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During the first year of the COVID-19 pandemic, Canadians were more than twice as likely to report suicidal ideation if they had increased alcohol consumption, according to a new report.

Men and adults over age 65 were the most likely to have links between alcohol consumption and suicidal thoughts.

Mélanie Varin

“Suicide is an important public health issue in Canada, and the relationship between alcohol use and suicide is complex. Evidence from the COVID-19 pandemic has shown an increase in alcohol use and alcohol-related harms among certain populations in Canada, generic differin adapalene ” lead study author Mélanie Varin, an epidemiologist at the Public Health Agency of Canada, told Medscape Medical News.

“There is also evidence from three international studies that showed an association between alcohol use and suicide during the COVID-19 pandemic,” she said. “We aimed to raise awareness of the relationship between alcohol use and suicide, particularly in the context of the COVID-19 pandemic.”

The study was published Oct. 6 in the Canadian Journal of Public Health.

Age Increased Risk

Alcohol use can increase the risk of suicide by impairing judgement, increasing impulsivity, and reducing inhibition, the study authors wrote. Heavy drinking can increase the risk as people struggle with emotional regulation, major depressive episodes, or stressful life events.

Varin and colleagues analyzed data from the Survey on COVID-19 Mental Health, which was conducted by Statistics Canada and the Public Health Agency of Canada from September to December 2020. The survey sampled 30,000 dwellings across each province and within the three territorial capital cities. In all, 12,344 Canadian adults completed the survey and agreed to share their data.

The research team compared the prevalence of suicidal ideation among people who reported an increase in alcohol consumption vs those who reported a decrease or no change in consumption. They also looked at the differences between those who reported past month heavy episodic drinking and those who didn’t have heavy episodic drinking. Heavy episodic drinking was defined as five or more drinks on one occasion for men and four or more drinks during one session for women in the previous 30 days.

Overall, 2.4% of Canadian adults reported having seriously contemplated suicide since the beginning of the pandemic. About 15.7% reported increased alcohol use, and 28.8% reported past month heavy episodic drinking. Those who reported suicidal ideation were more likely to have anxiety, depression, or probable post-traumatic stress disorder.

The prevalence and likelihood of suicidal ideation were significantly higher among people who reported increased alcohol consumption and past month heavy episodic drinking. About 4.9% of those who had increased alcohol consumption reported suicidal ideation, compared with 2% of those who didn’t have increased alcohol consumption during the pandemic. The odds were 5.5 times higher in respondents aged 65 and older, 3.6 times higher in men, and 3.4 times higher among those with a high school education or lower.

In addition, about 3.4% of those who reported heavy drinking during the previous month reported suicidal ideation, compared with 2.1% of those who didn’t have heavy drinking episodes. The odds were 4.2 times higher in respondents aged 65 and older and 2.1 times higher among men.

Future research could explore the associations between alcohol consumption and suicidal ideation during the pandemic while adjusting for social determinants of health, the study authors wrote, including income security, employment, education, social support, stress, and mental health.

In addition, ongoing surveillance of alcohol use and suicidal ideation during the COVID-19 pandemic are crucial for public health messaging and the development of targeted prevention strategies, the study authors wrote.

“We would like to continue raising awareness of the relationship between suicide and alcohol use and remind Canadians of the supports available,” said Varin.

Prevention Strategy Needed

The results are consistent with previous findings. “Our research suggests that suicide ideation and attempts increased during the pandemic,” Simon Sherry, PhD, professor of psychology and neuroscience at Dalhousie University in Halifax, Nova Scotia, Canada, told Medscape.

Simon Sherry PhD

Sherry, who wasn’t involved with the current study, conducted an international meta-analysis of research on suicide-related behaviors during the COVID-19 pandemic. He and colleagues found that rates increased for suicidal ideation, self-harm, and suicidal attempts.

The current study “is important, as it implicates alcohol misuse as a factor in increased suicide ideation during the pandemic,” Sherry said.

Earlier this year, the Mental Health Commission of Canada and the Canadian Centre on Substance Use and Addiction released a fact sheet about the relationship between alcohol and suicide, which explains who faces the highest risks for suicidal ideation while drinking and how to reduce the risks.

One in four deaths by suicide in Canada involve alcohol, the groups wrote. Alcohol use disorder is the second most common mental health disorder in people who have died by suicide.

“Canada is, regrettably, the only country in the G8 that does not have a developed and funded national suicide prevention strategy,” said Sherry. “Varin and colleagues’ research joins a chorus of voices suggesting that reductions in alcohol misuse belong front and center in our national suicide prevention strategy when it finally emerges.”

The study was supported by the Public Health Agency of Canada. Varin and Sherry reported no relevant disclosures.

CJPH. Published Oct. 6, 2022. Full text.

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

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