Suicidal acts, both fatal and nonfatal, have increased in the United States over the past several years (1–5), as have heavy drinking and alcohol use disorders (6–8), especially among women (7, 8), making the topic of the article by Edwards and colleagues in this issue (9)—namely, the relationship of alcohol use disorder (AUD) with suicide—an especially timely one for American investigators and health care providers. Edwards et al. made use of Swedish national register data that include information on health care utilization, diagnoses, and various other outcomes, such as involvements with the legal system. Focusing on the cohort of Swedes born between 1950 to 1970, the authors sought to determine the relationship of AUD to the risk for suicide mortality through 2012. Using proportional hazards analysis, the study found an association between AUD and subsequent suicide. Strengths of the study include analysis of an entire population rather than a sample, ample statistical power, the ability to employ a longitudinal approach, and inclusion of a number of relevant covariates. The message that alcohol use disorder carries a risk for eventual suicide is not a new one, nor is the message that this risk is compounded by psychiatric comorbidity. However, the information is important to reiterate in a fresh look, and to convey to health care providers. Some methodological aspects of the study do merit consideration. The main predictor of the study, AUD, is indicated by a “registration,” described only in supplementary materials. From a previous study referenced as providing more information about the methods and measures (10), these included a variety of medical and psychiatric conditions in which alcohol involvement was suspected, as well as records of drunk driving or drunk operation of a maritime vessel, crime registers, and a Swedish suspicion register that includes data on individuals suspected of crime. These are all termed registrations for AUD, although these various conditions in different Swedish registries are highly heterogeneous. Further, despite the apparent inclusiveness of this definition ...
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", language="en", issn="0002-953X", doi="10.1176/appi.ajp.2020.20050628", url="http://dx.doi.org/10.1176/appi.ajp.2020.20050628" }