INCREASE IN TEEN BOYS' SUICIDAL BEHAVIOUR LINKED WITH ALCOHOL MISUSE

Suicidal behaviours (ideas, attempts, or threats) are increasing in
adolescent boys, and data suggest that "alcohol misuse is the causal
factor", says Eric Fombonne (Institute of Psychiatry, London, UK). If these
time trends are confirmed in population-based studies, these findings
suggest targets for suicide prevention, he adds.

To investigate the underlying factors for increasing suicide rates,
Fombonne studied a data set of all 6091 children aged 8-18 years referred
to south London psychiatric services between 1970 and 1990. Suicidal
behaviours--a strong risk factor for suicide--increased over the 21-year
period in adolescent boys, but not in prepubertal boys or in girls of any
age. Logistic regression analysis revealed that substance misuse increased
contemporaneously in adolescent boys, and was the only such factor
predictive of suicidal behaviours (odds ratio [OR] 3B75, 95% CI
1B79-6B72). By contrast, depression was a strong correlate of suicidal
behaviours but did not increase over time, and family breakdown, which did
increase markedly, was not predictive of suicidal behaviours (Br J Psych
1998; 173: 154-59).

A review of randomly selected case notes found that alcohol was the most
frequently misused substance among the teenagers, and that "alcohol misuse
was the only behaviour showing both an increase over the study period and a
strong and positive association with suicidality". Furthermore, severity of
suicidal behaviours (attempts vs ideas or plans) was significantly
associated with alcohol misuse (OR 4B72, 95% CI 1B73-13B73).

When considered with other studies, these data suggest that alcohol misuse
may be the underlying cause behind the increase in youth suicidal
behaviours, says Fombonne, adding that psychiatrists should screen
adolescent boys for substance use, and educate vulnerable patients about
"the detrimental effects of alcohol misuse".

Checked-by: Richard Lake