Precontemplated and impulsive suicide attempts among individuals with alcohol dependence.
OBJECTIVE
Alcohol dependence confers risk for suicidal behavior. Some suicide attempts are precontemplated, whereas other attempts are impulsive. The purpose of this study was to compare characteristics and correlates of impulsive and precontemplated suicide attempts.


METHODS
Data were derived from analysis of The Collaborative Study on the Genetics of Alcoholism (COGA), which is a six-site family pedigree study of individuals in treatment for alcoholism (probands), relatives of probands, and control families. Subjects in the analysis were age 18 years or older with a diagnosis of current alcohol dependence according to the Diagnostic and Statistical Manual, Third Edition, Revised. Individuals reporting a lifetime history of one or more suicide attempts were divided into two strata: suicide attempters with a history of suicidal ideation that persisted for a week or more, conceptualized as attempters showing precontemplation (n=330), and suicide attempters without a history of persistent ideation, conceptualized as impulsive attempters (n=343). These groups were compared with subjects with no history of attempts (nonattempters; n=3115).


RESULTS
Precontemplated acts were carried out with greater intent and were more likely to result in medical treatment. Dependence on illicit drugs and history of depression were more likely among attempters showing precontemplation. Impulsive attempts were more likely to be carried out by women and individuals with higher levels of alcohol-related aggression.


CONCLUSIONS
Prevention of precontemplated suicide attempts by individuals with alcohol dependence should include a focus on recognition and treatment of depressive syndromes. Alcohol-related aggression was elevated among impulsive suicide attempters. Prevention efforts may include interventions targeting aggression.
Conner
Kenneth R
KR
Center for the Study and Prevention of Suicide and Department of Psychiatry, University of Rochester Medical Center, Rochester, New York 14620, USA. kenneth_conner@urmc.rochester.edu
Hesselbrock
Victor M
VM
Schuckit
Marc A
MA
Hirsch
Jameson K
JK
Knox
Kerry L
KL
Meldrum
Sean
S
Bucholz
Kathleen K
KK
Kramer
John
J
Kuperman
Samuel
S
Preuss
Ulrich
U
Soyka
Michael
M
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000235:genetics; D016241:Child of Impaired Parents / Q000706:statistics & numerical data; D003710:Demography; D007174:Disruptive, Impulse Control, and Conduct Disorders / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D013406:Suicide, Attempted / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013997:Time Factors