Role of alcohol in late-life suicide.

Suicide is among the leading causes of death in the United States, ranking 10th to 12th annually, depending on the year. Rates of suicide increase markedly among Americans over age 75, especially among white men. After age 85, rates are >5-fold higher in this group than in the general population. The relationship between alcohol use and later-life suicide is complex and currently ill defined. Substance use disorders, particularly alcohol abuse and dependence, are the second most common category of axis I disorders associated with completed suicide among adults aged 65 and older, following only depression. The co-occurrence of alcohol use disorders and depression heightens suicide risk. Most studies that have evaluated the effects of alcohol in geriatric suicide have focused on older adults who met DSM criteria for abuse and/or dependence. However, the majority of older adults who are experiencing problems related to their alcohol use do not meet alcohol abuse/dependence criteria. Therefore, the role of at-risk and problem alcohol use in geriatric suicide may be underestimated. Drinking among elders elevates suicide risk through interactions with other factors that are more prevalent in this age group, such as depressive symptoms, medical illness, negatively perceived health status, and low social support. This article reviews the literature related to alcohol use and suicide among older adults. Clinical and research recommendations for addressing this problem are also presented.