (a1) and I. Rossow (a5)...


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