Leo Sher, M.D.

Our research paper, “The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism” was published 15 years ago in the July 2005 issue of Addictive Behaviors (1). Studies suggest that depressed individuals with alcoholism have more chronic impairment and suicidal behavior than individuals with either diagnosis alone. We explored clinical features that may be associated with this increased suicidality.

In all, 219 depressed patients (n=62 males and n=157 females) without a history of alcohol or another substance use disorder and 129 (n=49 males and n=80 females) depressed individuals with a prior history of alcohol use disorder participated in the study. All study participants met DSM-IV criteria for a current major depressive episode and were free from alcohol or substance abuse for at least 2 months, therefore the current episode of major depression was independent, i.e., not alcohol- or substance-induced. Demographic and clinical parameters of all study participants were assessed and recorded.

Study participants with a history of alcoholism were younger, less likely to be married, and had fewer years of education compared with study participants without a history of alcoholism. Also, depressed individuals with a history of alcoholism had higher lifetime aggression and impulsivity, and were more likely to report a history of childhood abuse, suicide attempts, and tobacco smoking. Study participants with a history of alcoholism were younger at the time of the first depressive episode and first hospitalization in comparison to those without a history of alcoholism. Logistic regression analysis indicated that alcoholism was significantly associated with smoking and aggression. Suicidal behavior and higher suicidal ideation in depressed patients with a history of alcoholism might be attributed to higher aggression scores in this group.

The greater frequency of suicidal behavior and severity of suicidal ideation in major depression with comorbid alcoholism appears to be related to associated aggressive traits. Alcoholism, aggression, smoking, and suicide may have a common biological causal substrate. Our findings suggest that in addition to obtaining a history of depression and suicidal behavior, clinicians should assess comorbidity with alcoholism and personality traits such as aggression and impulsivity. This may help identify individuals at higher risk for suicidal behavior.

Reference

1. Sher L, Oquendo MA, Galfalvy HC, Grunebaum MF, Burke AK, Zalsman G, Mann JJ.  The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism. Addict Behav. 2005 Jul;30(6):1144-53. doi: 10.1016/j.addbeh.2004.12.001. Epub 2004 Dec 29.