title: Risk and protective factors for suicide mortality among patients with alcohol dependence.
abstract: People with alcohol dependence suffer from poor health outcomes, including excessive suicide mortality. This study estimated the suicide rate and explored the risk and protective factors for suicide in a large-scale Asian population.
  
  
  
  We enrolled patients with alcohol dependence (ICD-9 code 303**) consecutively admitted to a psychiatric center in northern Taiwan from January 1, 1985, through December 31, 2008 (N = 2,793). Using patient linkage to the national mortality database (1985-2008), we determined that 960 patients died during the study period. Of those deaths, 65 patients died of suicide. On the basis of risk-set sampling for the selection of controls, we conducted a nested case-control study and collected the information by means of a standardized chart review process. We estimated the standardized mortality ratio (SMR) for suicide mortality. Conditional logistic regression was employed for exploring the risk and protective factors for suicide.
  
  
  
  The study subjects had excessive suicide and all-cause deaths, with SMRs of 21.2 and 12.7, respectively. We pinpointed auditory hallucination (adjusted risk ratio [aRR] = 1.80, P = .04) and attempted suicide (aRR = 7.52, P = .001) as the risk factors associated with suicide. In contrast, protective factors included financial independence (aRR = 0.11, P = .005) and being married (aRR = 0.16, P = .02). Intriguingly, those with physical illnesses had a lower risk of suicide (aRR = 0.15, P = .01).
  
  
  
  Compared with the general population, those with alcohol dependence faced excessive suicide mortality. For a comprehensive approach to suicide prevention, recognizing and improving the protective factors could have equal importance in mitigating the risk of suicide.
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan|Department of Public Health, School of Medicine, National Yang-Ming University, Taipei, Taiwan
authors.forename: Galen Chin-Lun
authors.initials: GC
authors.lastname: Hung
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
authors.forename: Chia-Tzu
authors.initials: CT
authors.lastname: Cheng
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Jhong
authors.affiliation: Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan|Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan|Department of Psychiatry, Mackay Medical College, Taipei, Taiwan
authors.forename: Chiao-Chicy
authors.initials: CC
authors.lastname: Chen
authors.affiliation: Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan|Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan|Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan|Department of Education and Research, Taipei City Hospital, Taipei, Taiwan
authors.forename: Chian-Jue
authors.initials: CJ
authors.lastname: Kuo
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology*; D016022:Case-Control Studies; D002423:Cause of Death; D005260:Female; D006212:Hallucinations / Q000453:epidemiology; D006801:Humans; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009026:Mortality; D065840:Protective Factors; D012307:Risk Factors; D012923:Social Class; D013405:Suicide / Q000706:statistics & numerical data*; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult