Postmortem blood alcohol content among late-middle aged and older suicide decedents: Associations with suicide precipitating/risk factors, means, and other drug toxicology

Background: This study examined blood alcohol content (BAC) among suicide decedents aged 50 + and its associations with suicide precipitating/risk factors, means, and other drug toxicology. Methods: The National Violent Death Reporting System, 2005-2015, provided data (N = 56,118 for all suicide decedents and N = 29,115 with alcohol test results). We used logistic regression models, with BAC > 0.0 (BAC positive) and BAC > = 0.08 (intoxication) as the dependent variables. Results: Almost a third of decedents who were tested for alcohol were BAC positive, and almost two-thirds of those who were positive had a BAC > = 0.08. Alcohol problems prior to suicide (AOR = 6.71, 95% CI = 6.24-7.21), relationship problems (AOR = 1.53, 95% CI = 1.44-1.63), and death/suicide of family/friends (AOR = 1.22, 95% CI = 1.11-1.35) were associated with greater odds of a positive BAC, but suicide means were not significantly associated with a positive BAC. Alcohol problems (AOR = 2.98, 95% CI = 2.68-3.31), relationship problems (AOR = 1.18, 95% CI = 1.06-1.30), firearm use (AOR = 1.85, 95% CI = 1.59-2.16), and hanging/suffocation (AOR = 1.38, 95% CI = 1.16-1.64) were associated with greater odds of a BAC > = 0.08. A toxicology positive for antidepressants, marijuana, cocaine, or amphetamines was associated with greater odds of a positive BAC; however, a toxicology positive for antidepressants, opiates, or amphetamines was associated with lower odds of a BAC > = 0.08. BAC > = 0.08 rates increased over the study period. Conclusions: Alcohol intoxication may have contributed to using more violent suicide means. The significant association between relationship problems and intoxication before suicide calls for restricting access to alcohol and suicide means for individuals with these problems. Suicide prevention may require crisis counseling/support for acute life stressors and ongoing emotional support.