In 1999, the publication of Kay Redfield Jamison's Night Falls Fast (see Injury Prevention , December 2000; 6 :312) catalyzed national reassessment of suicide causes, prevention, and control in the USA. The book encouraged researchers to help find more and effective ways to prevent suicides and provided a base for institutionalization on suicide prevention.

A National Strategy for Suicide Prevention: Goals and Objectives for Action is the result of a process led by the US …

https://injuryprevention.bmj.com/content/injuryprev/8/2/171.1.full.pdf

National Strategy for Suicide Prevention: Goals and Objectives for Action.

Suicide exacts an enormous toll from the American people. Our Nation loses 30,000 lives to this tragedy each year, another 650,000 receive emergency care after attempting to take their own lives. The devastating trauma, loss, and suffering is multiplied in the lives of family members and friends. This document, National Strategy for Suicide Prevention – Goals and Objectives for Action, lays the foundation of our Nation's strategy to confront this serious public health problem. At this document's source are countless dedicated individuals representing every facet of our Nation's communities. They include representatives to a 1993 United Nations/World Health Organization Conference who played key roles in establishing guidelines for national suicide prevention strategies. They include the passionate grassroots activists whose work stimulated Congressional Resolutions declaring suicide prevention a national priority and calling for our own national strategy. They include dedicated public servants and private individuals who jointly organized and participated in the first National Suicide Prevention Conference in 1998 to consolidate a scientific base for this critical endeavor. These people and their efforts led directly to publication of the Surgeon General's Call to Action to Prevent Suicide-1999 with its most important recommendation , the completion of the National Strategy for Suicide Prevention. After listening to the concerns of the American people, Government leaders helped bring stakeholders together in a shining example of public private collaboration to achieve this major milestone in public health. Those who have invested their hearts and minds in this effort believe it effectively points the way for organizations and individuals to curtail the tragedy of suicide and suicidal behavior. Though it does not specify all the details, it provides essential guidance and suggests the fundamental activities that must follow–activities based on the best available science. Nearly half of the States are engaged in suicide prevention and many have already committed significant resources to implement programs. Their leadership in evaluating the effectiveness of these programs will help guide the efforts of States that follow in their paths. Most of these plans recognize that much of the work of suicide prevention must occur at the community level, where human relationships breathe life into public policy. American communities are also home to scores of faith-based and secular initiatives that help reduce risk factors and promote protective factors associated with many of our most pressing social problems, including suicide. As you read further, keep in mind that the National Strategy for …

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Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

Suicidal Behavior and Alcohol Abuse

Background: Both acute and chronic use of alcohol are associated with suicidal behavior However, the differing relationship of each component of alcohol use and possible causal mechanisms remain unclear

Methods: This article reviews and summarizes associations between acute alcohol consumption (with and without intoxication) and suicidal behavior (both completed suicide and suicide attempts) among adults 19 years and older, as presented in literature published between 1991 and 2001 Possible mechanisms and methodologic challenges for evaluating the association are also discussed An application of a research design (the case-crossover study) that has the potential for addressing the effects of acute alcohol use over and above usual or chronic use is presented

Results: The majority of articles reviewed were restricted to descriptive studies that documented the prevalence of suicide completers or attempters who tested positive for alcohol use A wide range of alcohol-positive cases were found for both completed suicide (10–69%) and suicide attempts (10–73%) Common methodologic limitations included the lack of control groups (for evaluating risk conferred by alcohol use), selection and ascertainment bias, and small sample sizes The results of the case-crossover pilot study indicated substantially higher risk of suicide during or shortly after use of alcohol compared with alcohol-free periods

Conclusions: Although there is a substantial literature of published studies on acute alcohol use and suicidal behavior, the majority of studies focus on completed suicide and report prevalence estimates Findings from such studies are subject to several possible sources of bias and have not advanced our knowledge of mechanisms in the association between acute alcohol use and suicidal behavior The case-crossover design may help to overcome some limitations of these studies and facilitate evaluation of associations and possible causal mechanisms by which acute alcohol use is linked to suicidal behavior

Acute alcohol use and suicidal behavior: a review of the literature.

The aim of this review was to review research addressing the relationship between population drinking and health, particularly mortality. The review is based primarily on articles published in international journals after 1994 to February 2005, identified via Medline. The method used in most studies is time-series analysis based on autoregressive intergrated moving average (ARIMA) modelling. The outcome measures covered included the following mortality indicators: mortality from liver cirrhosis and other alcohol-related diseases, accident mortality, suicide, homicide, ischaemic heart disease (IHD) mortality and all-cause mortality. The study countries included most of the EU member states as of 1995 (14 countries), Canada and the United States. For Eastern Europe there was only scanty evidence. The study period was in most cases the post-war period. There was a statistically significant relationship between per capita consumption and mortality from liver cirrhosis and other alcohol-related diseases in all countries. In about half the countries, there was a significant relationship between consumption, on one hand, and mortality from accidents and homicide as well as all-cause mortality on the other hand. A link between alcohol and suicide was found in all regions except for mid- and southern Europe. There was no systematic link between consumption and IHD mortality. Overall, a 1-litre increase in per capita consumption was associated with a stronger effect in northern Europe and Canada than in mid- and southern Europe. Research during the past decade has strengthened the notion of a relationship between population drinking and alcohol-related harm. At the same time, the marked regional variation in the magnitude of this relationship suggests the importance of drinking patterns for modifying the impact of alcohol. By and large, there was little evidence for any cardioprotective effect at the population level. It is a challenge for future research to reconcile this outcome with the findings from observational studies, most of which suggest a protective effect of moderate drinking.

Mortality and population drinking: a review of the literature.

The paper reviews Durkheim's theory of suicide, with particular reference to his treat ment of alcohol as a causal factor. It is argued that Durkheim views alcohol as an individual-level factor, rather than as a socio-cultural factor on a par with other social facts This conception is criticized, as is Durkheim's analysis of his data It is argued that the rate of alcohol abuse in society is a social fact that has an explanatory power beyond the level of individual suicides. Some possible causal links between the social suicide rate and rates of alcohol abuse are discussed.

Alcohol and Suicide - Durkheim Revisited:

The ecological model of density dependent organizational evolution is tested using data on the 7,709 breweries operating in the American market Besides covering the longest time period studied to date, these data allow for examination of three important issues that critics of the model have raised: (1) applicability to commercial business organizations; (2) plausibility of alternative interpretations involving size and mass; and (3) measurement of legitimation Estimates of stochastic rates of organizational founding and mortality show that, while there is merit in some of the criticisms, both rates are nonetheless non-monotonically related to organizational density in ways predicted by the model In most instances, these relationships persist when the rate functions are specified with different socio-economic control variables The strong support found for the model helps reconcile some previously reported negative evidence

Ole-Jørgen Skog

Papers

Alcohol and Suicide - Durkheim Revisited:

Alcohol and Suicide--Durkheim Revisited