The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism
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.
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Subjects
Participants were recruited through advertising and referrals and participated in mood disorders research in a university hospital. All subjects gave written informed consent as required by the Institutional Review Board for Biomedical Research. In all, 219 depressed subjects (n=62 males and n=157 females) without a history of any alcohol or substance abuse/dependence and 129 (n=49 males and n=80 females) depressed individuals with a history of alcohol abuse/dependence participated in the
Demographic data
Demographic and clinical characteristics of depressed subjects with or without a history of alcoholism are presented in Table 1, Table 2, Table 3. Subjects with a history of alcoholism were younger, less likely to be married, and had fewer years of education compared with subjects without a history of alcoholism.
Clinical characrteristics
Subjects with a history of alcoholism were younger at the time of the first depressive episode and at the time of the first hospitalization than subjects without alcoholism (Table 3).
Alcoholism and suicidality
We found that depressed subjects with a history of alcoholism were more likely to be suicide attempters than depressed subjects without a history of alcoholism, and that suicide ideators with a history of alcoholism had higher suicidal ideation scores than suicide ideators without a history of alcoholism. Our findings are consistent with the literature reporting higher suicidal ideation and higher risk for attempted suicides in individuals with alcoholism compared to persons without a history
Acknowledgements
This work was partly supported by MH62185 and MH48514.
References (53)
- et al.
Personality, smoking and suicide: A prospective study
Journal of Affective Disorders
(1998) - et al.
Aggression in human correlates with cerebrospinal fluid amine metabolites
Psychiatry Research
(1979) - et al.
A longitudinal study of the order of onset of alcohol dependence and major depression
Drug and Alcohol Dependence
(2001) - et al.
Additional psychiatric illness by diagnostic interview schedule in male alcoholics
Comprehensive Psychiatry
(1990) - et al.
Essential fatty acids predict metabolites of serotonin and dopamine in cerebrospinal fluid among healthy control subjects, and early-and late-onset alcoholics
Biological Psychiatry
(1998) - et al.
Serotonin and alcohol intake, abuse, and dependence: Clinical evidence
Biological Psychiatry
(1994) - et al.
Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior
Life Science
(1983) - et al.
Suicidal behavior in bipolar mood disorder: Clinical characteristics of attempters and nonattempters
Journal of Affective Disorders
(2000) - et al.
Aggressivity, suicide attempts, and depression: Relationship to cerebrospinal fluid monoamine metabolite levels
Biological Psychiatry
(2001) - et al.
Risk of suicide in mood disorders
Clinical Neuroscience Research
(2001)
Mortality in relation to smoking history: 13 years' follow-up of 68,000 Norwegian men and women 35–49 years
Journal of Clinical Epidemiology
Diagnostic and statistical manual of mental disorders (DSM-IV)
A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts
Journal of Clinical Psychiatry
Factor analysis of some psychometric measures of impulsiveness and anxiety
Psychological Reports
Classification of suicidal behaviors: I. Quantifying intent and medical lethality
American Journal of Psychiatry
Assessment of suicidal intention: The scale for suicide ideation
Journal of Consulting and Clinical Psychology
An inventory for measuring depression
Archives of General Psychiatry
The measurement of pessimism: The hopelessness scale
Journal of Consulting and Clinical Psychology
Cross-validation of the suicidal intent scale
Psychological Reports
Affective disorders and suicide risk: A reexamination
American Journal of Psychiatry
Human aggression and suicide
Suicide and Life Threatening Behavior
Genetic heterogeneity and the classification of alcoholism
Advances in Alcohol and Substance Abuse
Neurotransmitter correlates of impulsive aggression in humans
Annals of New York Academy of Sciences
Patterns of suicidality and alcohol use in alcoholics with major depression
Alcoholism: Clinical and Experimental Research
Co-morbid depression and drinking outcome in those with alcohol dependence
Alcohol and Alcoholism
Mortality in relation to smoking: 20 years' observations on male British doctors
British Medical Journal
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