Is There a Dose-dependent Positive Association Between Alcohol Consumption and Suicide Mortality?

High average alcohol consumption is associated with depression, suicide attempts, and completed suicides. Furthermore, a substantial fraction of completed suicides involve impairment-level blood alcohol concentrations indicative of ”binge” patterns of acute consumption (i.e., ≥5 drinks for men or ≥4 drinks for women per drinking occasion). However, the relationship between lower levels of consumption and the risk of suicide is less understood. Researchers conducted a meta-analysis of cohort studies of the relationship between average levels of alcohol use and death from suicide.

• Eight trials were included in the analysis; all eight included men (n=1,215,772) and three also included women (n=781,205).
• For both men and women, consuming an average of 10 g of ethanol/day (~0.7 US standard drinks) was significantly associated with an increased risk of suicide (relative risk [RR], 1.11 for men, 1.64 for women), compared with lifetime alcohol abstainers.
• Risks increased at higher levels of consumption, especially for women (RR, 1.38 for men versus 4.39 for women at 30 g/day average consumption levels), compared with lifetime abstainers.

Comments: This meta-analysis found positive associations for average alcohol consumption and the risk of death from suicide for both men and women, including at relatively low levels of consumption. Notably, the risk of suicide among women consuming an average of around four drinks daily was over four times greater than that of lifetime abstainers, and over three times greater than that of men drinking the same amounts. Future research would benefit from disentangling the effects of average consumption from those of risky patterns of consumption, which are prevalent even among those with low average consumption.

Timothy S. Naimi, MD, MPH

Reference: Lange S, Llamosas-Falcón L,Kim KV. A dose-response meta-analysis on the relationship between average amount of alcohol consumed and death by suicide. Drug Alcohol Depend. 2024;260:111348.