The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism

Abstract

Background

Alcoholism and depression are often comorbid. Studies suggest that depressed subjects with alcoholism have more chronic impairment and suicidal behavior than individuals with either diagnosis alone. The reason for higher rate of suicide and suicide attempts in comorbid subjects is uncertain. We explored clinical characteristics that may be associated with this increased suicidality.

Methods

In all, 219 depressed subjects (n=62 males and n=157 females) without a history of any alcohol or substance use disorder and 129 (n=49 males and n=80 females) depressed individuals with a prior history of alcohol use disorder participated in the study. Demographic and clinical parameters were assessed and recorded.

Results

Depressed subjects with a history of alcoholism had higher lifetime aggression and impulsivity, and were more likely to report a history of childhood abuse, suicide attempts, and tobacco smoking. Depressed suicide ideators with a history of alcoholism had higher suicide ideation scores than depressed suicide ideators without a history of alcoholism. Subjects with a history of alcoholism were younger at the time of the first depressive episode and first hospitalization than those without a history of alcoholism. Logistic regression analysis indicated that alcoholism was significantly associated with smoking and aggression. Suicidal behavior and higher suicidal ideation in depressed subjects with a history of alcoholism might be attributed to higher aggression scores in this group.

Conclusion

The greater frequency of suicidal behavior and severity of suicidal ideation in major depression with comorbid alcoholism appears related to associated aggressive traits. Alcoholism, aggression, smoking, and suicide may have a common biological causal substrate.

Introduction

Alcohol dependence and affective disorders are often comorbid (Cornelius et al., 1996, Davidson & Blackburn, 1998, Gilman & Abraham, 2001, Herz et al., 1990, O'Sullivan et al., 1988, Schuckit, 1986, Spak et al., 2000, Thase et al., 2001). Schuckit (1986) suggests that between one-quarter and two-thirds of subjects with alcoholism have had depressive symptoms severe enough to interfere with functioning.

Suicide is commonly associated with depression and alcoholism (Mann, 2003, Oquendo et al., 1997, Roy & Linnoila, 1986, Sher et al., 2001). The lifetime mortality due to suicide in major depression is estimated to range from 2% to 15% depending on severity and inpatient status (Bostwick & Pankratz, 2000, Sher et al., 2001). Lifetime mortality due to suicide in alcoholism was been reported to be as high as 18% (Roy & Linnoila, 1986) although others give lower estimates (2–15%) (Murphy & Wetzel, 1990).

Studies suggest that depressed subjects with alcoholism have more chronic impairment and suicidal behavior than individuals with either diagnosis alone (O'Sullivan et al., 1988, Cornelius et al., 1996, Thase et al., 2001). The reason for the higher rate of suicide and suicide attempts in comorbid subjects is uncertain. A number of studies suggest that aggression and smoking are associated with suicidal behavior as well as with substance abuse (Angst & Clayton, 1998, Doll & Peto, 1976, Hemenway et al., 1993, Koller et al., 2002, Malone et al., 2003, Mann et al., 1999, Miller et al., 2000, Oquendo et al., 2000, Paffenbarger et al., 1994, Placidi et al., 2001, Sher et al., 2001, Tanskanen et al., 1998, Tverdal et al., 1993). We hypothesized that (1) subjects with alcoholism and depression will have greater aggression scores and more likely to be smokers; and (2) higher suicidality in depressed subjects with alcoholism is related to higher aggression and higher prevalence of smoking in this group.