The relationship between alcohol abuse and suicide risk according to smoking status: A cross-sectional study.

BACKGROUND: Considering the rising suicide risk rate, we investigated the associations between alcohol abuse, smoking, and suicide risk.

METHODS: Participants were 21,654 (male: 9,729, female: 11,925) responders of the National Nutrition Survey from 2013 to 2015 in Korea. Associations between alcohol, smoking, and suicide risk were analyzed using logistic regression and path analysis. The Alcohol Use Disorder Identification Test (AUDIT) measured alcohol consumption levels.

RESULTS: Among participants, 1,718 (male: 602, female: 1,116) presented a suicide risk related to alcohol and smoking. Men's odds ratio of suicide ideation was the highest among those reporting current smoking and AUDIT scores ≥ 20, at 83.75 (95% confidence interval [CI] = 48.07-145.94); that of suicide ideation was the highest for men reporting current smoking and AUDIT scores ≥ 20, at 121.49 (CI = 48.92-301.67); and that of suicide attempts was the highest for men reporting current smoking and AUDIT scores of 16-19, at 256.341 (CI = 77.12-852.05). Women's odds ratio of suicide ideation was the highest for those reporting current smoking and AUDIT scores ≥ 20, at 21.92 (CI = 7.19-66.80); that of suicide ideation was the highest for women reporting current smoking and AUDIT scores ≥ 20, at 19.26 (CI = 4.52-82.17); and that for suicide attempts was the highest for those reporting past smoking and AUDIT scores 8-15, at 104.64 (CI = 10.32- < 999.99). As a result of the path analysis, six paths were fully adopted. Smoking status had a statistically significant positive effect on attempted suicide (t = 146.50, p < .001). AUDIT scores were found to have a significant positive effect on attempted suicide (t = 2503.74, p < .001).

LIMITATIONS: Results must be interpreted within the study design context. Suicidality does not assess any depressive episode. the sample did not include persons who had committed suicide. As suicidal ideation, plans, and attempts are on a spectrum it is difficult to find valid and appropriate, as well as culturally-sensitive, screening questions for suicidal risk that are comparable across international studies. The data used in this study were based on self-reports of smoking, drinking, and suicide risk.

CONCLUSIONS: The combination of alcohol use and smoking was associated with greater suicide risk than were alcohol and smoking separately.