The researchers honed their study methods in several ways. They examined individual risk rather than risk across the population. They included both fatal and non-fatal outcomes, tested the effects of multiple types of alcohol outlet, and analyzed the data by sex. Working with Swedish national databases relating to population, health, and the distribution of bars, nightclubs, and government alcohol stores (similar to state-run liquor outlets in the US), they analyzed data on adults aged 18–25. Information on suicide attempts during two-year windows relating to four periods in the early 2000s was available for 347,900–420,000 women and 371,000–448,000 men (depending on the timeframe). The investigators also considered demographic factors (biological sex at birth, age, parent education, and neighborhood deprivation) and individuals’ aggregate genetic risk of suicidal behavior. They used statistical analysis to explore associations between neighborhood alcohol access, suicide attempts, and other factors.
A young adult living in a neighborhood with bars or government alcohol outlets had a slightly higher risk of suicidal behavior in the subsequent two years than those living further from alcohol retailers. Young adults with higher genetic liabilities for suicide attempts were slightly more susceptible to these exposures. The findings remain somewhat perplexing, however. Across the four observation periods and the full sample of young adults, proximity to bars was linked to a higher risk of non-fatal suicide attempts—but a lower risk of dying by suicide. These seemingly paradoxical results suggest that alcohol accessibility may differentially influence the risk for the two outcomes (perhaps through hours of operation, clientele age, and other factors). Overall, government alcohol outlets were associated with an increased risk of suicide and suicide attempts (though not for all separate observation periods), especially among men. This tallies with previous studies showing that the effects of alcohol on suicide risk were limited to or driven by men. These study findings suggest that policies affecting a range of alcohol outlet types may help reduce suicidal behavior, especially among men and people with a genetic risk for suicide attempts. The authors recommend further study into the complex relationships between alcohol use, suicidal behavior, and other relevant factors.
Exposure to alcohol outlets and risk of suicidal behavior in a Swedish cohort of young adults. A. Edwards, H. Ohlsson, M. Stephenson, C. Crump, J. Sundquist, K. Kendler, K. Sunquist. (pp xx)