Severe alcohol withdrawal symptoms and the risk of suicidal acts in patients treated for alcohol use disorder

Alcohol use disorder (AUD) increases the likelihood of suicide attempts. The characteristics of AUD that increase suicide attempt risk remain unclear.

To identify factors associated with a history of suicide attempts and with suicidal acts occurring within a 2-year follow-up in patients with AUD.

This multicentre, prospective cohort study included patients with AUD within 1 week of admission to in-patient care for alcohol withdrawal management. Sociodemographic and clinical data were collected during a face-to-face clinician interview at baseline. Follow-up telephone interviews were conducted up to 24 months post-inclusion to assess the primary end-point: the occurrence of a suicidal act (suicide attempt or completed suicide). To identify factors associated with past suicide attempts, Student's t-tests, chi-squared tests and logistic regression were performed. Univariate survival analyses and a multivariate Cox model were computed to identify predictors of suicidal acts occurring during the follow-up period.

Of the 779 patients included in the study, 337 (43.3%) had a history of suicide attempts. This was significantly associated with a history of major depressive disorder, female gender and higher levels of suicidal ideation and hopelessness. Regarding the prospective analysis, suicidal acts occurred in 90 (11.5%) patients. A history of severe alcohol withdrawal symptoms, defined as delirium tremens or seizures (adjusted hazard ratio (aHR) 2.38, 95% CI 1.38-4.10, P = 0.002), and a history of suicide attempts (aHR 1.84, 95% CI 1.14-2.99, P = 0.013), were associated with higher occurrence of suicidal acts, while living alone (0.47, 95% CI 0.28-0.78, P = 0.004) was a protective factor.

While a history of suicide attempts is a well-established risk factor for future suicidal acts, a history of severe alcohol withdrawal symptoms emerges as an even stronger predictor. Further studies are necessary to generalise this finding and use it to identify patients at higher risk of suicidal acts.