Commentary on "The modal suicide decedent did not consume alcohol just prior to the time of death: An analysis with implications for understanding suicidal behavior".

This is a commentary on a meta-analysis in this journal by Anestis, Joiner, Hanson, and Gutierrez (2014) that analyzed 92 studies reporting data on the presence/absence of alcohol in suicide decedents based on positive blood alcohol concentrations (BACs). The authors conclude that the weighted mean percentage of suicide decedents with positive BACs is 26.9%, a result that is underestimated by 6.7% due to a coding error. The authors argue that acute use of alcohol may not be an important proximal risk factor for suicide based largely on the fact that it is not modal in decedents, a point that overlooks the fact that risk factors need not be modal to be of major public health significance. For example, most traffic fatalities do not involve a driver who had been drinking but this does not imply that alcohol use is unimportant in road deaths. Furthermore, the authors do not discuss controlled studies providing evidence that acute use of alcohol confers marked risk. The authors also predict that the percentage of suicide decedents with positive BACs who are intoxicated is low. However, published data on alcohol levels and suicide in the United States are available and show that most suicide decedents with positive blood tests have BACs at or above the U.S. legal limit of 0.08 g/dl for drinking and driving, with mean BACs well in excess of the legal limit, evidence of intoxication. (c) 2015 APA, all rights reserved).