Alcohol has become in Russia a system-forming factor in the last 50years. Many processes in the country directly or indirectly are connected with alcohol consumption, including suicides (SC). This was demonstrated repeatedly in Russia by different methods [1-3]. However a suicide is a multi-factor phenomenon, so it’s important not only to show the connection between two phenomena, but to estimate the input of alcohol consumption on SC.

The period analyzed was 1959-2013.Coefficients of mortality from SC in men and women were obtained from: http://demogr.nes.ru/index.php/ru/demogr_indicat/data (application date 07.03.2016). The calculations of alcohol consumption in liters per capita were based on based on the relationship of violent deaths with alcohol in the blood and sober to the real consumption of alcohol (whenever possible). When this became impossible, these data were correlated with deaths in alcohol poisoning [4]. The calculation of the share of mortality connected with alcohol consumption was made with ARIMA as well as Index methods [5].

The mortality rates from SC in Russia, for both men and women, in the second half of the 20^th Century to the beginning of 21^th Century had growth in the first half of this period and a decline in the second half (Figure 1). The significant deviation (sharp decrease) from this dynamic happened at the beginning of anti-alcohol campaign (1985-1986), however the recurrent increase started in 1987 and reached the record level for Russia in 1994. In the last decade the speed of decrease for SC started to slow down, as well as for mortality from alcohol poisoning. There are periods of more (for example, 2004-2006) or less (for example, 1995-1998) similarity in the dynamic of the two phenomena. The socioeconomic indexes were also significantly different in these periods (Table 1), Rosstat data. The calculation of the share of SC, dependent on alcohol, has shown that 46.1% for men SC and 37.7% for women SC are connected with alcohol consumption (SC in men are by 5.3 times higher than SC in women).

Figure 1: Suicide of men and total consumption of alcohol in Russia in 1959-2013.

One of the main results of the research is that in the period of 1953-2013 44% of SC in Russia were connected with alcohol (46.1% for men and 37.7% for women). SC in men is 5.3 times higher than SC in women. In Russia realities of alcohol abuse is significant, but not the only factor SC. It also depends on socioeconomic factors (Table 1), which were changing during the observed period. The questions are: who were these 44% of SC in our research and who died from alcohol? Based on epidemiological data, we can only make an assumption, that those who died, were connected with alcohol not accidently, but were alcoholics and heavy drinkers. In several research studies, which were using forensic medicine data, the share of SC with alcohol in blood varies up to 60% [1,6,7]. One can assume that alcohol in blood was by accident, a trigger factor, in approximately 20% of SC. This is only a hypothesis which requires verification.

An examination of the correlates of incident ecstasy use revealed that there was similar impact of correlates of incident of ecstasy use across this sample of adolescent female offenders regarding suicide ideation as a function of race. In this study, there were few differences between adolescent female juvenile offenders with a past history of ecstasy use in terms of selected risk practices and item specific indices of suicide ideation as it regards ethnic and/or racial indicators. Thus, distinctions among suicide ideation as a function of ecstasy use may not be helpful in assessing other risks associated with such experiences. In addition, use of ecstasy as an exclusive variable may be less informative than other drug and risk factors during investigations of suicide ideation. The most significant observation was that African American study participants were more than six times more likely to have sought and/or received treatment from a physician or health professional if they had tried to attempt suicide in the past offenders. Also of interest was the variation in rates of ecstasy use, in particular the observation that 15.9 percent and 55.8 percent of white and African American female offenders respectively in our sample reported having used Ecstasy prior to their most recent incarceration.

In terms of suicidal behaviors, about 9.1 percent of our total sample reported previously having attempting to committee suicide (10.4 percent for whites and 7.4 percent for African Americans), and of the sample reported having attempted suicide in the period prior their current incarceration, 10.2 percent of whites and 8.4 percent of African American had indicted past use of ecstasy. While about 8.1 percent reported suicidal ideation only. These levels are much lower for both suicide and ecstasy use reported by Kim and associates in 2011[49] and the Centers for Disease Control and Prevention [6,7]. It may be that other social or behavioral factors for ecstasy users may explain the findings herein. Nonetheless, our examination is important given that MDMA is an indirect serotonergic agonist which causes flooding of the serotonin system and frequently results in temporary positive changes in mood. From a physiological perspective, the serotonergic system combines a widespread innervation of most cortical and subcortical structures [50], including the largest nucleus, the dorsal raphe as well as the median raphe nucleus, which projects to all parts of the brain [51]. The raphe nuclei are a medium size cluster of nuclei located in the brain stem traditionally considered to be the medial portion of the reticular formation. Their main function is to release serotonin to the rest of the brain. Thus, ecstasy may impact functional roles of serotonin which may influence the occurrence of mood disorders frequently affiliated with a predisposition for suicidal behavior that contribute to impulsive aggressive traits that possibly manifest in the form of increased risk for suicidal behavior [52,53].

Moreover, that regular use of ecstasy may damage serotonin neurons, consequently resulting in a decrease in serotonin production [54], which has the capacity to manifest in increases in depressive symptoms, including but not limited to aggression [55], impulsivity [56] and poor judgment [57]: all factors that contribute to suicide ideation and thoughts of inflicting self-harm. This may be why some researchers have found ecstasy use to be a correlate of increased sexual risk taking and the past occurrence of sexually transmitted infections (STIs) among adolescent offender populations [58,59]. Our results should be interpreted with some limitations in mind. First, deals with the problems associated with using survey methods to collect information on sensitive and personal issues such as drug use and suicide, especially in incarcerated settings with adolescent populations. This may impact measures in terms of the magnitude of self-reported ecstasy use, making it possible to be either underestimated rather than overestimated.

Second, the small number of ecstasy users, due to a low prevalence, limits our ability to perform precise analyses to probe the likely nature of correlates, albeit we made use of a robust sample. Last, operational definitions via items employed may play a role in both the self-reported incident of suicide and use of substances among this population. Another major limitation of our study pertains to sample size, specifically the small sample size of the comparison groups. Research notes that many behavioral studies may be influenced by the presence of confounding variables [60]. Consequently, larger sample sizes are preferred since confounding variables must be controlled for in the analysis. Thus a more complex statistical model may have been required. Also, the value of the statistical significance depends on the standard error of the estimator and the power of the study. Therefore, given smaller sample sizes in terms of use verses non-use, our level of power is possibly decreased, meaning findings may reflect such in the resulting risk ratios and 95 percent CIs. This has been reported to occur because Logistic regression overestimates odds ratios in studies with small to moderate samples size by inducing systematic bias in a direction away from the null hypothesis, or in other words, the odds ratios shifting away from one.

In conclusion, ecstasy is a commonly used illegal drug among U.S. adolescent populations including adolescent offenders. Additionally, studying the associations linking ecstasy use with factors that may contribute to mental health morbidity and even suicide, is extremely important if public and mental health practitioners are to both expand on current epidemiological data to deal with this serious and extremely prevalent problem among high-school aged adolescent such to reduce the prevalence of suicide attempts by this population.

This Research was funded by the National Institute on Alcohol Abuse and Alcoholism [1 R01 AA11767].