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Excessive drinking has long been known to play a role in suicides. A recent review led by a School of Public Health researcher shows that certain government policies, such as those limiting liquor store density and imposing taxes on alcohol, have a protective effect in reducing suicides.

The review, published online in the journal Alcoholism: Clinical and Experimental Research, examined associations between alcohol policies and suicides, as well as alcohol levels among those who died by suicide, in 17 studies conducted between 1999 and 2014, both in the United States and internationally. While past research in this and other countries has established a link between alcohol consumption and suicide rates, research into that relationship has been limited.

The researchers discovered that overall, higher alcohol taxation was associated with lower rates of suicide. Similarly, studies gauging the effects of policies limiting the density of liquor outlets found an association between lower availability of alcohol and lower suicide rates, as well as lower odds of alcohol involvement, so-called BAC (blood alcohol concentration) levels, in suicide deaths. Other policies, such as zero tolerance laws for underage drinkers who drive while intoxicated, also were associated with a decline in suicides among young adults.

“Consistent with the conclusion that alcohol policies are among the most important population-level interventions that influence drinking levels and alcohol-related harms, our review found that such policies are important determinants in reducing suicide deaths,” says study lead author Ziming Xuan, an SPH associate professor of community health sciences. “These findings highlight the importance of population-based alcohol policies in suicide prevention.”

Among the research cited by the authors was a 2014 study that used data from 14 US states, from 2003 to 2011, to find that greater liquor store densities were associated with higher proportions of alcohol-related suicides among men.

Another study, from 2003, used youth suicide data from 1976 to 1999 and found that increases in the excise tax on beer were associated with reduced numbers of male suicides (although not affecting female suicides).

Studies in other countries produced results similar to those in this country. A 2013 study of the impact of alcohol restrictions implemented in Russia in 2006 found a 9 percent reduction in male suicides. A 2011 Canada-based study found that a rapid rise in the density of private liquor outlets in British Columbia was associated with an increase in alcohol-related deaths, including suicides.

In the review, Xuan and his coauthors advocate a public health approach to suicide prevention, rather than targeting interventions to only those people at highest risk of suicide.

“By making alcohol less available, it is possible to reduce the average risk of suicide, especially those where alcohol is involved,” they write. “Departing from approaches that narrowly target members deemed at ‘high risk’ and that commonly address suicidal behaviors almost exclusively as problems of individuals, this population-based approach is likely to maximize public health benefit and to show long-lasting influence on reducing suicide.”

The research team acknowledged several limitations of the studies they reviewed, including the wide array of the policy interventions assessed and a lack of research into the role of binge drinking, as opposed to regular heavy consumption.

They also noted that because suicide is a “multifaceted public health problem that is determined by multiple risk factors…it is important to recognize that other socio-contextual determinants (e.g., economic recession, divorce rate, firearm legislation) may independently or interactively affect suicide, in addition to alcohol policies.”

Suicide was the 10th leading cause of death in the United States in 2013, resulting in more than 41,000 deaths, or about 113 each day. Age-adjusted suicide rates have increased steadily from 1999 (10.5 per 100,000 population) to 2014 (13.0 per 100,000).

Research has established that intoxication and chronic heavy drinking often are associated with suicide. The effects of heavy alcohol use on suicide risk have been attributed to the reciprocal relationship between depression and alcohol use disorders. In addition, the authors note, alcohol use may result in “interpersonal disruption” that leads to stress-related suicidal behavior.

The other BU coauthors on the study are Richard Saitz (CAS’78, MED’87), an SPH professor and chair of community health sciences, and Timothy Naimi, an SPH associate professor of community health sciences and a School of Medicine associate professor of medicine. The study was funded in part by a grant from the National Institute on Alcohol Abuse and Alcoholism.

Lisa Chedekel can be reached at chedekel@bu.edu.