Ledden, Sarah; (2024) Alcohol use and its relationship with self-harm and suicidal outcomes in the general population. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Background: Research on associations between alcohol use and suicide/self-harm often focuses on clinical populations. To identify potential areas of intervention prior to reaching clinical thresholds for care, research is needed in non-clinical samples. My PhD examines associations between aspects of alcohol use in the general population and its relationship to suicide, suicide attempts, suicidal thoughts, and non-suicidal self-harm. Method: I conducted a systematic review looking at longitudinal associations between quantity and frequency of alcohol consumption and self-harm and suicidal outcomes, and three quantitative analyses of epidemiological datasets. First, a cross-sectional analysis on the Adult Psychiatric Morbidity Survey, an English household survey, testing associations of different domains of alcohol use and their associations with suicidal behaviour and non-suicidal self-harm. Then, a replication of parts of this analysis longitudinally in a Swedish general population-based cohort study using the Stockholm Public Health Cohort (SPHC). The final analysis tested the bidirectional and mediating effects of alcohol use and psychological distress on suicidal outcomes in the general population using the SPHC. Results: I found consistent evidence that greater quantities of weekly alcohol consumption, and higher frequencies of heavy episodic drinking are associated with increased odds of suicide attempts and suicidal thoughts. I demonstrated that different domains of alcohol use have different associations with suicide attempt, suicidal thoughts, and non-suicidal self-harm; with domains regarding dependence symptoms and negative consequences of alcohol use most strongly associated. My analyses regarding the inter-relationship between alcohol use, psychological distress, and suicidal behaviour indicated independent effects for alcohol use as a risk factor which could not be explained by psychological distress either through confounding, interaction or mediation. Conclusions: My findings demonstrate that the increased risk of suicidal behaviour and non-suicidal self-harm associated with alcohol use across a wide range of people who consume alcohol, beyond clinical thresholds for harmful alcohol use.

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