Alcohol use and suicidal behavior in women: longitudinal patterns in a U.S. national sample.
BACKGROUND
Much of the research on suicidality has focused on adolescents and completed suicides, with less attention to types of suicidal behavior (ideation and attempts) that are more common among women. Research has associated women's suicidality with hazardous drinking, adverse childhood experiences, relationship problems, depression, and earlier suicidal behavior. The longitudinal analyses here examine long-term antecedents of suicidal ideation among women in the U.S. general population.


METHODS
We used 1981 and 1991 survey data to predict post-1991 suicidal ideation in a 1996 national sample of 709 women aged 26 to 54 (538 current drinkers). Predictors included 1991 measures of hazardous drinking, depressive episodes, illicit drug use, general health, children at home, interaction with partner, and previous suicidal ideation. Predictors from childhood included recalled parental drinking, parental love or rejection, early drinking and sexual intercourse, and sexual abuse. Demographic predictors included age, education, and ethnicity. A three-stage structural equation model that included these variables was evaluated with Mplus for women who were drinkers in 1991 and/or 1996.


RESULTS
Almost all women who attempted suicide also reported suicidal ideation. Among women drinkers, suicidal ideation before 1991 was more common in the following groups: Latinas, women who believed that their parents had rejected them, and women who reported childhood sexual abuse. Hazardous drinking and poorer health in 1991, childhood histories of sexual abuse and early drinking, and previous suicidal ideation predicted suicidal ideation after 1991. Domestic stressors in 1991 (inability to share feelings with a partner and having four or more young children at home) also predicted subsequent suicidal ideation, but depressive episodes did not. Suicidal ideation was less likely among women drinkers who reported past illicit drug use.


CONCLUSIONS
Suicidal ideation among women drinkers was largely predictable from previous suicidal ideation, hazardous drinking, adverse childhood experiences, and domestic stressors. Higher rates of pre-1991 suicidal ideation among Latinas indicate a need for further study of ethnic influences on suicidality. Reduced suicidal ideation among women with past illicit drug use suggests that conclusions about such use from shorter-term studies may be oversimplified. Understanding women's suicidal ideation, as a precursor to suicidal actions, requires more detailed research on pathways by which hazardous drinking as well as combined distress from childhood experiences and adult domestic environments may increase women's despair and thoughts of suicide.