The Relationship of Childhood Abuse to Impulsivity and Suicidal Behavior in Adults With Major Depression

Conter Center for the Study of Suicidal Behavior, Department of Psychiatry, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 12/2001; 158(11):1871-7. DOI: 10.1176/appi.ajp.158.11.1871
Source: PubMed


This study investigated whether a higher frequency of reported childhood trauma would be found in depressed adults with higher levels of trait impulsivity, aggression, and suicidal behavior.
In 136 depressed adult inpatients, the authors assessed trait impulsivity, aggression history, and number of lifetime suicide attempts as well as the medical lethality and the intent to die associated with the most lethal attempt. These variables were then compared between those with and those without a reported history of childhood physical or sexual abuse.
Subjects who reported an abuse history were more likely to have made a suicide attempt and had significantly higher impulsivity and aggression scores than those who did not report an abuse history. Impulsivity and aggression scores were significantly higher in subjects with a history of at least one suicide attempt. A logistic regression analysis revealed that abuse history remained significantly associated with suicide attempt status after adjustment for impulsivity, aggression history, and presence of borderline personality disorder. Among those who attempted suicide, there were no significant differences in severity of suicidal behavior between those with and without a childhood history of abuse.
Abuse in childhood may constitute an environmental risk factor for the development of trait impulsivity and aggression as well as suicide attempts in depressed adults. Alternatively, impulsivity and aggression may be inherited traits underlying both childhood abuse and suicidal behavior in adulthood disorders. Additional research is needed to estimate the relative contributions of heredity and environmental experience to the development of impulsivity, aggression, and suicidal behavior.

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    • "To explore additional sources of variance that may contribute to aggression, we examined possible effects of childhood abuse. As expected from prior studies (Bonomi et al., 2008; Brodsky et al., 2001; Carey et al., 2008; Cong et al., 2012; Draper et al., 2008; Fergusson et al., 2008; Jumper, 1995; Kaplow and Widom, 2007; Kendler and Aggen, 2013; Kendler et al., 2000; Kendler et al., 2004; Levitan et al., 1998; Paolucci et al., 2001; Rohde et al., 2008; Young et al., 1997), a higher prevalence of self-reported childhood abuse was seen in MDD patients compared to HV, and childhood abuse was a significant predictor of aggression. However, we found that childhood abuse history did not mitigate the association between plasma EPA and SUD on aggression or impulsivity, indicating that the effects of EPA and childhood abuse on aggression are independent. "
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    ABSTRACT: Major depressive disorder (MDD) is associated with low levels of omega-3 polyunsaturated fatty acids (PUFAs), holding promise for new perspectives on disease etiology and treatment targets. As aggressive and impulsive behaviors are associated with low omega-3 PUFA levels in some clinical contexts, we investigated plasma PUFA relationships with trait aggression and impulsivity in patients with MDD. Medication-free MDD patients (n=48) and healthy volunteers (HV, n=35) were assessed with the Brown-Goodwin Aggression Inventory. A subset (MDD, n=39; HV, n=33) completed the Barratt Impulsiveness Scale. Plasma PUFAs eicosapentaenoic acid (EPA, 20:5n-3), docosahexaenoic acid (DHA, 22:6n-3), and arachidonic acid (AA, 20:4n-6) were quantified and ln-transformed to mitigate distributional skew. Ln-transformed PUFA (lnPUFA) levels were predictors in regression models, with aggression or impulsivity scores as outcomes, and cofactors of sex and diagnostic status (MDD with or without a history of substance use disorder [SUD], or HV). Interactions were tested between relevant PUFAs and diagnostic status. Additional analyses explored possible confounds of depression severity, self-reported childhood abuse history, and, in MDD patients, suicide attempt history. Among PUFA, lnEPA but not lnDHA predicted aggression (F1,76=12.493, p=0.001), and impulsivity (F1,65=5.598, p=0.021), with interactions between lnEPA and history of SUD for both aggression (F1,76=7.941, p=0.001) and impulsivity (F1,65=3.485, p=0.037). Results remained significant when adjusted for childhood abuse, depression severity, or history of suicide attempt. In conclusion, low EPA levels were associated with aggression and impulsivity only in patients with MDD and comorbid SUD, even though in most cases SUD was in full sustained remission.
    Journal of Psychiatric Research 10/2014; 57(1). DOI:10.1016/j.jpsychires.2014.06.012 · 3.96 Impact Factor
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    • "Although contradictory findings have also been published (Bevilacqua et al., 2012), together, these results suggest that trauma and impulsivity may indeed exert a multiplier effect on interindividual cognitive emotion regulation differences. Previous studies established a clear link between impulsivity and emotional reactions after trauma exposure in clinical (abuse survivors: Brodsky et al., 2001; accident survivors: Joseph, Dalgleish, Thrasher, & Yule, 1997) and non-clinical samples alike (students: Aidman & Kollaras- Mitsinikos, 2006). However, as reviewed by Simmen- Janevska, Brandstätter, and Maercker (2012), these studies result in only limited comprehension of this relationship as they failed to consider impulsivity as a multifactorial construct. "
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    ABSTRACT: Background: Traumatic exposure may modulate the expression of impulsive behavioral dispositions and change the implementation of emotion regulation strategies associated with depressive mood. Past studies resulted in only limited comprehension of these relationships, especially because they failed to consider impulsivity as a multifactorial construct. Objective: Based on Whiteside and Lynam’s multidimensional model that identifies four distinct dispositionalfacets of impulsive-like behaviors, namely urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking (UPPS), the current study used a sample of community volunteers to investigate whether an interaction exists between impulsivity facets and lifetime trauma exposure in predicting cognitive emotion regulation and depressive mood. Methods: Ninety-three adults completed questionnaires measuring lifetime trauma exposure, impulsivity, cognitive emotion regulation, and depressive mood. Results: Results showed that trauma-exposed participants with a strong disposition toward urgency (predisposition to act rashly in intense emotional contexts) tended to use fewer appropriate cognitive emotion regulation strategies than other individuals. Unexpectedly, participants lacking in perseverance (predisposition to have difficulties concentrating on demanding tasks) used more appropriate emotion regulation strategies if they had experienced traumatic events during their life than if they had not. Emotion regulation mediated the path between these two impulsivity facets and depressive mood. Conclusions: Together, these findings suggest that impulsivity has a differential impact on emotion regulation and depressive mood depending on lifetime exposure to environmental factors, especially traumatic events.
    European Journal of Psychotraumatology 09/2014; 5:24104. DOI:10.3402/ejpt.v5.24104 · 2.40 Impact Factor
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    • "Traumatic early experiences may predispose individuals, in the authors' opinion, to suicidal behavior. Similarly, Brodsky et al. (2001) reported that adult inpatients with a childhood abuse history were more likely to report attempted suicide and have significantly higher impulsivity and aggression scores compared to those who did not report child maltreatment. A significant association was also found between child sexual abuse and subsequent treatment for mental disorders using a prospective cohort design in a sample of 1612 children (Spataro et al., 2004). "
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    ABSTRACT: In the current cross-sectional study, we aimed to investigate the presence and severity of "male" depressive symptoms and suicidal behaviors in psychiatric patients with and without a history of child abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), as well as to explore the associations among childhood maltreatment, "male depression" and suicide risk. The sample consisted of 163 consecutively admitted adult inpatients (80 men; 83 women). The patients were administered the CTQ, Gotland Male Depression Scale (GMDS), and Suicidal History Self-Rating Screening Scale (SHSS). Those with a moderate-severe childhood maltreatment history were more likely to be female (p<0.05) and reported more "male depression" (p<0.001) and suicidal behaviors (p<0.01) as compared to those not having or having a minimal history of child abuse and neglect. In the multivariate analysis, only the minimization/denial scale of the CTQ (odds ratio=0.31; p<0.001) and "male depression" (odds ratio=1.83; p<0.05) were independently associated with moderate/severe history of child maltreatment. The findings suggest that exposure to abuse and neglect as a child may increase the risk of subsequent symptoms of "male depression", which has been associated with higher suicidal risk.
    Psychiatry Research 08/2014; 220(1-2). DOI:10.1016/j.psychres.2014.07.056 · 2.47 Impact Factor
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