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Meta-Analysis
. 2024 Mar 4;7(3):e241941.
doi: 10.1001/jamanetworkopen.2024.1941.

Sex-Specific Association of Alcohol Use Disorder With Suicide Mortality: A Systematic Review and Meta-Analysis

Shannon Lange  1   2   3   4 , Kawon V Kim  1 , Aurélie M Lasserre  1   5 , Heather Orpana  6   7 , Courtney Bagge  8   9 , Michael Roerecke  1   2   10 , Jürgen Rehm  1   2   3   4   10   11   12
Affiliations
Meta-Analysis

Sex-Specific Association of Alcohol Use Disorder With Suicide Mortality: A Systematic Review and Meta-Analysis

Shannon Lange et al. JAMA Netw Open. .

Abstract

Importance: Despite individual studies suggesting that sex differences exist in the association between alcohol use disorder (AUD) and suicide, most existing systematic reviews and meta-analyses have reported associations across the sexes.

Objective: To estimate the sex-specific association between AUD and suicide mortality.

Data sources: Embase, MEDLINE (including MEDLINE In-Process), PsycINFO, PubMed, and Web of Science were searched from database inception to April 27, 2022.

Study selection: Inclusion criteria consisted of the following: (1) original, quantitative study, (2) inclusion of a measure of association and its corresponding measure of variability (or sufficient data to calculate these [eg, 95% CI]), and (3) results stratified by sex.

Data extraction and synthesis: Data extraction was completed by one reviewer and then cross-checked by a second reviewer. Risk of bias was assessed by study design. Categorical random-effects meta-analyses were conducted to obtain sex-specific pooled estimates of the association between AUD and suicide mortality risk. Methodological moderators (ie, study design and comparator group) were assessed using sex-stratified meta-regressions.

Main outcomes and measures: The association between AUD and suicide mortality.

Results: A total of 16 347 unique records were identified in the systematic search; 24 studies were ultimately included for 37 870 699 participants (59.7% male and 40.3% female) (23 risk estimates for male and 17 for female participants). Participants ranged in age from 15 years to 65 years or older. Sex-specific meta-regression models indicated that study design (ie, longitudinal vs cross-sectional study design) affected the observed association between AUD and suicide mortality for both male participants (log odds ratio, 0.68 [95% CI, 0.08-1.28]; P = .03) and female participants (log odds ratio, 1.41 [95% CI, 0.57-2.24]; P < .001). For males and females, among longitudinal studies, the pooled odds ratios were 2.68 (95% CI, 1.86-3.87; I2 = 99% [n = 14]) and 2.39 (95% CI, 1.50-3.81; I2 = 90% [n = 11]), respectively.

Conclusions and relevance: This systematic review and meta-analysis yielded substantive evidence that AUD was associated with suicide mortality and that the association was similar across the sexes. The findings underscore the importance of identifying and treating AUD as part of a comprehensive suicide prevention strategy.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Lange reported receiving grant funding from Canadian Institutes of Health Research (CIHR) during the conduct of the study. Dr Lasserre reported receiving grant funding from the Swiss National Science Foundation during the conduct of the study. Dr Rehm reported receiving grant funding from the CIHR during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flowchart
Figure 2.
Figure 2.. Association of Alcohol Use Disorder With Suicide Mortality Risk Among Male Individuals by Study Design
OR indicates odds ratio. Error bars indicate 95% CI.
Figure 3.
Figure 3.. Association of Alcohol Use Disorder With Suicide Mortality Risk Among Female Individuals by Study Design
OR indicates odds ratio. Error bars indicate 95% CI.
See this image and copyright information in PMC

References

    1. World Health Organization . Suicide worldwide in 2019: global health estimates. June 16, 2021. Accessed August 7, 2023. https://www.who.int/publications/i/item/9789240026643
    1. UN General Assembly . Resolution adopted by the General Assembly on 25 September 2015: transforming our world: the 2030 Agenda for Sustainable Development. September 2015. Accessed August 7, 2023. https://www.un.org/en/development/desa/population/migration/generalassem...
    1. Ferrari AJ, Norman RE, Freedman G, et al. . The burden attributable to mental and substance use disorders as risk factors for suicide: findings from the Global Burden of Disease Study 2010. PLoS One. 2014;9(4):e91936. doi:10.1371/journal.pone.0091936 - DOI - PMC - PubMed
    1. Flensborg-Madsen T, Knop J, Mortensen EL, Becker U, Sher L, Grønbaek M. Alcohol use disorders increase the risk of completed suicide–irrespective of other psychiatric disorders: a longitudinal cohort study. Psychiatry Res. 2009;167(1-2):123-130. doi:10.1016/j.psychres.2008.01.008 - DOI - PubMed
    1. Darvishi N, Farhadi M, Haghtalab T, Poorolajal J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis. PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870 - DOI - PMC - PubMed

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