Roles of Alcohol Use Disorder and Resilience in Risk of Suicide Attempt in Men: A Swedish Population-based Cohort

Introduction: Alcohol use disorder (AUD) has been identified as a strong risk factor for suicide attempt. However, few studies have considered protective factors that may moderate this association, such as resilience.

Methods: We used longitudinal nationwide Swedish data of 903,333 males born 1960-1980 and 48,285 males born 1949-1951. We performed Cox proportional hazards models to test the role of AUD, resilience, and their interaction on risk for suicide attempt. We used co-relative models to account for familial factors.

Results: Alcohol use disorder was strongly associated with increased risk of suicide attempt [hazard ratio (HR) = 12.22], while resilience was associated with reduced risk (HR = 0.73). Multiplicative interaction (HR = 1.21) showed that, in the context of AUD, the protective role of resilience on risk of suicide attempt was somewhat attenuated. Co-relative analyses supported both familial liability and a possible causal pathway between AUD, resilience, and suicide attempt. In the cohort born 1949-1951, resilience subcomponents-social maturity, interests, psychological energy, home conditions, and emotional control-were all associated with reduced suicide attempt risk (HRs between 0.63 and 0.74).

Conclusion: While resilience is associated with reduced risk of suicide attempt, this effect is less pronounced in the context of AUD. These associations are potentially causal.