Detection of alcohol consumption in suicides

  • B. Schneider
  • A. Schnabel
  • D. Sargk
  • K. Maurer
  • B. Weber
  • T. Wetterling


Screening instruments for detection of alcohol consumption, abuse, and dependence for use in psychological autopsy studies with case control design are not validated. Therefore, interrater and test–retest reliability of the Luebeck Alcohol Dependence and Abuse Screening Test (LAST) and the usability of this test for the psychological autopsy method were investigated. Alcohol consumption was evaluated by a semi–structured interview including the Structured Clinical Interview for DSM–IV Axis I (SCID–I) and the LAST in 163 completed suicides (mean age 49.6 ± 19.3 years; 64.4% men) and by personal interview in 396 population–based controls (mean age 51.6 ± 17.0 years; 55.8% men). Of the controls, 35 were additionally assessed by interviewing informants; these results were compared with those generated by personal interview. Comparison of LAST scores by personal and informant’s interview of controls generated a Spearman correlation coefficient of 0.74 (P < 0.0001). The LAST (7 item–version, cut–off of 2) revealed high sensitivity and specificity for alcohol abuse and dependence, in both controls and suicides. LAST scores were significantly associated with high, frequent, and hazardous alcohol consumption (P < 0.001) in suicides. Our findings provide support for reliability and validity of identifying individuals with alcohol dependence and abuse obtained through the best–estimate method using the LAST. This 7–item questionnaire can be recommended as a useful tool for the psychological autopsy procedure in postmortem research.

Key words

alcoholism suicide postmortem diagnoses screening instruments 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Baldessarini RJ, Finklstein S, Arana GW (1983) The prevalence power of diagnostic tests and the effect of prevalence of illness. Arch Gen Psychiatry 40:569–573PubMedGoogle Scholar
  2. 2.
    Bernadt MW, Mumford J, Taylor D, Smith B, Murray RM (1982) Comparison of questionnaire and laboratory tests in the detection of excessive drinking and alcoholism. Lancet 2/6:325–328CrossRefGoogle Scholar
  3. 3.
    Beresford TP, Blow FC, Hill E, Singer K, Lucey MR (1990) Comparison of CAGE questionnaire and computer-assisted laboratory profiles in screening for covert alcoholism. Lancet 336:482–485CrossRefPubMedGoogle Scholar
  4. 4.
    Bleich S, Bleich K, Kropp S, Bittermann HJ, Degner D, Sperling W, Rüther E, Kornhuber J (2001) Moderate alcohol consumption in social drinkers raises plasma homocysteine levels: a contradiction to the French paradox? Alcohol alcohol 36:189–192PubMedGoogle Scholar
  5. 5.
    Brent DA, Perper JA, Moritz G, Allman C, Friend A, Roth C, Schweers J, Balach L, Baugher M (1993) Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry 32:521–529Google Scholar
  6. 6.
    Cheng ATA (1995) Mental illness and suicide. A case-control study in East Taiwan. Arch Gen Psychiatry 52:594–603PubMedGoogle Scholar
  7. 7.
    Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED (1996) Relationship of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 153:1001–1008PubMedGoogle Scholar
  8. 8.
    Fiellin DA, Reid MC, O’Connor PG (2000) Screening for alcohol problems. Arch Intern Med 160:1977–1989CrossRefPubMedGoogle Scholar
  9. 9.
    Fleiss JL (1981) The measurement of interrater agreement. In: Statistical Methods for Rates and Proportions. John Wiley and Sons, New York, pp 212–236Google Scholar
  10. 10.
    Foster T, Gillespie K, McClelland R, Patterson C (1999) Risk factors for suicide independent of DSM-III-R Axis I disorder. Casecontrol psychological autopsy study in Northern Ireland. Br J Psychiatry 175:175–179PubMedGoogle Scholar
  11. 11.
    Hawton K, Appleby L, Platt S, Foster T, Cooper, J, Malmberg A, Simkin S (1998) The psychological autopsy approach to studying suicide: a review of methodological issues. J Affect Disord 50:269–276CrossRefPubMedGoogle Scholar
  12. 12.
    Heather N (1994) Alcohol, accidents, and aggression. The concept of ‘alcoholism’ is a barrier to understanding. BMJ 308:1254PubMedGoogle Scholar
  13. 13.
    Henriksson MM, Aro HM, Marttunen MJ, Heikkinen ME, Isometsä ET, Kuoppasalmi KI, Lönnqvist JK (1993) Mental disorders and comorbidity in suicide. Am J Psychiatry 150:935–940PubMedGoogle Scholar
  14. 14.
    Inskip HM, Harris C, Barraclough B (1998) Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry 172:35–37PubMedGoogle Scholar
  15. 15.
    Leckman JF, Sholomskas D, Thompson D, Belanger A, Weissman MM (1982) Best estimate of lifetime psychiatric diagnosis. Arch Gen Psychiatry 39:879–888PubMedGoogle Scholar
  16. 16.
    Lesage AD, Boyer R, Grunberg F, Vanier C, Morissette R, Menard- Buteau C, Loyer M (1994) Suicide and mental disorders: a casecontrol study of young men. Am J Psychiatry 151:1063–1068PubMedGoogle Scholar
  17. 17.
    Malcolm R, Anton RF, Conrad SE, Sutherland S (1999) Carbohydrate- deficient transferring and alcohol use in medical examiner cases. Alcohol 17:7–11CrossRefPubMedGoogle Scholar
  18. 18.
    Mayfield DG, McLeod G, Hall P (1974) The CAGE questionnaire: validation of a new alcoholism screening instrument. Am J Psychiatry 131:1121–1123PubMedGoogle Scholar
  19. 19.
    Nielsen SD, Storgaard H, Moesgaard F, Gluud C (1994) Prevalence of alcohol problems among adult somatic in-patients of a Copenhagen hospital. Alcohol Alcohol 29:583–590PubMedGoogle Scholar
  20. 20.
    Rohde P, Lewinsohn PM, Seeley JR (1996) Psychiatric comorbidity and problematic alcohol use in high school students. J Am Acad Child Adolesc Psychiatry 35:101–109PubMedGoogle Scholar
  21. 21.
    Preuss UW, Koller G, Zill P, Bondy B, Soyka M (2003) Alcoholismrelated phenotypes and genetic variants of the CB1 receptor. Eur Arch Psychiatry Clin Neurosci 253:275–280PubMedGoogle Scholar
  22. 22.
    Rumpf HJ, Hapke U, Erfurth A, John U (1998) Screening questionnaires in the detection of hazardous alcohol consumption in the general hospital – direct or disguised assessment. J Stud Alcohol 59:698–703PubMedGoogle Scholar
  23. 23.
    Rumpf HJ, Hapke U, Hill A, John U (1997) Development of a screening questionnaire for the General Hospital and General Practices. Alcohol Clin Exp Res 21:894–898PubMedGoogle Scholar
  24. 24.
    Rumpf HJ, Hapke U, Meyer C, John U (2002) Screening for alcohol use disorders and at-risk drinking in the general population: psychometric performance of three questionnaires. Alcohol alcohol 37:261–268PubMedGoogle Scholar
  25. 25.
    Schmidt LG, Samochowiec J, Finckh U, Fiszer-Piosik E, Horodnicki J, Wendel B, Rommelspächer H, Hoehe MR (2002) Association of a CB1 cannabinoid receptor gene (CNR1) polymorphism with severe alcohol dependence. Drug Alcohol Depend 65:221–224Google Scholar
  26. 26.
    Schneider B, Maurer K, Sargk D, Heiskel H, Weber B, Frölich L, Georgi K, Fritze J, Seidler A (2004) Concordance of DSM-IV Axis I and II Diagnoses by Personal and Informant’s Interview. Psychiatry Res 127:121–136PubMedGoogle Scholar
  27. 27.
    Selzer ML (1971) The Michigan alcoholism screening test: The quest for a new diagnostic instrument. Am J Psychiatry 127:1653–1658PubMedGoogle Scholar
  28. 28.
    Siegfried N, Parry CDH, Morojele NK, Wason D (2001) Profile of drinking behaviour and comparison of self-report with the CAGE questionnaire and carbohydrate-deficient transferrin in a rural Lesotho community. Alcohol alcohol 36:243–248PubMedGoogle Scholar
  29. 29.
    Soyka M, Morhart-Klute V, Horak M (2002) A combination of carbamazepine/tiapride in outpatient alcohol detoxification. Results from an open clinical study. Eur Arch Psychiatry Clin Neurosci 252:197–200CrossRefPubMedGoogle Scholar
  30. 30.
    Spitzer RL, Williams JBW, Gibbon M, First MB (1984) Structured Clinical Interview for DSM-III Axis I Disorders. New York State Psychiatric Institute, Biometrics Research Department, New YorkGoogle Scholar
  31. 31.
    Storgaard H, Nielsen SD, Gluud C (1994) The validity of the Michigan Alcoholism Screening Test (MAST). Alcohol alcohol 29:493–502PubMedGoogle Scholar
  32. 32.
    Strobl M, Klapper J, Pelzel KH, Bader G, Zahn H, Lange S (2002) Suchthilfestatistik 2001 für Deutschland. Tabellenband für die ambulante Suchtkrankenhilfe. (Dependence aid statistics 2001 for Germany, Tables for ambulatory aid for the dependent). IFT Institut für Therapieforschung, MünchenGoogle Scholar
  33. 33.
    Vijayakumar L, Rajkumar S (1999) Are risk factors for suicide universal? A case-control study in India. Acta Psychiatr Scand 99:407–411PubMedGoogle Scholar
  34. 34.
    Waern M (2003) Alcohol dependence and misuse in elderly suicides. Alcohol alcohol 38:249–254PubMedGoogle Scholar
  35. 35.
    Wetterling T, Kanitz RD, Rumpf HJ, Hapke U, Fischer D (1998) Comparison of CAGE and MAST with ‘alcohol markers’(CDT, y- GT,ALAT,ASAT,MCV). Alcohol alcohol 33:424–430PubMedGoogle Scholar
  36. 36.
    Wittchen HU, Wunderlich U, Gruschwitz S, Zaudig M (1997) Strukturiertes Klinisches Interview für DSM-IV, Achse I. Eine deutschsprachige erweiterte Bearbeitung der amerikanischen Originalversion des SCID-I. (Structured Clinical Interview for DSM-IV, Axis I. A German enlarged version of the American original version of SCID-I). Hogrefe, GöttingenGoogle Scholar

Copyright information

© Steinkopff Verlag 2004

Authors and Affiliations

  • B. Schneider
    • 1
  • A. Schnabel
    • 2
  • D. Sargk
    • 1
  • K. Maurer
    • 1
  • B. Weber
    • 1
  • T. Wetterling
    • 1
  1. 1.Center of Psychiatry, Dept. of Psychiatry & PsychotherapyJohann Wolfgang Goethe-UniversityFrankfurt/MainGermany
  2. 2.Center of Forensic MedicineJohann Wolfgang Goethe-UniversityFrankfurt/MainGermany

Personalised recommendations