Alcohol use by suicide victims in the city of Sao Paulo, Brazil, 2011–2015
Introduction
Suicide refers to all causes of death triggered by the action of the victim against him or herself, with awareness of the likely outcome.1 It is a leading cause of violent death worldwide and one of the four leading causes of death among individuals between 15 and 44 years old,2 making it a public health issue.3
The worldwide suicide rates may be influenced by cultural, regional and socio-demographic factors2, 4 and suicide may be related to several predisposing factors, such as domestic problems, unemployment, poverty, financial difficulties, previous suicide attempts, family history, stressful life events, chronic diseases, psychiatric conditions – particularly depression and substance abuse/dependence on alcohol and drugs.5, 6, 7, 8, 9
There are some studies in Brazil on suicide mortality. Lovisi et al. (2009) observed that the overall rate of suicide in Brazil, from 1980 to 2006, increased from 4.4 to 5.7 deaths per 100,000 inhabitants, representing an increase of 29.5%, with prevalence of male victims (77.3%). The most employed suicide methods were: hanging (47.2%), injury by firearms (18.7%) and intentional self-poisoning (14.3%).10
Alcohol is a licit psychoactive, easily available and low cost drug, making it one of the most consumed substances worldwide.11 Excessive alcohol consumption and/or abuse of other drugs are closely linked to suicide deaths,12 as drunkenness can affect critical judgment and self-control and trigger suicidal behavior. It is well recognized that individuals with a history of psychoactive substances abuse are overrepresented in mortality statistics.13, 14, 15
Studies in European and North American countries indicate the association between alcohol consumption and suicide, despite the socio-cultural differences.16 In Sweden, it was observed that 34% of suicide victims had consumed alcohol before death, with mean BAC levels of 1.32 ± 0.89 g/L, wherein 71% of the victims were males and 29% females.17 In Germany, it was found that 32% of suicide attempts were after acute ingestion of alcohol.18 In Finland, 36% of suicide victims were found with positive BAC, and a positive BAC was observed twice more often in men than in women.19 In the United States, 24% of suicide victims had BAC greater than 0.8 g/L,20 and the prevalence of alcohol consumption among suicide victims in the state of New Mexico was 44.3%, with mean BAC levels of 1.98 ± 0.88 g/L.21 In a study conducted in the United Kingdom, from 1988 to 1995, 45% of suicide victims had positive BAC.15 In Ireland, from 2001 to 2002, 55.5% of suicide victims had consumed alcohol before committing suicide, with mean BAC levels of 1.6 g/L.22 In Australia, 41% of suicide victims had positive BAC and, among these, 44% were men and 27% women, and it was observed that the prevalence of alcohol differed according to the suicide method.23
Brazil has a high prevalence of alcohol consumption and dependence.24 According to the “I National inquiry about alcohol consumption patterns in Brazilian population”, 45% of adults who drink alcohol reported they have or have had at least one injury related to the use/abuse of alcohol.25
Carlini-Cotrim et al. (1998) found that 36.2% of suicide victims in the metropolitan region of Sao Paulo, Brazil, in 1994 had a positive BAC; the majority of the victims was male (77%) and belonged to the age group 20–39 years (44%).26 Ponce et al. (2008) found that 37.1% of men and 20.1% of women suicide victims had positive BAC in the State of Sao Paulo, Brazil, in 2005; with prevalence of male victims (76.4%) and prevalence of age group 20–49 years (68%). In this study, hanging was the most prevalent suicide method (39.8%).27 Sinagawa et al. (2008) reported that 32.1% of suicide victims had positive BAC, with mean BAC levels of 1.6 g/L, in Sao Paulo, Brazil, in 2006.28 Zerbini et al. (2012) found that 37.5% of suicide victims by hanging had positive BAC in Sao Paulo city, Brazil, in 2007; the mean BAC levels was 1.80 ± 0.90 g/L, with prevalence of male victims (84.2%), prevalence of age group 15–44 years (67.4%) and mean age of 38 years.29
The results of these studies support the hypothesis that people have more suicidal thoughts and behavior when they consume alcohol,30 because there was a dose-response relationship: the higher the alcohol consumption, the greater the prevalence of suicidal behaviors.31 Furthermore, it was also noted that the reduction of alcohol consumption in some countries was associated with a decrease in the number of suicides, while in others, high alcohol consumption was associated with high suicide rates.32, 33
Despite the considerable prevalence of suicides and other violent deaths in Brazil, there is a lack of studies that allow an epidemiological approach to support possible public health policies on this issue. Similarly, there is little information and epidemiological data on alcohol consumption in Brazil that show its association with suicide mortality in order to be included in preventive strategies aiming to reduce mortality from suicide. Premature death generates repercussions with economic and social consequences, and the identification of individuals at high risk of committing suicide is the major challenge for health professionals.11
Section snippets
Objective
The objective of this study was to analyze the association between alcohol consumption and suicide deaths in the city of Sao Paulo, from 2011 to 2015, as well as its relationship with socio-demographic characteristics of the victims and the circumstances of the suicide: gender, age, ethnicity, suicide method, and blood alcohol concentration (BAC).
Methods
A cross-sectional retrospective study was conducted by analyzing the secondary data of suicide victims from the city of Sao Paulo, Brazil, from 2011 to 2015. Data were reviewed from the Institute of Legal Medicine of the State of Sao Paulo and the State Criminal Information System (INFOCRIM). Cases that were marked as solved suicides, after criminal investigation, were selected. The inclusion criteria was only suicide victims subjected to examination of BAC (n = 1700).
Data consisted of
Results
This study examined data from 1700 suicide victims subjected to examination of blood alcohol concentration (BAC).
Table 1 presents socio-demographic information, BAC levels as positive and negative and suicide methods. In the sample studied, 30.24% (514 cases) of the victims had a positive BAC, and the BAC results ranged from 0.3 g/L to 5.6 g/L, with mean BAC levels of 1.73 ± 0 08 g/L. The mean age of the sample was 39.90 ± 0.75 years (n = 1700).
Suicide victims were predominantly males (74.59%,
Discussion
In Brazil, the investigation of deaths by external causes (homicides, suicides, traffic accidents, etc) is carried out by the Police of the State in which it happened and includes, besides the police investigation, a crime scene analysis and post mortem examination of the victim. The results of these investigations, as well as the cause and method of death are registered in an online Criminal Information System (INFOCRIM). For the present study, cases that were ultimately classified as
Ethics
This study was based on confidential data and the identity of the victims has been preserved. The study protocol was approved by the Research Ethics Committee of the University of Sao Paulo Medical School, Brazil (Protocol n. 097/15).
Conflicts of interest
None.
Acknowledgments
The authors wish to thank Dr. Victor Alexandre Percinio Gianvecchio and to the Institute of Legal Medicine of Sao Paulo for their continuing support in conducting the data collection and the LIM-40-HCFMUSP.
References (40)
- et al.
Suicides in northern India: comparison of trends and review of literature
J Forensic Leg Med
(2007) - et al.
Suicide Lancet
(2009) - et al.
Toxicology findings in suicides: concentrations of ethanol and other drugs in femoral blood in victims of hanging and poisoning in relation to age and gender of the deceased
J Forensic Leg Med
(2013) - et al.
Who takes alcohol prior to suicide?
J Clin Forensic Med
(1998) - et al.
Demographics of suicide victims in Sweden in relation to their blood-alcohol concentration and the circumstances and manner of death
Forensic Sci Int
(2010) - et al.
The role of alcohol use disorder and alcohol consumption in suicide attempts: a secondary analysis of 1921 suicide attempts
Eur Psychiatry
(2010) - et al.
Blood alcohol levels in suicide by hanging cases in the state of Sao Paulo
Braz J Forensic Leg Med
(2012) Alcohol and suicidal behaviour
Clin Psychol Rev
(2001)Suicides and alcohol consumption in Russia, 1965-1999
Drug Alcohol Dependence
(2003)- et al.
Is suicide under the influence of alcohol a deliberate self-harm syndrome? An autopsy study of lethality
J Affect Disord
(2015 May 15)
The effects of introducing or lowering legal per se blood alcohol limits for driving: an international review
Accid Anal Prev
Suicídio [Suicide]
Clinical epidemiology of suicide
J Clin Psychiatry
Suicides of alcohol misusers and non-misusers in a nationwide population
Alcohol Alcohol
Characteristics of attempted suicides seen in emergency-care settings of general hospital in eight low- and middle-income countries
Psychol Med
Completed suicide after a suicide attempt: a 37-year follow-up study
Am J Psychiatry
Sex differences in risk factors for suicide after attempted suicide: a follow-up study of 1052 suicide attempters
Soc Psychiatry Pschiatr Epidemiol
Análise epidemiológica do suicídio no Brasil entre 1980 e 2006 [Epidemiological analysis of suicide in Brazil from 1980 to 2006]
Rev Bras Psiquiatr
Alcohol consumption in homicide victims in the city of São Paulo
Addiction
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