title: Stressful life events and suicidal behavior in adults with alcohol use disorders: role of event severity, timing, and type.
abstract: BACKGROUND
  Stressful life events (SLEs) play a key role in suicidal behavior among adults with alcohol use disorders (AUD), yet there are meager data on the severity of SLEs preceding suicidal behavior or the timing of such events.
  
  
  METHODS
  Patients in residential substance use treatment who made a recent suicide attempt (cases, n=101) and non-suicidal controls matched for site (n=101) were recruited. SLEs that occurred within 30 days of the attempt and on the day of the attempt in cases were compared to SLEs that occurred in the corresponding periods in controls. SLEs were categorized by type (interpersonal, non-interpersonal) and severity (major, minor) and were dated to assess timing. Degree of planning of suicide attempts was also assessed.
  
  
  RESULTS
  Major interpersonal SLEs conferred risk for a suicide attempt, odds ratio (95% CI)=5.50 (1.73, 17.53), p=0.005. Cases were also more likely to experience an SLE on the day of the attempt than on the corresponding day in controls, OR (95% CI)=6.05 (1.31, 28.02), p=0.021. However, cases that made an attempt on the day of a SLE did not make lower planned suicide attempts compared to other cases, suggesting that suicide attempts that are immediately preceded by SLEs cannot be assumed to be unplanned.
  
  
  CONCLUSIONS
  Results suggest the central importance of major interpersonal SLEs in risk among adults with AUD, a novel finding, and documents that SLEs may lead to suicide attempts within a short window of time (i.e., same day), a daunting challenge to prevention efforts.
authors.affiliation: University of Rochester Medical Center, 300 Crittenden Boulevard, Rochester, NY 14642, USA. kenneth conner@urmc.rochester.edu
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Conner
authors.forename: Rebecca J
authors.initials: RJ
authors.lastname: Houston
authors.forename: Marc T
authors.initials: MT
authors.lastname: Swogger
authors.forename: Yeates
authors.initials: Y
authors.lastname: Conwell
authors.forename: Sungeun
authors.initials: S
authors.lastname: You
authors.forename: Hua
authors.initials: H
authors.lastname: He
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Gamble
authors.forename: Arthur
authors.initials: A
authors.lastname: Watts
authors.forename: Paul R
authors.initials: PR
authors.lastname: Duberstein
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019973:Alcohol-Related Disorders / Q000523:psychology*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007406:Interview, Psychological; D008016:Life Change Events; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology; D013406:Suicide, Attempted / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult