We don’t talk about it. The media doesn’t report on it. The stigma around suicide means we’re too often kept in the dark as to what might lead someone to take their own life. The answer might surprise you. Elle Hunt investigates the link between New Zealand’s high suicide rate and alcohol.

In a TED talk given last year, JD Schramm of Stanford University spoke in favour of breaking the silence around suicide: “Because of our taboos around suicide, we’re not sure what to say, and so quite often we say nothing.”

Such a response is typical in New Zealand, even though suicide is a major public health concern. Around 540 suicides and at least 20,000 attempts occur every year, making it the largest cause of death by external causes seen by coroners. But because of its social stigma, the general public tends to be unaware of what factors can lead to suicide – and one is both easily accessible and socially acceptable.

Though there is rarely any one cause for suicide, the connection between alcohol and suicide has been established by numerous studies. In fact, alcohol is considered the second most significant risk factor of suicide, after depression – but this receives nowhere near as much airtime as other consequences of alcohol abuse, in part, because the media is restricted from reporting on individual suicides in too much detail.

The government has been criticised for its perceived inaction on suicide, with Community Action on Suicide Prevention Education and Research’s (CASPER) calls for a Royal Commission of Inquiry into the matter to be established so far being ignored. “The fact is, there is absolutely no sense of urgency in government about the fact that 558 people are dying a year – 11 a week,” CASPER founder Maria Bradshaw told Fairfax Media in February. “If it was anything else, it would be a national state of emergency.”

Of utmost concern is New Zealand’s high rate of youth suicide. Of the 500-odd suicides that occur here every year, between 20 and 25 percent involve people under the age of 25. The latest Ministry of Health statistics show 114 people aged between 15 and 24 took their own lives in 2009, and 93 of that number were male, meaning New Zealand has the highest male youth suicide rate of all 34 countries in the

OECD (though discrepancies in reporting between countries temper those statistics). According to Dr Annette Beautrais, an eminent suicide researcher at the University of Auckland, consumption of alcohol can influence a person’s decision to end their life in one of two ways. “Amongst older people, it’s likely to be the effects of long-term dependence,” he says. “Their lives begin to deteriorate in many different ways, which ultimately and inevitably seems to end up restricting their life options.”

It can take people who are dependent on alcohol years, even decades, to reach a point where suicide seems like their only option, meaning there are often a number of opportunities for intervention. The same cannot be said of the other way in which consumption of alcohol is conducive to suicide, in that its disinhibiting effects can lead people to end their life in response to a particular crisis.

This is particularly widespread among people under the age of 25, explains Dr Beautrais. “There’s typically a lethal combination of some sort of social or precipitating crisis, plus intoxication and access to a lethal method.”

The example Dr Beautrais gives is a teenage boy reacting “aggressively, impulsively and with anger” to seeing his ex-girlfriend out with one of his friends. “Suicide is an option he thinks of, but it’s not necessarily associated with any long period of ideation. It’s more like a reaction,” she says. “It creates a tragedy that would not necessarily occur if he was not intoxicated.”

Consequently, New Zealand’s high youth suicide rate has been blamed in part on the prevalence of binge drinking in society, making the move to increase or split the minimum alcohol purchase age all the more vital a debate. “You have a large fraction of the youth population in a binge-drinking culture, therefore exposing themselves to that risk,” says Dr Beautrais. “The fact that it’s widespread... probably adds a significant number of suicides to the total that we would have if we didn’t have that sort of culture.”

This aligns with the findings of Swahn and Bossarte of the National Center for Injury Prevention and Control, published in the Journal of Adolescent Health in 2007, which found alcohol use among adolescents to be an “important risk factor for both suicide ideation and suicide attempts among boys and girls”. Swahn and Bossarte concluded that increasing efforts to delay and reduce preteens’ alcohol use could reduce suicide attempts.

Similarly, a study conducted by researchers at Harvard University’s School of Public Health found an inverse correlation between the minimum legal drinking age and youth suicide rates of 48 contiguous American states, based on figures for the 20 years from 1970 to 1990. The study concluded that lowering the drinking age from 21 to 18 years in all states could increase the number of suicides in the 18- to 20-year-old population by approximately 125 deaths each year.

For these reasons, Dr Beautrais speculates that increasing the minimum alcohol purchase age to 20, or splitting the age between on- and off-licence premises, could “make a marginal difference” on the youth suicide rate here. Dr Doug Sellman, director of the National Addiction Centre, is in favour of increasing the purchase age across the board, arguing that a split age would be an “awkward and potentially confusing compromise”.

Dr Beautrais is in favour of aligning law that governs the sale and consumption of alcohol with the New Zealand Suicide Prevention Strategy, but points out that legislation can only go so far in reducing the rate of suicide. What’s called for is a cultural shift. Curbing the prevalence of binge drinking behaviour in society would be a definite step in the right direction. But for as long as it’s more taboo to talk about suicide than it is to drink to a point where it’s a real risk, we’ve got our priorities wrong.