title: Economic contraction, alcohol intoxication and suicide: analysis of the National Violent Death Reporting System.
abstract: OBJECTIVE
  Although there is a large and growing body of evidence concerning the impact of contracting economies on suicide mortality risk, far less is known about the role alcohol consumption plays in the complex relationship between economic conditions and suicide. The aims were to compare the postmortem alcohol intoxication rates among male and female suicide decedents before (2005-2007), during (2008-2009) and after (2010-2011) the economic contraction in the USA.
  
  
  METHODS
  Data from the restricted National Violent Death Reporting System (2005-2011) for male and female suicide decedents aged 20 years and older were analysed by Poisson regression analysis to test whether there was significant change in the fractions of suicide decedents who were acutely intoxicated at the time of death (defined as blood alcohol content ≥0.08 g/dL) prior, during and after the downturn.
  
  
  RESULTS
  The fraction of all suicide decedents with alcohol intoxication increased by 7% after the onset of the recession from 22.2% in 2005-2007 to 23.9% in 2008-2011. Compared with the years prior to the recession, male suicide decedents showed a 1.09-fold increased risk of alcohol intoxication within the first 2 years of the recession. Surprisingly, there was evidence of a lag effect among female suicide decedents, who had a 1.14-fold (95% CI 1.02 to 1.27) increased risk of intoxication in 2010-2011 compared with 2005-2007.
  
  
  CONCLUSIONS
  These findings suggest that acute alcohol intoxication in suicide interacts with economic conditions, becoming more prevalent during contractions.
authors.affiliation: Department of Social Welfare, UCLA Luskin School of Public Affairs, Los Angeles, California, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Kaplan
authors.affiliation: Center for Public Health Studies, Portland State University, Portland, Oregon, USA.
authors.forename: N
authors.initials: N
authors.lastname: Huguet
authors.affiliation: School of Public Health, University of Texas, Dallas, Texas, USA.
authors.forename: R
authors.initials: R
authors.lastname: Caetano
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: N
authors.initials: N
authors.lastname: Giesbrecht
authors.affiliation: Alcohol Research Group, Public Health Institute, Emeryville, California, USA.
authors.forename: W C
authors.initials: WC
authors.lastname: Kerr
authors.affiliation: Department of Psychiatry, Oregon Health & Science University, Portland, Oregon, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: McFarland
mesh_terms: D017677:Age Distribution; D000435:Alcoholic Intoxication / Q000097:blood / Q000401:mortality* / Q000523:psychology; D001344:Autopsy; D001774:Blood Chemical Analysis; D005260:Female; D006801:Humans; D007182:Income; D008297:Male; D011159:Population Surveillance; D011203:Poverty; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012959:Socioeconomic Factors; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology