Evaluating the Impact of Alcohol Policy on Suicide Mortality: A Sex-Specific Time-Series Analysis for Lithuania

Abstract

Objective

It is reasonable to believe that the alcohol policy environment can impact the suicide mortality rates in a given country, considering the well-known link between alcohol use and death by suicide. The current literature, albeit limited, suggests that an increase in alcohol taxation may result in a decrease in deaths by suicide and that the effect is sex-specific. Therefore, the objective of the current study was to test the impact of three alcohol control policy enactments (in 2008, 2017 and 2018) on suicide mortality among adults 25–74 years of age in Lithuania, by sex.

Methods

To estimate the unique impact of three alcohol control policies, we conducted interrupted time-series analyses by employing a generalized additive mixed model on monthly sex-specific age-standardized suicide mortality rates from January 2001 to December 2018.

Results

Analyses showed a significant impact of the 2017 (p = 0.016) alcohol control policy on suicide mortality for men only. Specifically, we estimated that in the year following the 2017 policy enactment, approximately 57 (95% CI: 9–107) deaths by suicide were prevented among men, 25–74 years of age. The three policy enactments tested were not found to significantly impact the suicide mortality rate among women.

Conclusion

Alcohol control policies involving pricing, which result in a notable decrease in alcohol affordability, could be a cost-effective indirect suicide prevention mechanism in not only countries of the former Soviet Union, but in other high-income countries with a comparable health care system to that in Lithuania.

HIGHLIGHTS

• Increasing excise tax on alcohol was found to have a sex-specific impact on suicide mortality

• The 2017 alcohol policy prevented 57 deaths by suicide among men, 25–74 years of age, in the following year

• Alcohol pricing policies may be a cost-effective indirect suicide prevention mechanism

Keywords:

• Alcohol control policy
• death by suicide
• suicide mortality
• taxation
• time-series analysis

AUTHOR NOTES

Shannon Lange, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada.

Huan Jiang, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Mindaugas Štelemėkas, Health Research Institute, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania; Department of Preventive Medicine, Faculty of Public Health, Lithuanian University of Health Sciences, Kaunas, Lithuania.

Alexander Tran, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada.

Cheryl Cherpitel, Public Health Institute, Alcohol Research Group, Emeryville, CA, USA.

Norman Giesbrecht, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.

Nijole Gostautaite Midttun, Mental Health Initiative, Vilnius, Lithuania.

Domantas Jasilionis, Laboratory of Demographic Data, Max Planck Institute for Demographic Research, Rostock, Germany; Demographic Research Centre, Faculty of Social Sciences, Vytautas Magnus University, Kaunas, Lithuania.

Mark S. Kaplan, Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, CA, USA.

Jakob Manthey, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Center for Interdisciplinary Addiction Research (ZIS), Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany; Department of Psychiatry, Medical Faculty, University of Leipzig, Leipzig, Germany.

Ziming Xuan, Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA.

Jürgen Rehm, Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada; Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany; Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Institute of Medical Science, University of Toronto, Toronto, ON, Canada; Department of Psychiatry and Psychotherapy; Center for Interdisciplinary Addiction Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

The original data are administrative data of the Lithuanian government agencies and need to be obtained directly from the original source (exact sources as indicated in the article). The R code used to analyze and compute variables can be found as Supplementary Material.

Additional information

Funding

This work was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health (NIAAA) under grant [1R01 AA028224-01] and was conducted as part of the project "Evaluation of the impact of alcohol control policies on morbidity and mortality in Lithuania and other Baltic states". Dr. Cherpitel is supported by [R01 2 AA013750] from the National Institutes of Health; and Dr. Xuan is supported by [P30 AI042853] from the National Institutes of Health and by an internal fund from The Frederick S. Pardee Center for the Study of the Longer-Range Future at Boston University.