Annual AAS Conference 2012

BALTIMORE – Researchers identified markers in two genes involved in the production of norepinephrine that significantly linked with an increased rate of suicide attempts among patients with schizophrenia in an exploratory study of 241 patients.

If the findings are confirmed in expanded clinical studies, the results could advance physicians’ ability to identify patients with schizophrenia who have an elevated risk for attempting suicide, provide important leads for developing new agents to treat patients at risk for suicide, and help better target existing treatments to suicidal patients who could most benefit from them, Dr. Vincenzo De Luca said at the annual conference of the American Association of Suicidology.

Elevated noradrenergic activity is associated with aggressive behavior, which led Dr. De Luca and his associates to explore the hypothesis that a link exists between genes involved in norepinephrine metabolism and suicidal behavior in patients with schizophrenia, explained Dr. De Luca, a psychiatrist at the University of Toronto. Prior work by his group led to preliminary evidence linking a marker in a gene involved in regulating the hypothalamic-pituitary-adrenal pathway to an increased risk for suicide attempts in patients with schizophrenia (J. Psychopharmacol. 2010;24:677-82).

The current study involved 241 patients who met the DSM-IV criteria for schizophrenia and were recruited from several psychiatric care facilities in the Toronto area. The patients averaged 36 years old, with an average duration of illness of 16 years; 71% were men; and 80% were white. Fifty-three of the patients (22%) had a history of at least one well-documented suicide attempt, a rate that fits with prior reports of suicide attempt rates of 20%-50% among patients with schizophrenia, he said.

A series of analyses showed no demographic or clinical differences between the suicide attempters and nonattempters. However, the genetic analysis showed two very statistically significant differences in the prevalence of specific genetic polymorphisms in two different genes involved in norepinephrine production. One marker was in the gene for tyrosine hydroxylase (the enzyme that converts tyrosine to dopamine), and the second marker was in the gene for dopamine beta-hydroxylase (the enzyme that converts dopamine to norepinephrine).

The tyrosine hydroxylase polymorphism linked with a 3.7-fold increased rate of suicide attempts, compared with patients without the marker. And the dopamine beta-hydroxylase polymorphism linked with a 3.5-fold increased rate of suicide attempts, compared with patients who lacked this marker.

If this finding is confirmed in a larger number of patients, it might mean that these markers could constitute "a predictive test to help clinicians assess a patient’s suicide risk," Dr. De Luca said in an interview. The findings may apply not only to patients with schizophrenia, but also to patients with bipolar disorder, a possibility that also needs assessment in future clinical studies, he said. Key elements in trying to make these genetic links are having "clean," well-characterized, and well-documented data about patients’ clinical status; their diagnosed phenotypes; their suicide-attempt histories; and their ethnicity, as well as a large number of potential genetic markers.

Dr. De Luca said he had no relevant financial disclosures.

BALTIMORE – Researchers identified markers in two genes involved in the production of norepinephrine that significantly linked with an increased rate of suicide attempts among patients with schizophrenia in an exploratory study of 241 patients.

If the findings are confirmed in expanded clinical studies, the results could advance physicians’ ability to identify patients with schizophrenia who have an elevated risk for attempting suicide, provide important leads for developing new agents to treat patients at risk for suicide, and help better target existing treatments to suicidal patients who could most benefit from them, Dr. Vincenzo De Luca said at the annual conference of the American Association of Suicidology.

Elevated noradrenergic activity is associated with aggressive behavior, which led Dr. De Luca and his associates to explore the hypothesis that a link exists between genes involved in norepinephrine metabolism and suicidal behavior in patients with schizophrenia, explained Dr. De Luca, a psychiatrist at the University of Toronto. Prior work by his group led to preliminary evidence linking a marker in a gene involved in regulating the hypothalamic-pituitary-adrenal pathway to an increased risk for suicide attempts in patients with schizophrenia (J. Psychopharmacol. 2010;24:677-82).

The current study involved 241 patients who met the DSM-IV criteria for schizophrenia and were recruited from several psychiatric care facilities in the Toronto area. The patients averaged 36 years old, with an average duration of illness of 16 years; 71% were men; and 80% were white. Fifty-three of the patients (22%) had a history of at least one well-documented suicide attempt, a rate that fits with prior reports of suicide attempt rates of 20%-50% among patients with schizophrenia, he said.

A series of analyses showed no demographic or clinical differences between the suicide attempters and nonattempters. However, the genetic analysis showed two very statistically significant differences in the prevalence of specific genetic polymorphisms in two different genes involved in norepinephrine production. One marker was in the gene for tyrosine hydroxylase (the enzyme that converts tyrosine to dopamine), and the second marker was in the gene for dopamine beta-hydroxylase (the enzyme that converts dopamine to norepinephrine).

The tyrosine hydroxylase polymorphism linked with a 3.7-fold increased rate of suicide attempts, compared with patients without the marker. And the dopamine beta-hydroxylase polymorphism linked with a 3.5-fold increased rate of suicide attempts, compared with patients who lacked this marker.

If this finding is confirmed in a larger number of patients, it might mean that these markers could constitute "a predictive test to help clinicians assess a patient’s suicide risk," Dr. De Luca said in an interview. The findings may apply not only to patients with schizophrenia, but also to patients with bipolar disorder, a possibility that also needs assessment in future clinical studies, he said. Key elements in trying to make these genetic links are having "clean," well-characterized, and well-documented data about patients’ clinical status; their diagnosed phenotypes; their suicide-attempt histories; and their ethnicity, as well as a large number of potential genetic markers.

Dr. De Luca said he had no relevant financial disclosures.

BALTIMORE – Researchers identified markers in two genes involved in the production of norepinephrine that significantly linked with an increased rate of suicide attempts among patients with schizophrenia in an exploratory study of 241 patients.

If the findings are confirmed in expanded clinical studies, the results could advance physicians’ ability to identify patients with schizophrenia who have an elevated risk for attempting suicide, provide important leads for developing new agents to treat patients at risk for suicide, and help better target existing treatments to suicidal patients who could most benefit from them, Dr. Vincenzo De Luca said at the annual conference of the American Association of Suicidology.

Elevated noradrenergic activity is associated with aggressive behavior, which led Dr. De Luca and his associates to explore the hypothesis that a link exists between genes involved in norepinephrine metabolism and suicidal behavior in patients with schizophrenia, explained Dr. De Luca, a psychiatrist at the University of Toronto. Prior work by his group led to preliminary evidence linking a marker in a gene involved in regulating the hypothalamic-pituitary-adrenal pathway to an increased risk for suicide attempts in patients with schizophrenia (J. Psychopharmacol. 2010;24:677-82).

The current study involved 241 patients who met the DSM-IV criteria for schizophrenia and were recruited from several psychiatric care facilities in the Toronto area. The patients averaged 36 years old, with an average duration of illness of 16 years; 71% were men; and 80% were white. Fifty-three of the patients (22%) had a history of at least one well-documented suicide attempt, a rate that fits with prior reports of suicide attempt rates of 20%-50% among patients with schizophrenia, he said.

A series of analyses showed no demographic or clinical differences between the suicide attempters and nonattempters. However, the genetic analysis showed two very statistically significant differences in the prevalence of specific genetic polymorphisms in two different genes involved in norepinephrine production. One marker was in the gene for tyrosine hydroxylase (the enzyme that converts tyrosine to dopamine), and the second marker was in the gene for dopamine beta-hydroxylase (the enzyme that converts dopamine to norepinephrine).

The tyrosine hydroxylase polymorphism linked with a 3.7-fold increased rate of suicide attempts, compared with patients without the marker. And the dopamine beta-hydroxylase polymorphism linked with a 3.5-fold increased rate of suicide attempts, compared with patients who lacked this marker.

If this finding is confirmed in a larger number of patients, it might mean that these markers could constitute "a predictive test to help clinicians assess a patient’s suicide risk," Dr. De Luca said in an interview. The findings may apply not only to patients with schizophrenia, but also to patients with bipolar disorder, a possibility that also needs assessment in future clinical studies, he said. Key elements in trying to make these genetic links are having "clean," well-characterized, and well-documented data about patients’ clinical status; their diagnosed phenotypes; their suicide-attempt histories; and their ethnicity, as well as a large number of potential genetic markers.

Dr. De Luca said he had no relevant financial disclosures.

BALTIMORE – The 35,000 American suicides that occurred in 2007 as well as attempted suicides that year cost the United States a total of roughly $48 billion in direct and indirect expenses.

This economic impact highlights the potential financial benefit from allocating additional resources toward suicide prevention, Donald S. Shepard, Ph.D., said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"Investment in additional medical and counseling services would be relatively inexpensive and would likely reduce these national costs. It would pay for itself in economic terms, and it would also pay for itself many times over in human terms," said Dr. Shepard, a health economist and professor of health policy at Brandeis University in Waltham, Mass.

Dr. Shepard identified three primary opportunities for suicide prevention that he derived from the analysis:

• Strengthen the capacity of emergency departments to identify patients at risk.

• Strengthen the availability of community-based providers to treat patients at risk.

• Strengthen the linkage between acute care and community-based behavioral-health delivery systems to ensure continuity of care.

"The costs really make the case for an ounce of prevention," said Jerry Reed, Ph.D., director of the Center for the Study and Prevention of Injury, Violence ,and Suicide at the Education Development Center in Waltham, and a collaborator on the study. "If we can connect people with resources in the community and have the resources resolve the burden, we can save what these people contribute to the economic prosperity of the nation," Dr. Reed said. "Further investment in [suicide] prevention would be very productive."

To make their cost estimate, Dr. Shepard, Dr. Reed, and their associates began with the 34,598 U.S. suicides in 2007, the most recent year with complete data available at the time they began their analysis, as well as nonfatal attempted suicides that year. They identified the total direct medical costs for the fatal and nonfatal self-inflicted injuries as $1.3 billion, calculated in 2012 dollars and adjusted to 2012 medical costs. They then added to this their calculated $46.3 billion in indirect costs, primarily from the fatal suicide attempts, a figure that primarily derives from lost future productivity, especially lost wages. The total cost added up to $47.6 billion projected for this year, with 83% accounted for by men and 17% by women.

This estimate is conservative, because the number of completed suicides and nonfatal attempts has risen since 2007, Dr. Shepard said. A manuscript based on this material has been submitted for publication, he added.

Dr. Shepard and Dr. Reed said they had no relevant relevant financial disclosures.

BALTIMORE – The 35,000 American suicides that occurred in 2007 as well as attempted suicides that year cost the United States a total of roughly $48 billion in direct and indirect expenses.

This economic impact highlights the potential financial benefit from allocating additional resources toward suicide prevention, Donald S. Shepard, Ph.D., said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"Investment in additional medical and counseling services would be relatively inexpensive and would likely reduce these national costs. It would pay for itself in economic terms, and it would also pay for itself many times over in human terms," said Dr. Shepard, a health economist and professor of health policy at Brandeis University in Waltham, Mass.

Dr. Shepard identified three primary opportunities for suicide prevention that he derived from the analysis:

• Strengthen the capacity of emergency departments to identify patients at risk.

• Strengthen the availability of community-based providers to treat patients at risk.

• Strengthen the linkage between acute care and community-based behavioral-health delivery systems to ensure continuity of care.

"The costs really make the case for an ounce of prevention," said Jerry Reed, Ph.D., director of the Center for the Study and Prevention of Injury, Violence ,and Suicide at the Education Development Center in Waltham, and a collaborator on the study. "If we can connect people with resources in the community and have the resources resolve the burden, we can save what these people contribute to the economic prosperity of the nation," Dr. Reed said. "Further investment in [suicide] prevention would be very productive."

To make their cost estimate, Dr. Shepard, Dr. Reed, and their associates began with the 34,598 U.S. suicides in 2007, the most recent year with complete data available at the time they began their analysis, as well as nonfatal attempted suicides that year. They identified the total direct medical costs for the fatal and nonfatal self-inflicted injuries as $1.3 billion, calculated in 2012 dollars and adjusted to 2012 medical costs. They then added to this their calculated $46.3 billion in indirect costs, primarily from the fatal suicide attempts, a figure that primarily derives from lost future productivity, especially lost wages. The total cost added up to $47.6 billion projected for this year, with 83% accounted for by men and 17% by women.

This estimate is conservative, because the number of completed suicides and nonfatal attempts has risen since 2007, Dr. Shepard said. A manuscript based on this material has been submitted for publication, he added.

Dr. Shepard and Dr. Reed said they had no relevant relevant financial disclosures.

BALTIMORE – The 35,000 American suicides that occurred in 2007 as well as attempted suicides that year cost the United States a total of roughly $48 billion in direct and indirect expenses.

This economic impact highlights the potential financial benefit from allocating additional resources toward suicide prevention, Donald S. Shepard, Ph.D., said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"Investment in additional medical and counseling services would be relatively inexpensive and would likely reduce these national costs. It would pay for itself in economic terms, and it would also pay for itself many times over in human terms," said Dr. Shepard, a health economist and professor of health policy at Brandeis University in Waltham, Mass.

Dr. Shepard identified three primary opportunities for suicide prevention that he derived from the analysis:

• Strengthen the capacity of emergency departments to identify patients at risk.

• Strengthen the availability of community-based providers to treat patients at risk.

• Strengthen the linkage between acute care and community-based behavioral-health delivery systems to ensure continuity of care.

"The costs really make the case for an ounce of prevention," said Jerry Reed, Ph.D., director of the Center for the Study and Prevention of Injury, Violence ,and Suicide at the Education Development Center in Waltham, and a collaborator on the study. "If we can connect people with resources in the community and have the resources resolve the burden, we can save what these people contribute to the economic prosperity of the nation," Dr. Reed said. "Further investment in [suicide] prevention would be very productive."

To make their cost estimate, Dr. Shepard, Dr. Reed, and their associates began with the 34,598 U.S. suicides in 2007, the most recent year with complete data available at the time they began their analysis, as well as nonfatal attempted suicides that year. They identified the total direct medical costs for the fatal and nonfatal self-inflicted injuries as $1.3 billion, calculated in 2012 dollars and adjusted to 2012 medical costs. They then added to this their calculated $46.3 billion in indirect costs, primarily from the fatal suicide attempts, a figure that primarily derives from lost future productivity, especially lost wages. The total cost added up to $47.6 billion projected for this year, with 83% accounted for by men and 17% by women.

This estimate is conservative, because the number of completed suicides and nonfatal attempts has risen since 2007, Dr. Shepard said. A manuscript based on this material has been submitted for publication, he added.

Dr. Shepard and Dr. Reed said they had no relevant relevant financial disclosures.

BALTIMORE – A cognitive-behavioral intervention showed promise for reducing suicidal ideation among substance users in a pilot, controlled study with 46 patients.

"Preliminary evidence supports the short-term efficacy of CBT [cognitive-behavioral therapy] for suicidal substance users, but more comprehensive data are needed," Mark A. Ilgen, Ph.D., said at the annual conference of the American Association of Suicidology.

The study’s main finding was that among 22 patients assessed 1 month after the end of a 4-week CBT intervention, 3 participants (14%) said they had recent suicidal ideation, compared with 10 of 24 (42%) people from the control arm of the study, a statistically significant difference, said Dr. Ilgen, a psychologist at the University of Michigan in Ann Arbor.

Suicidal ideation and attempts among substance users receive little attention in "standard" addiction-treatment programs. But attention in this area is needed because "substance use disorders are strong risk factors for suicide attempts," he said. Results from prior studies of people receiving substance use treatment showed that 45% reported making at least one suicide attempt, and a third reported suicidal ideation within the prior 2 weeks.

The current study by Dr. Ilgen and his associates began with 56 people enrolled in a residential addiction-treatment program in Waterford, Mich.; many of the residents lived at the center in lieu of going to jail, he noted. The participants in Dr. Ilgen’s study all had a history of at least one suicide attempt and current suicidal ideation. The researchers randomized 29 people into the CBT intervention and 27 into a control education-support program. The intervention consisted of eight sessions, done twice a week for 4 weeks.

The average age of the participants was 32, and they closely split between women and men. About four-fifths were white, 71% had used more than one substance, and 70% had a history of at least two suicide attempts.

Dr. Ilgen modeled the CBT intervention on CBT programs used for depression and substance use that have a focus on avoiding and managing suicidal crises. The program began with a suicide-risk assessment; subsequent sessions included the development of a narrative of past suicide attempts; advice on safety plans, coping skills, and problem solving; identifying reasons for living; and guidance on social support and relapse prevention. Patients in the CBT program attended an average of six of the eight scheduled sessions, while those in the control group attended an average of seven sessions.

Forty-six of the 56 enrolled participants returned for a follow-up assessment 1 month after the end of treatment, and 36 returned for a second assessment 3 months following treatment. At the first follow-up, participants in the CBT program had a significantly reduced prevalence of suicidal ideation, compared with the controls. The CBT participants also had statistically significant reductions in several other measurements of suicidality at 1-month follow-up. A wish to die sentiment was expressed by 8 of the 22 assessed (38%) in the CBT group, vs. 14 of the 24 (58%) controls. The average number of depressive symptoms was 14 in the CBT group and 18.8 in the controls. And the average level of suicide self-efficacy was 133 in the CBT patients, significantly higher than the average of 106 among the controls.

In contrast, the researchers found no statistically significant differences between the two treatment groups at the 3-month follow-up, possibly in part explained by the reduced number of study participants who returned for the second assessment, Dr. Ilgen said.

He said he had no relevant financial disclosures.

BALTIMORE – A cognitive-behavioral intervention showed promise for reducing suicidal ideation among substance users in a pilot, controlled study with 46 patients.

"Preliminary evidence supports the short-term efficacy of CBT [cognitive-behavioral therapy] for suicidal substance users, but more comprehensive data are needed," Mark A. Ilgen, Ph.D., said at the annual conference of the American Association of Suicidology.

The study’s main finding was that among 22 patients assessed 1 month after the end of a 4-week CBT intervention, 3 participants (14%) said they had recent suicidal ideation, compared with 10 of 24 (42%) people from the control arm of the study, a statistically significant difference, said Dr. Ilgen, a psychologist at the University of Michigan in Ann Arbor.

Suicidal ideation and attempts among substance users receive little attention in "standard" addiction-treatment programs. But attention in this area is needed because "substance use disorders are strong risk factors for suicide attempts," he said. Results from prior studies of people receiving substance use treatment showed that 45% reported making at least one suicide attempt, and a third reported suicidal ideation within the prior 2 weeks.

The current study by Dr. Ilgen and his associates began with 56 people enrolled in a residential addiction-treatment program in Waterford, Mich.; many of the residents lived at the center in lieu of going to jail, he noted. The participants in Dr. Ilgen’s study all had a history of at least one suicide attempt and current suicidal ideation. The researchers randomized 29 people into the CBT intervention and 27 into a control education-support program. The intervention consisted of eight sessions, done twice a week for 4 weeks.

The average age of the participants was 32, and they closely split between women and men. About four-fifths were white, 71% had used more than one substance, and 70% had a history of at least two suicide attempts.

Dr. Ilgen modeled the CBT intervention on CBT programs used for depression and substance use that have a focus on avoiding and managing suicidal crises. The program began with a suicide-risk assessment; subsequent sessions included the development of a narrative of past suicide attempts; advice on safety plans, coping skills, and problem solving; identifying reasons for living; and guidance on social support and relapse prevention. Patients in the CBT program attended an average of six of the eight scheduled sessions, while those in the control group attended an average of seven sessions.

Forty-six of the 56 enrolled participants returned for a follow-up assessment 1 month after the end of treatment, and 36 returned for a second assessment 3 months following treatment. At the first follow-up, participants in the CBT program had a significantly reduced prevalence of suicidal ideation, compared with the controls. The CBT participants also had statistically significant reductions in several other measurements of suicidality at 1-month follow-up. A wish to die sentiment was expressed by 8 of the 22 assessed (38%) in the CBT group, vs. 14 of the 24 (58%) controls. The average number of depressive symptoms was 14 in the CBT group and 18.8 in the controls. And the average level of suicide self-efficacy was 133 in the CBT patients, significantly higher than the average of 106 among the controls.

In contrast, the researchers found no statistically significant differences between the two treatment groups at the 3-month follow-up, possibly in part explained by the reduced number of study participants who returned for the second assessment, Dr. Ilgen said.

He said he had no relevant financial disclosures.

BALTIMORE – A cognitive-behavioral intervention showed promise for reducing suicidal ideation among substance users in a pilot, controlled study with 46 patients.

"Preliminary evidence supports the short-term efficacy of CBT [cognitive-behavioral therapy] for suicidal substance users, but more comprehensive data are needed," Mark A. Ilgen, Ph.D., said at the annual conference of the American Association of Suicidology.

The study’s main finding was that among 22 patients assessed 1 month after the end of a 4-week CBT intervention, 3 participants (14%) said they had recent suicidal ideation, compared with 10 of 24 (42%) people from the control arm of the study, a statistically significant difference, said Dr. Ilgen, a psychologist at the University of Michigan in Ann Arbor.

Suicidal ideation and attempts among substance users receive little attention in "standard" addiction-treatment programs. But attention in this area is needed because "substance use disorders are strong risk factors for suicide attempts," he said. Results from prior studies of people receiving substance use treatment showed that 45% reported making at least one suicide attempt, and a third reported suicidal ideation within the prior 2 weeks.

The current study by Dr. Ilgen and his associates began with 56 people enrolled in a residential addiction-treatment program in Waterford, Mich.; many of the residents lived at the center in lieu of going to jail, he noted. The participants in Dr. Ilgen’s study all had a history of at least one suicide attempt and current suicidal ideation. The researchers randomized 29 people into the CBT intervention and 27 into a control education-support program. The intervention consisted of eight sessions, done twice a week for 4 weeks.

The average age of the participants was 32, and they closely split between women and men. About four-fifths were white, 71% had used more than one substance, and 70% had a history of at least two suicide attempts.

Dr. Ilgen modeled the CBT intervention on CBT programs used for depression and substance use that have a focus on avoiding and managing suicidal crises. The program began with a suicide-risk assessment; subsequent sessions included the development of a narrative of past suicide attempts; advice on safety plans, coping skills, and problem solving; identifying reasons for living; and guidance on social support and relapse prevention. Patients in the CBT program attended an average of six of the eight scheduled sessions, while those in the control group attended an average of seven sessions.

Forty-six of the 56 enrolled participants returned for a follow-up assessment 1 month after the end of treatment, and 36 returned for a second assessment 3 months following treatment. At the first follow-up, participants in the CBT program had a significantly reduced prevalence of suicidal ideation, compared with the controls. The CBT participants also had statistically significant reductions in several other measurements of suicidality at 1-month follow-up. A wish to die sentiment was expressed by 8 of the 22 assessed (38%) in the CBT group, vs. 14 of the 24 (58%) controls. The average number of depressive symptoms was 14 in the CBT group and 18.8 in the controls. And the average level of suicide self-efficacy was 133 in the CBT patients, significantly higher than the average of 106 among the controls.

In contrast, the researchers found no statistically significant differences between the two treatment groups at the 3-month follow-up, possibly in part explained by the reduced number of study participants who returned for the second assessment, Dr. Ilgen said.

He said he had no relevant financial disclosures.

BALTIMORE – Acutely suicidal adolescents who also were bullies had a heightened prevalence of suicidal ideation, substance use, and functional impairment, compared with similar suicidal adolescents who were not bullies, a review of more than 400 American teenagers has shown.

Results from a post hoc analysis of a suicide intervention trial also showed that the bullying behaviors in most study participants resolved over the course of 1 year.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents," Cheryl A. King, Ph.D., reported in a poster at the meeting. "The coinciding improvement in mental health suggests that targeting bullying perpetrators for treatment could improve outcomes for both the bullies as well as potential victims," said Dr. King, professor of psychology and director of the institute for human adjustment at the University of Michigan in Ann Arbor.

The post hoc analysis she and her associates ran included 433 of the 448 hospitalized, suicidal adolescents, aged 13-17, who participated in the Youth-Nominated Support Team–Version II intervention study (J. Consulting Clin. Psychology 2009;77:880-93). The investigators randomized suicidal teenagers in a psychiatric hospital to receive either usual care or usual care plus the Youth-Nominated Support Team–Version II intervention, a 3-month treatment based on social support and healthy behavior models. Results from the primary analysis showed very limited positive effects from this intervention, with no effect on suicide attempts and no enduring effect on suicidal ideation scores.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents."

For the post hoc analysis, the researchers evaluated 433 of the participating adolescents at baseline on a bullying scale that rated each participant by six criteria: teasing, physical attacks, meanness to others, destroying belongings of others, threats to hurt others, and getting into many fights. Fifty-four (12%) of the adolescents included in this analysis met the assessment’s threshold for being bullies.

The bully subgroup had significantly higher levels of suicidal ideation, substance use, and functional impairment, compared with the other teens in the study who did not meet the bully criteria.

One year after their first assessment, 4 of the original 54 teens who met the bullying criteria continued to have scores that classified them as bullies. In addition, 12 other adolescents who initially had not met the bullying criteria did so when they underwent reassessment at 12 months. Most of those initially identified as bullies showed improvements in their suicidal ideation and substance use during the following 12 months. However, they continued to have greater functional impairment than the nonbullies at 12 months.

The total group of 16 adolescents who met the bullying criteria at 1 year again showed higher levels of suicidal ideation and other suicide risk factors, compared with the nonbullies.

The factors that shape the fluctuating trajectories of bullying in this study population might help identify targets for intervention that could decrease bullying and suicidal behaviors among adolescents, Dr. King and her associates concluded.

Dr. King said she had no relevant financial disclosures.

BALTIMORE – Acutely suicidal adolescents who also were bullies had a heightened prevalence of suicidal ideation, substance use, and functional impairment, compared with similar suicidal adolescents who were not bullies, a review of more than 400 American teenagers has shown.

Results from a post hoc analysis of a suicide intervention trial also showed that the bullying behaviors in most study participants resolved over the course of 1 year.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents," Cheryl A. King, Ph.D., reported in a poster at the meeting. "The coinciding improvement in mental health suggests that targeting bullying perpetrators for treatment could improve outcomes for both the bullies as well as potential victims," said Dr. King, professor of psychology and director of the institute for human adjustment at the University of Michigan in Ann Arbor.

The post hoc analysis she and her associates ran included 433 of the 448 hospitalized, suicidal adolescents, aged 13-17, who participated in the Youth-Nominated Support Team–Version II intervention study (J. Consulting Clin. Psychology 2009;77:880-93). The investigators randomized suicidal teenagers in a psychiatric hospital to receive either usual care or usual care plus the Youth-Nominated Support Team–Version II intervention, a 3-month treatment based on social support and healthy behavior models. Results from the primary analysis showed very limited positive effects from this intervention, with no effect on suicide attempts and no enduring effect on suicidal ideation scores.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents."

For the post hoc analysis, the researchers evaluated 433 of the participating adolescents at baseline on a bullying scale that rated each participant by six criteria: teasing, physical attacks, meanness to others, destroying belongings of others, threats to hurt others, and getting into many fights. Fifty-four (12%) of the adolescents included in this analysis met the assessment’s threshold for being bullies.

The bully subgroup had significantly higher levels of suicidal ideation, substance use, and functional impairment, compared with the other teens in the study who did not meet the bully criteria.

One year after their first assessment, 4 of the original 54 teens who met the bullying criteria continued to have scores that classified them as bullies. In addition, 12 other adolescents who initially had not met the bullying criteria did so when they underwent reassessment at 12 months. Most of those initially identified as bullies showed improvements in their suicidal ideation and substance use during the following 12 months. However, they continued to have greater functional impairment than the nonbullies at 12 months.

The total group of 16 adolescents who met the bullying criteria at 1 year again showed higher levels of suicidal ideation and other suicide risk factors, compared with the nonbullies.

The factors that shape the fluctuating trajectories of bullying in this study population might help identify targets for intervention that could decrease bullying and suicidal behaviors among adolescents, Dr. King and her associates concluded.

Dr. King said she had no relevant financial disclosures.

BALTIMORE – Acutely suicidal adolescents who also were bullies had a heightened prevalence of suicidal ideation, substance use, and functional impairment, compared with similar suicidal adolescents who were not bullies, a review of more than 400 American teenagers has shown.

Results from a post hoc analysis of a suicide intervention trial also showed that the bullying behaviors in most study participants resolved over the course of 1 year.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents," Cheryl A. King, Ph.D., reported in a poster at the meeting. "The coinciding improvement in mental health suggests that targeting bullying perpetrators for treatment could improve outcomes for both the bullies as well as potential victims," said Dr. King, professor of psychology and director of the institute for human adjustment at the University of Michigan in Ann Arbor.

The post hoc analysis she and her associates ran included 433 of the 448 hospitalized, suicidal adolescents, aged 13-17, who participated in the Youth-Nominated Support Team–Version II intervention study (J. Consulting Clin. Psychology 2009;77:880-93). The investigators randomized suicidal teenagers in a psychiatric hospital to receive either usual care or usual care plus the Youth-Nominated Support Team–Version II intervention, a 3-month treatment based on social support and healthy behavior models. Results from the primary analysis showed very limited positive effects from this intervention, with no effect on suicide attempts and no enduring effect on suicidal ideation scores.

"These findings highlight the importance of specifically assessing for and targeting bullying behavior when treating suicidal adolescents."

For the post hoc analysis, the researchers evaluated 433 of the participating adolescents at baseline on a bullying scale that rated each participant by six criteria: teasing, physical attacks, meanness to others, destroying belongings of others, threats to hurt others, and getting into many fights. Fifty-four (12%) of the adolescents included in this analysis met the assessment’s threshold for being bullies.

The bully subgroup had significantly higher levels of suicidal ideation, substance use, and functional impairment, compared with the other teens in the study who did not meet the bully criteria.

One year after their first assessment, 4 of the original 54 teens who met the bullying criteria continued to have scores that classified them as bullies. In addition, 12 other adolescents who initially had not met the bullying criteria did so when they underwent reassessment at 12 months. Most of those initially identified as bullies showed improvements in their suicidal ideation and substance use during the following 12 months. However, they continued to have greater functional impairment than the nonbullies at 12 months.

The total group of 16 adolescents who met the bullying criteria at 1 year again showed higher levels of suicidal ideation and other suicide risk factors, compared with the nonbullies.

The factors that shape the fluctuating trajectories of bullying in this study population might help identify targets for intervention that could decrease bullying and suicidal behaviors among adolescents, Dr. King and her associates concluded.

Dr. King said she had no relevant financial disclosures.

BALTIMORE – Family-focused treatment might be an effective intervention for veterans at risk for suicide, based on findings from a preliminary study with 52 veterans and their families at one U.S. center.

Future work could involve modifying conventional family-focused treatment (FFT) to make it more appropriate for veterans with suicidal thoughts and behaviors, Elizabeth D. Ballard said at the annual conference of the American Association of Suicidology.

The assessment she and her associates performed included 52 veterans with suicidal thoughts and behaviors and their families who self-selected to participate in a series of FFT sessions at the Veterans Affairs Medical Center in Denver. Each veteran participated in an average of 13 sessions; the median number of sessions for each veteran was 14.

Before the FFT intervention began, 24 of the 52 veterans (46%) had been hospitalized at least once for a suicide-related cause, and in the year preceding the start of the FFT sessions 14 (27%) had at least one suicide-related hospitalization. The hospitalization rate appeared to drop off during and after the FFT program, with six participants (12%) requiring hospitalization for a suicide-related cause during FFT, six needing hospitalization immediately after the FFT program, and three (6%) hospitalized for a suicide-related reason during the year after the program, said Ms. Ballard, a researcher in the Mental Illness Research Education and Clinical Center at the VA Medical Center in Denver.

The effect on suicide-related hospitalizations was "striking," and provides a basis for further study of FFT as an intervention for veterans at risk for suicide, Ms. Ballard said in an interview. But she emphasized that the current study had not been designed to measure the efficacy of FFT in this setting.

She and her associates looked at FFT because the treatment was originally developed for patients with bipolar disorder (Am. J. Psychiatry 2008;165:1408-19), and bipolar disorder is associated with suicide and suicide attempts in both the general population and in veterans, Ms. Ballard said. However, no family-oriented interventions currently exists geared specifically toward suicide issues.

The researchers’ first step involved assessing FFT’s applicability when applied in an unmodified way. Among the 52 veterans who opted for FFT (about a third of veterans at risk for suicide at the time at the Denver VAMC), 90% were men, and their average age was 44 years old. In all, 42 (81%) of the veterans who participated in the FFT program had a diagnosis of bipolar disorder.

The patients participated in a total of 698 FFT sessions. Patients could bring whichever family members they wanted. In 66% of sessions a spouse was present, in 25% of sessions a mother attended, and in 6% of sessions a father attended.

Suicide-related thoughts or behaviors came up during 55 of the 698 sessions (8%), but other thoughts or behaviors considered to be suicide risk factors occurred during 540 (77%) of the sessions. The FFT sessions were not designed to elicit references to suicide, and suicide was not brought up by the therapists who ran the FFT sessions, Ms. Ballard said.

Future work might involve an assessment of the impact of FFT on suicide risk, with a more systematic measure of suicidal thoughts and behaviors before and after the FFT interventions, she said.

Ms. Ballard had no disclosures.

BALTIMORE – Family-focused treatment might be an effective intervention for veterans at risk for suicide, based on findings from a preliminary study with 52 veterans and their families at one U.S. center.

Future work could involve modifying conventional family-focused treatment (FFT) to make it more appropriate for veterans with suicidal thoughts and behaviors, Elizabeth D. Ballard said at the annual conference of the American Association of Suicidology.

The assessment she and her associates performed included 52 veterans with suicidal thoughts and behaviors and their families who self-selected to participate in a series of FFT sessions at the Veterans Affairs Medical Center in Denver. Each veteran participated in an average of 13 sessions; the median number of sessions for each veteran was 14.

Before the FFT intervention began, 24 of the 52 veterans (46%) had been hospitalized at least once for a suicide-related cause, and in the year preceding the start of the FFT sessions 14 (27%) had at least one suicide-related hospitalization. The hospitalization rate appeared to drop off during and after the FFT program, with six participants (12%) requiring hospitalization for a suicide-related cause during FFT, six needing hospitalization immediately after the FFT program, and three (6%) hospitalized for a suicide-related reason during the year after the program, said Ms. Ballard, a researcher in the Mental Illness Research Education and Clinical Center at the VA Medical Center in Denver.

The effect on suicide-related hospitalizations was "striking," and provides a basis for further study of FFT as an intervention for veterans at risk for suicide, Ms. Ballard said in an interview. But she emphasized that the current study had not been designed to measure the efficacy of FFT in this setting.

She and her associates looked at FFT because the treatment was originally developed for patients with bipolar disorder (Am. J. Psychiatry 2008;165:1408-19), and bipolar disorder is associated with suicide and suicide attempts in both the general population and in veterans, Ms. Ballard said. However, no family-oriented interventions currently exists geared specifically toward suicide issues.

The researchers’ first step involved assessing FFT’s applicability when applied in an unmodified way. Among the 52 veterans who opted for FFT (about a third of veterans at risk for suicide at the time at the Denver VAMC), 90% were men, and their average age was 44 years old. In all, 42 (81%) of the veterans who participated in the FFT program had a diagnosis of bipolar disorder.

The patients participated in a total of 698 FFT sessions. Patients could bring whichever family members they wanted. In 66% of sessions a spouse was present, in 25% of sessions a mother attended, and in 6% of sessions a father attended.

Suicide-related thoughts or behaviors came up during 55 of the 698 sessions (8%), but other thoughts or behaviors considered to be suicide risk factors occurred during 540 (77%) of the sessions. The FFT sessions were not designed to elicit references to suicide, and suicide was not brought up by the therapists who ran the FFT sessions, Ms. Ballard said.

Future work might involve an assessment of the impact of FFT on suicide risk, with a more systematic measure of suicidal thoughts and behaviors before and after the FFT interventions, she said.

Ms. Ballard had no disclosures.

BALTIMORE – Family-focused treatment might be an effective intervention for veterans at risk for suicide, based on findings from a preliminary study with 52 veterans and their families at one U.S. center.

Future work could involve modifying conventional family-focused treatment (FFT) to make it more appropriate for veterans with suicidal thoughts and behaviors, Elizabeth D. Ballard said at the annual conference of the American Association of Suicidology.

The assessment she and her associates performed included 52 veterans with suicidal thoughts and behaviors and their families who self-selected to participate in a series of FFT sessions at the Veterans Affairs Medical Center in Denver. Each veteran participated in an average of 13 sessions; the median number of sessions for each veteran was 14.

Before the FFT intervention began, 24 of the 52 veterans (46%) had been hospitalized at least once for a suicide-related cause, and in the year preceding the start of the FFT sessions 14 (27%) had at least one suicide-related hospitalization. The hospitalization rate appeared to drop off during and after the FFT program, with six participants (12%) requiring hospitalization for a suicide-related cause during FFT, six needing hospitalization immediately after the FFT program, and three (6%) hospitalized for a suicide-related reason during the year after the program, said Ms. Ballard, a researcher in the Mental Illness Research Education and Clinical Center at the VA Medical Center in Denver.

The effect on suicide-related hospitalizations was "striking," and provides a basis for further study of FFT as an intervention for veterans at risk for suicide, Ms. Ballard said in an interview. But she emphasized that the current study had not been designed to measure the efficacy of FFT in this setting.

She and her associates looked at FFT because the treatment was originally developed for patients with bipolar disorder (Am. J. Psychiatry 2008;165:1408-19), and bipolar disorder is associated with suicide and suicide attempts in both the general population and in veterans, Ms. Ballard said. However, no family-oriented interventions currently exists geared specifically toward suicide issues.

The researchers’ first step involved assessing FFT’s applicability when applied in an unmodified way. Among the 52 veterans who opted for FFT (about a third of veterans at risk for suicide at the time at the Denver VAMC), 90% were men, and their average age was 44 years old. In all, 42 (81%) of the veterans who participated in the FFT program had a diagnosis of bipolar disorder.

The patients participated in a total of 698 FFT sessions. Patients could bring whichever family members they wanted. In 66% of sessions a spouse was present, in 25% of sessions a mother attended, and in 6% of sessions a father attended.

Suicide-related thoughts or behaviors came up during 55 of the 698 sessions (8%), but other thoughts or behaviors considered to be suicide risk factors occurred during 540 (77%) of the sessions. The FFT sessions were not designed to elicit references to suicide, and suicide was not brought up by the therapists who ran the FFT sessions, Ms. Ballard said.

Future work might involve an assessment of the impact of FFT on suicide risk, with a more systematic measure of suicidal thoughts and behaviors before and after the FFT interventions, she said.

Ms. Ballard had no disclosures.

BALTIMORE – Suicides by active-duty soldiers in the U.S. Army reached their highest level in history last year, with 164 confirmed instances of soldiers taking their lives.

This unprecedented level came in the seventh consecutive year of steadily increasing suicide rates; in 2008, the suicide rate among active-duty U.S. Army personnel exceeded the prevailing civilian rate for the first time in history, and in the years following 2008 the annual rate among soldiers continued to rise, Maj. Gen. L.P. Chang said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"The Army takes this very seriously because our most valuable asset is our soldiers," said Gen. Chang, commanding general of the 807th Medical Command based in Fort Douglas, Utah. He noted that in 2009, with the Army’s leadership recognizing that the suicide rate had surpassed the rate among civilians, the U.S. Department of Defense launched a suicide prevention task force that, among other goals, has worked to update suicide education and prevention programs. "It will take continued, concerted effort to begin to see the results we’re expecting from the changes that have been implemented," said Gen. Chang, who is also a doctor of osteopathic medicine practicing in Alexandria, Va.

According to Army data presented by Gen. Chang, the suicide rate among active-duty soldiers stood at 10 episodes per 100,000 in 2004, and then steadily rose to a level of 22 per 100,000 in both 2009 and 2010. The rate seen last year projected to a new high, of 24 per 100,000, he said. Throughout this period, the suicide rate among American civilian adults held steady at about 19 episodes per 100,000.

Army data for the first 3 months of 2012 showed no ebbing of the suicide rate. In a press release on April 18, the Department of Defense reported 45 potential suicides among active-duty Army personnel during the first 3 months of 2012, including 20 confirmed suicides and 25 episodes still under investigation. At that rate, the 2012 rate could exceed what happened last year: In May 2011, the Department of Defense reported that during the first 3 months of last year it had tallied six confirmed suicides and was investigating an additional 24 possible cases.

The factors behind the burgeoning rate of Army suicides since 2004 remain unclear. "Our hypothesis is that repeated exposures to stressors have changed," said Gen. Chang, and he particularly cited the increasing rate of multiple deployments among U.S. soldiers as a possible contributing factor. In 2011, 43% of soldiers had been deployed more than once, a statistic that has risen steadily in recent years. But other factors also play a role. Data collected by the Army showed that among active-duty soldiers work-related stress is the most common stressor faced, followed by relationship issues, and discipline.

An Army study of the most immediate triggers identifiable just before suicides during 2007-2011 were failed relationships (37%), followed by work problems (21%), legal concerns (16%), and financial problems (6%). But Gen. Chang added "a lot of relationship and work problems can be financial." The data also showed that about 19% of the suicides involved alcohol use, he said.

Gen. Chang said he had no disclosures.

BALTIMORE – Suicides by active-duty soldiers in the U.S. Army reached their highest level in history last year, with 164 confirmed instances of soldiers taking their lives.

This unprecedented level came in the seventh consecutive year of steadily increasing suicide rates; in 2008, the suicide rate among active-duty U.S. Army personnel exceeded the prevailing civilian rate for the first time in history, and in the years following 2008 the annual rate among soldiers continued to rise, Maj. Gen. L.P. Chang said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"The Army takes this very seriously because our most valuable asset is our soldiers," said Gen. Chang, commanding general of the 807th Medical Command based in Fort Douglas, Utah. He noted that in 2009, with the Army’s leadership recognizing that the suicide rate had surpassed the rate among civilians, the U.S. Department of Defense launched a suicide prevention task force that, among other goals, has worked to update suicide education and prevention programs. "It will take continued, concerted effort to begin to see the results we’re expecting from the changes that have been implemented," said Gen. Chang, who is also a doctor of osteopathic medicine practicing in Alexandria, Va.

According to Army data presented by Gen. Chang, the suicide rate among active-duty soldiers stood at 10 episodes per 100,000 in 2004, and then steadily rose to a level of 22 per 100,000 in both 2009 and 2010. The rate seen last year projected to a new high, of 24 per 100,000, he said. Throughout this period, the suicide rate among American civilian adults held steady at about 19 episodes per 100,000.

Army data for the first 3 months of 2012 showed no ebbing of the suicide rate. In a press release on April 18, the Department of Defense reported 45 potential suicides among active-duty Army personnel during the first 3 months of 2012, including 20 confirmed suicides and 25 episodes still under investigation. At that rate, the 2012 rate could exceed what happened last year: In May 2011, the Department of Defense reported that during the first 3 months of last year it had tallied six confirmed suicides and was investigating an additional 24 possible cases.

The factors behind the burgeoning rate of Army suicides since 2004 remain unclear. "Our hypothesis is that repeated exposures to stressors have changed," said Gen. Chang, and he particularly cited the increasing rate of multiple deployments among U.S. soldiers as a possible contributing factor. In 2011, 43% of soldiers had been deployed more than once, a statistic that has risen steadily in recent years. But other factors also play a role. Data collected by the Army showed that among active-duty soldiers work-related stress is the most common stressor faced, followed by relationship issues, and discipline.

An Army study of the most immediate triggers identifiable just before suicides during 2007-2011 were failed relationships (37%), followed by work problems (21%), legal concerns (16%), and financial problems (6%). But Gen. Chang added "a lot of relationship and work problems can be financial." The data also showed that about 19% of the suicides involved alcohol use, he said.

Gen. Chang said he had no disclosures.

BALTIMORE – Suicides by active-duty soldiers in the U.S. Army reached their highest level in history last year, with 164 confirmed instances of soldiers taking their lives.

This unprecedented level came in the seventh consecutive year of steadily increasing suicide rates; in 2008, the suicide rate among active-duty U.S. Army personnel exceeded the prevailing civilian rate for the first time in history, and in the years following 2008 the annual rate among soldiers continued to rise, Maj. Gen. L.P. Chang said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

"The Army takes this very seriously because our most valuable asset is our soldiers," said Gen. Chang, commanding general of the 807th Medical Command based in Fort Douglas, Utah. He noted that in 2009, with the Army’s leadership recognizing that the suicide rate had surpassed the rate among civilians, the U.S. Department of Defense launched a suicide prevention task force that, among other goals, has worked to update suicide education and prevention programs. "It will take continued, concerted effort to begin to see the results we’re expecting from the changes that have been implemented," said Gen. Chang, who is also a doctor of osteopathic medicine practicing in Alexandria, Va.

According to Army data presented by Gen. Chang, the suicide rate among active-duty soldiers stood at 10 episodes per 100,000 in 2004, and then steadily rose to a level of 22 per 100,000 in both 2009 and 2010. The rate seen last year projected to a new high, of 24 per 100,000, he said. Throughout this period, the suicide rate among American civilian adults held steady at about 19 episodes per 100,000.

Army data for the first 3 months of 2012 showed no ebbing of the suicide rate. In a press release on April 18, the Department of Defense reported 45 potential suicides among active-duty Army personnel during the first 3 months of 2012, including 20 confirmed suicides and 25 episodes still under investigation. At that rate, the 2012 rate could exceed what happened last year: In May 2011, the Department of Defense reported that during the first 3 months of last year it had tallied six confirmed suicides and was investigating an additional 24 possible cases.

The factors behind the burgeoning rate of Army suicides since 2004 remain unclear. "Our hypothesis is that repeated exposures to stressors have changed," said Gen. Chang, and he particularly cited the increasing rate of multiple deployments among U.S. soldiers as a possible contributing factor. In 2011, 43% of soldiers had been deployed more than once, a statistic that has risen steadily in recent years. But other factors also play a role. Data collected by the Army showed that among active-duty soldiers work-related stress is the most common stressor faced, followed by relationship issues, and discipline.

An Army study of the most immediate triggers identifiable just before suicides during 2007-2011 were failed relationships (37%), followed by work problems (21%), legal concerns (16%), and financial problems (6%). But Gen. Chang added "a lot of relationship and work problems can be financial." The data also showed that about 19% of the suicides involved alcohol use, he said.

Gen. Chang said he had no disclosures.

BALTIMORE – Alcohol intoxication commonly exists at the time when Americans take their lives, especially among men, younger adults, and those who use firearms to commit suicide.

During 2003-2009, roughly 20% of all U.S. residents who killed themselves had blood alcohol levels that met the standard definition of intoxication, a level of at least 0.08 g/dL, Mark S. Kaplan, Dr.P.H. said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

The prevalence of intoxication at the time of death was 24% among men and 17% among women, based on data from nearly 44,000 suicides that occurred from 2003 to 2009 in data reported to the National Violent Death Reporting System, a program of the Centers for Disease Control and Prevention.

"There is a relationship between young age, alcohol use, and use of highly lethal means" in suicide decedents, said Dr. Kaplan, professor of community health at Portland (Ore.) State University. "There is a lethal combination of gun availability, alcohol, and a precipitating life crisis. The message to clinicians is that they need to probe for alcohol misuse among patients at risk for suicide," he said in an interview.

"Alcohol is especially relevant in younger-age adults because suicide is more impulsive" at younger ages, he explained. "Alcohol serves as a lubricant, as a disinhibitor. What alcohol does in younger-age groups is short circuit the standard suicide trajectory. We see less of this in older-age people because, perhaps, their suicide attempts are more planned and there is less need for disinhibition."

Other types of drug abuse can play a similar role, but alcohol is by far the number-one agent for abuse because of its greater availability. "This is new evidence that is nationally based that suggests that acute intoxication is a problem for suicide that needs to be addressed," Dr. Kaplan said.

He and his associates used data collected by the National Violent Death Reporting System, which began collecting information on U.S. violent decedents in 2002 and currently gathers data in 18 states. The researchers used data collected during 2003-2009 from 16 states where information existed for the entire state. (The states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Wisconsin, and Virginia.) Among the 57,813 total suicide deaths included in the database, information on blood alcohol levels obtained soon after death was available for 76% of decedents.

Prevalence of alcohol intoxication varied by state and by sex, ranging from a high of about 47% among women and about 37% for men in Alaska to a low of about 7% in women and about 10% for men in New Jersey. Alaska was the only state where intoxication prevalence among women suicide decedents exceeded prevalence in men.

Alcohol intoxication prevalence also varied by age, race and ethnicity, education level, metropolitan versus nonmetropolitan residence, veteran status, and suicide method used.

In a series of adjusted analyses that controlled for these variables, the highest prevalence of alcohol intoxication by age was in men aged 25-34 years and those aged 35-44, who were 28% and 33%, respectively, more likely to be intoxicated at the time of their death than the reference group, men aged 18-24 – differences that were statistically significant. Men aged 55 and older were significantly less likely to be intoxicated than the reference group, and the prevalence of intoxication fell off markedly among men aged 65 and older. No subgroup of women by age showed a significantly increased rate of intoxication prevalence, but older women showed a significantly decreased prevalence.

The adjusted analyses also highlighted other subgroups with an especially high prevalence of intoxication at the time of their suicide. Decedents categorized as American Indian or Alaskan Native who were men had a significant 78% higher prevalence and women had a significant 99% higher prevalence, compared with white men and woman, the reference group.

When categorized by method of suicide, men who used firearms had a 76% increased prevalence and women who used firearms had a 68% increased prevalence compared with decedents who used poison, the reference group. Another method that linked with intoxication was hanging or suffocation, which was 38% higher in men and 48% higher in women, compared with the reference group. All these between-group differences were statistically significant.

Dr. Kaplan said that he had no relevant financial disclosures.

BALTIMORE – Alcohol intoxication commonly exists at the time when Americans take their lives, especially among men, younger adults, and those who use firearms to commit suicide.

During 2003-2009, roughly 20% of all U.S. residents who killed themselves had blood alcohol levels that met the standard definition of intoxication, a level of at least 0.08 g/dL, Mark S. Kaplan, Dr.P.H. said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

The prevalence of intoxication at the time of death was 24% among men and 17% among women, based on data from nearly 44,000 suicides that occurred from 2003 to 2009 in data reported to the National Violent Death Reporting System, a program of the Centers for Disease Control and Prevention.

"There is a relationship between young age, alcohol use, and use of highly lethal means" in suicide decedents, said Dr. Kaplan, professor of community health at Portland (Ore.) State University. "There is a lethal combination of gun availability, alcohol, and a precipitating life crisis. The message to clinicians is that they need to probe for alcohol misuse among patients at risk for suicide," he said in an interview.

"Alcohol is especially relevant in younger-age adults because suicide is more impulsive" at younger ages, he explained. "Alcohol serves as a lubricant, as a disinhibitor. What alcohol does in younger-age groups is short circuit the standard suicide trajectory. We see less of this in older-age people because, perhaps, their suicide attempts are more planned and there is less need for disinhibition."

Other types of drug abuse can play a similar role, but alcohol is by far the number-one agent for abuse because of its greater availability. "This is new evidence that is nationally based that suggests that acute intoxication is a problem for suicide that needs to be addressed," Dr. Kaplan said.

He and his associates used data collected by the National Violent Death Reporting System, which began collecting information on U.S. violent decedents in 2002 and currently gathers data in 18 states. The researchers used data collected during 2003-2009 from 16 states where information existed for the entire state. (The states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Wisconsin, and Virginia.) Among the 57,813 total suicide deaths included in the database, information on blood alcohol levels obtained soon after death was available for 76% of decedents.

Prevalence of alcohol intoxication varied by state and by sex, ranging from a high of about 47% among women and about 37% for men in Alaska to a low of about 7% in women and about 10% for men in New Jersey. Alaska was the only state where intoxication prevalence among women suicide decedents exceeded prevalence in men.

Alcohol intoxication prevalence also varied by age, race and ethnicity, education level, metropolitan versus nonmetropolitan residence, veteran status, and suicide method used.

In a series of adjusted analyses that controlled for these variables, the highest prevalence of alcohol intoxication by age was in men aged 25-34 years and those aged 35-44, who were 28% and 33%, respectively, more likely to be intoxicated at the time of their death than the reference group, men aged 18-24 – differences that were statistically significant. Men aged 55 and older were significantly less likely to be intoxicated than the reference group, and the prevalence of intoxication fell off markedly among men aged 65 and older. No subgroup of women by age showed a significantly increased rate of intoxication prevalence, but older women showed a significantly decreased prevalence.

The adjusted analyses also highlighted other subgroups with an especially high prevalence of intoxication at the time of their suicide. Decedents categorized as American Indian or Alaskan Native who were men had a significant 78% higher prevalence and women had a significant 99% higher prevalence, compared with white men and woman, the reference group.

When categorized by method of suicide, men who used firearms had a 76% increased prevalence and women who used firearms had a 68% increased prevalence compared with decedents who used poison, the reference group. Another method that linked with intoxication was hanging or suffocation, which was 38% higher in men and 48% higher in women, compared with the reference group. All these between-group differences were statistically significant.

Dr. Kaplan said that he had no relevant financial disclosures.

BALTIMORE – Alcohol intoxication commonly exists at the time when Americans take their lives, especially among men, younger adults, and those who use firearms to commit suicide.

During 2003-2009, roughly 20% of all U.S. residents who killed themselves had blood alcohol levels that met the standard definition of intoxication, a level of at least 0.08 g/dL, Mark S. Kaplan, Dr.P.H. said at the annual conference of the American Association of Suicidology.

Mitchel L. Zoler/IMNG Medical Media

The prevalence of intoxication at the time of death was 24% among men and 17% among women, based on data from nearly 44,000 suicides that occurred from 2003 to 2009 in data reported to the National Violent Death Reporting System, a program of the Centers for Disease Control and Prevention.

"There is a relationship between young age, alcohol use, and use of highly lethal means" in suicide decedents, said Dr. Kaplan, professor of community health at Portland (Ore.) State University. "There is a lethal combination of gun availability, alcohol, and a precipitating life crisis. The message to clinicians is that they need to probe for alcohol misuse among patients at risk for suicide," he said in an interview.

"Alcohol is especially relevant in younger-age adults because suicide is more impulsive" at younger ages, he explained. "Alcohol serves as a lubricant, as a disinhibitor. What alcohol does in younger-age groups is short circuit the standard suicide trajectory. We see less of this in older-age people because, perhaps, their suicide attempts are more planned and there is less need for disinhibition."

Other types of drug abuse can play a similar role, but alcohol is by far the number-one agent for abuse because of its greater availability. "This is new evidence that is nationally based that suggests that acute intoxication is a problem for suicide that needs to be addressed," Dr. Kaplan said.

He and his associates used data collected by the National Violent Death Reporting System, which began collecting information on U.S. violent decedents in 2002 and currently gathers data in 18 states. The researchers used data collected during 2003-2009 from 16 states where information existed for the entire state. (The states: Alaska, Colorado, Georgia, Kentucky, Maryland, Massachusetts, New Jersey, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Wisconsin, and Virginia.) Among the 57,813 total suicide deaths included in the database, information on blood alcohol levels obtained soon after death was available for 76% of decedents.

Prevalence of alcohol intoxication varied by state and by sex, ranging from a high of about 47% among women and about 37% for men in Alaska to a low of about 7% in women and about 10% for men in New Jersey. Alaska was the only state where intoxication prevalence among women suicide decedents exceeded prevalence in men.

Alcohol intoxication prevalence also varied by age, race and ethnicity, education level, metropolitan versus nonmetropolitan residence, veteran status, and suicide method used.

In a series of adjusted analyses that controlled for these variables, the highest prevalence of alcohol intoxication by age was in men aged 25-34 years and those aged 35-44, who were 28% and 33%, respectively, more likely to be intoxicated at the time of their death than the reference group, men aged 18-24 – differences that were statistically significant. Men aged 55 and older were significantly less likely to be intoxicated than the reference group, and the prevalence of intoxication fell off markedly among men aged 65 and older. No subgroup of women by age showed a significantly increased rate of intoxication prevalence, but older women showed a significantly decreased prevalence.

The adjusted analyses also highlighted other subgroups with an especially high prevalence of intoxication at the time of their suicide. Decedents categorized as American Indian or Alaskan Native who were men had a significant 78% higher prevalence and women had a significant 99% higher prevalence, compared with white men and woman, the reference group.

When categorized by method of suicide, men who used firearms had a 76% increased prevalence and women who used firearms had a 68% increased prevalence compared with decedents who used poison, the reference group. Another method that linked with intoxication was hanging or suffocation, which was 38% higher in men and 48% higher in women, compared with the reference group. All these between-group differences were statistically significant.

Dr. Kaplan said that he had no relevant financial disclosures.