Risk of suicide following an alcohol-related emergency hospital admission: An electronic cohort study of 2.8 million people

<div><p>Objective</p><p>Alcohol misuse is a well-known risk factor for suicide however, the relationship between alcohol-related hospital admission and subsequent risk of death from suicide is unknown. We aimed to determine the risk of death from suicide following emergency admission to hospital with an alcohol-related cause.</p><p>Methods</p><p>We established an electronic cohort study of all 2,803,457 residents of Wales, UK, aged from 10 to under 100 years on 1 January 2006 with six years’ follow-up. The outcome event was death from suicide defined as intentional self-harm (ICD-10 X60-84) or undetermined intent (Y10-34). The main exposure was an alcohol-related admission defined as a ‘wholly attributable’ ICD-10 alcohol code in the admission record. Admissions were coded for the presence or absence of co-existing psychiatric morbidity. The analysis was by Cox regression with adjustments for confounding variables within the dataset.</p><p>Results</p><p>During the study follow-up period, there were 15,546,355 person years at risk with 28,425 alcohol-related emergency admissions and 1562 suicides. 125 suicides followed an admission (144.6 per 100,000 person years), of which 11 (9%) occurred within 4 weeks of discharge. The overall adjusted hazard ratio (HR) for suicide following admission was 26.8 (95% confidence interval (CI) 18.8 to 38.3), in men HR 9.83 (95% CI 7.91 to 12.2) and women HR 28.5 (95% CI 19.9 to 41.0). The risk of suicide remained substantial in subjects without known co-existing psychiatric morbidity: HR men 8.11 (95% CI 6.30 to 10.4) and women HR 24.0 (95% CI 15.5 to 37.3). The analysis was limited by the absence in datasets of potentially important confounding variables and the lack of information on alcohol-related harm and psychiatric morbidity in subjects not admitted to hospital.</p><p>Conclusion</p><p>Emergency alcohol-related hospital admission is associated with an increased risk of suicide. Identifying individuals in hospital provides an opportunity for psychosocial assessment and suicide prevention of a targeted at-risk group before their discharge to the community.</p></div

Clinical triggers and clinical actions investigated in the healthcare pathway for coronary heart disease.

<p>Top row shows the clinical triggers in the healthcare pathway. The left-hand side shows the clinical actions identified in the pathway of care. Where boxes corresponding to a clinical trigger and clinical action are ticked, equity in the provision of care for that combination of clinical trigger and clinical action was investigated.</p

Cumulative survival plot for diagnostic categories of alcohol-related admissions: Females.

<p>Cumulative survival plot for diagnostic categories of alcohol-related admissions: Females.</p

Cumulative survival plot for diagnostic categories of alcohol-related admissions: Males.

<p>Cumulative survival plot for diagnostic categories of alcohol-related admissions: Males.</p

Numbers of medications initiated for each indication and discontinued within observation period by indication and medication type.

<p>Numbers of medications initiated for each indication and discontinued within observation period by indication and medication type.</p

Frequency and incidence rates of death from suicide by alcohol admission codes.

<p>Frequency and incidence rates of death from suicide by alcohol admission codes.</p

Adjusted risk of death from suicide for categories of alcohol-related admission, stratified by sex.

<p>Adjusted risk of death from suicide for categories of alcohol-related admission, stratified by sex.</p

Numbers of clinical triggers and associated clinical actions at different positions in the pathway of care for coronary heart disease.

<p>Numbers of clinical triggers and associated clinical actions at different positions in the pathway of care for coronary heart disease.</p

Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between absolute socioeconomic inequalities and provision of healthcare for or coronary heart disease.

<p>Where the association is not statistically significant at the p<0.05 level the box is coloured white. For statistically significant results, the box is coloured according to the magnitude of effect on a logarithmic scale; green shading indicates that the most deprived quintile of the population was more likely to receive the clinical action; red shading indicates that the least deprived quintile of the population was more likely to receive the clinical action.</p

Study flow chart.

<p>Study flow chart.</p