title: Do survivors respond differently when alcohol abuse complicates suicide? Findings from the psychological autopsy study in Estonia.
abstract: BACKGROUND
  When a person with alcohol use disorder commits suicide, do the immediate family members (parents, spouses, and children) react differently from the relatives of non-alcohol-related suicides?
  
  
  METHODS
  From a series of 427 psychological autopsies conducted in Estonia we selected 261 cases of suicide where the key informants were close relatives. Of the 261 suicides, 148 met the DSM-IV criteria for alcohol use disorder (alcohol abuse and alcohol dependence), while 113 did not. Unconditional logistic regression was used to estimate the association in terms of emotions.
  
  
  RESULTS
  The spouses of alcohol misusing suicides were significantly more likely to react with anger than those when alcohol did not complicate the picture (adjusted OR=3.8, 95% CI=1.4-0.4). The children of persons with alcohol use disorder, who committed suicide were less likely to feel guilty (adjusted OR=0.2, 95% CI=0.1-0.8) or abandoned (adjusted OR=0.2, 95% CI=0.1-0.7) than children of non-alcohol-related suicide victims. There were no statistically significant differences in surviving parents' emotions.
  
  
  CONCLUSIONS
  Alcohol use disorder before suicide changes affective responses in spouses and children who are left behind. Bereavement counsellors should be alert for complex grief and mourning responses among this group of suicide survivors.
authors.affiliation: Estonian-Swedish Mental Health & Suicidology Institute, Estonian Centre of Behavioural and Health Sciences, Oie 39, 11615 Tallinn, Estonia.
authors.forename: Karmel
authors.initials: K
authors.lastname: Tall
authors.forename: Kairi
authors.initials: K
authors.lastname: Kõlves
authors.forename: Merike
authors.initials: M
authors.lastname: Sisask
authors.forename: Airi
authors.initials: A
authors.lastname: Värnik
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000523:psychology*; D000786:Anger; D001601:Bereavement; D002648:Child; D002670:Child, Abandoned / Q000523:psychology; D004644:Emotions; D004957:Estonia; D005190:Family / Q000523:psychology*; D005260:Female; D006117:Grief; D006167:Guilt; D006801:Humans; D008297:Male; D008875:Middle Aged; D013405:Suicide / Q000523:psychology*; D017741:Survivors / Q000523:psychology*