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Abstract
The purpose of this study was to investigate the relationship among impulsivity, mental disorder, and suicide with a sample of rural young Chinese.
Subjects were 392 consecutively recruited male and female suicides aged 15-34 years and 416 community male and female controls of the same age range sampled in rural China. The case-control data were obtained using psychological autopsy method with structured and semi-structured instruments.
Dysfunctional impulsivity was a significant risk factor regardless of mental disorder in rural China.
Dysfunctional impulsivity is a potential area for further study of suicidal behavior. The suicide prevention efforts in rural China may address impulsivity.
... Suicide is a severe public health problem around the world and is particularly serious in China, which accounts for more than 30% of the world's suicides [6,7]. It has been reported that mental disorder was a less important risk factor for suicide in China [8]. Other factors, such as acute stressors and impulsivity, might play a more important role in Chinese suicides (Chinese women are more likely to commit suicide [9]) than in Western suicides [8,10,11]. ...
... It has been reported that mental disorder was a less important risk factor for suicide in China [8]. Other factors, such as acute stressors and impulsivity, might play a more important role in Chinese suicides (Chinese women are more likely to commit suicide [9]) than in Western suicides [8,10,11]. As impulsive suicide attempts are hard to predict, it is a challenge to intervene in a timely manner [12][13][14]. ...
People with suicidal ideation (PSI) are increasingly using social media to express suicidal feelings. Researchers have found that their internet-based communication may lead to the spread of suicidal ideation, which presents a set of challenges for suicide prevention. To develop effective prevention and intervention strategies that can be efficiently applied in online communities, we need to understand the behavior of PSI in internet-based communities. However, to date there have been no studies that specifically focus on the behavior of PSI in Chinese online communities. A total of 4489 postings in which users explicitly expressed their suicidal ideation were labeled from 560,000 postings in an internet-based suicidal community on Weibo (one of the biggest social media platforms in China) to explore their behavior. The results reveal that PSI are significantly more active than other users in the community. With the use of social network analysis, we also found that the more frequently users communicate with PSI, the more likely that users would become suicidal. In addition, Chinese women may be more likely to be at risk of suicide than men in the community. This study enriches our knowledge of PSI’s behavior in online communities, which may contribute to detecting and assisting PSI on social media.
... 11 Furthermore, increased impulsivity and aggression have been associated with death by suicide. [12][13][14] Assessment of impulsivity Self-administered questionnaires are the most common approach to assessing impulsivity. The Barrat Impulsivity Scale (BIS-11), which assesses impulsive personality traits, is a commonly used measure. ...
Introduction
Impulsivity is present in a range of mental disorders and has been associated with suicide. Traditional measures of impulsivity have certain limitations, such as the lack of ecological validity. Virtual reality (VR) may overcome these issues. This study aims to validate the VR assessment tool ‘Spheres & Shield Maze Task’ and speech analysis by comparing them with traditional measures. We hypothesise that these innovative tools will be reliable and acceptable by patients, potentially improving the simultaneous assessment of impulsivity and decision-making.
Methods and analysis
This study will be carried out at the University Hospital Fundación Jiménez Díaz (Madrid, Spain). Our sample will consist of adults divided into three groups: psychiatric outpatients with a history of suicidal thoughts and/or behaviours, psychiatric outpatients without such a history and healthy volunteers. The target sample size was established at 300 participants (100 per group). Participants will complete the Barratt Impulsiveness Scale 11; the Urgency, Premeditation, Perseverance, Sensation Seeking, Positive Urgency, Impulsive Behaviour Scale; Iowa Gambling Task; Continuous Performance Test; Stop signal Task, and Go/no-go task, three questions of emotional affect, the Spheres & Shield Maze Task and two satisfaction surveys. During these tasks, participant speech will be recorded. Construct validity of the VR environment will be calculated. We will also explore the association between VR-assessed impulsivity and history of suicidal thoughts and/or behaviour, and the association between speech and impulsivity and decision-making.
Ethics and dissemination
This study was approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz (PIC128-21_FJD). Participants will be required to provide written informed consent. The findings will be presented in a series of manuscripts that will be submitted to peer-reviewed journals for publication.
Trial registration number
NCT05109845 ; Pre-results.
... Impulsivity is an important personality trait characterized by reflection impulsivity, impulsive action, and impulsive choice (19). Individuals with the personality of impulsivity are more likely to take risk behaviors, including suicide (20,21). To test the proposed mediation mechanism that links QOL and hopelessness to suicide, the impact of this personality trait must be considered. ...
Background
People who had died by suicide always being associated with negative emotions and even mental disorders. Understanding mechanisms underlying the association between quality of life (QOL), hopelessness, and suicide are of great significance. In this study, we aimed to test a model in which the QOL-suicide relationship was mediated by hopelessness and moderated by impulsivity.Methods
Participants (N = 484, including 242 suicide deaths and 242 matched controls) were rural residents 60 years of age and older, randomly selected from 12 rural counties in China using a two-stage stratified cluster sampling method. Data were collected with standard psychological autopsy technique from informants (n = 968). The outcome variable was a suicide death. QOL, hopelessness, and impulsivity were assessed using validated scales. The proposed relationships were tested using mediation and moderated mediation models.ResultsOf the total sample, 55.8% were men with a median age of 75.5 years. Results from the moderated mediation analysis indicated that QOL was negatively associated with suicide (beta = −0.141, p < 0.01); this association was mediated by hopelessness (indirect effect: beta =0.578, p < 0.01), accounting for 73% of the total effect. Impulsivity significantly moderated the mediation effect from QOL to hopelessness (beta =0.005, p < 0.01).Conclusions
Study findings have confirmed the negative association between QOL and suicide with psychological autopsy data, and demonstrated the role of hopelessness in mediating the QOL-suicide relation that is further modified by impulsiveness. These findings depend on our understanding of the suicide epidemiology among the elder in rural China and provide information much needed for suicide prevention.
... Some observers worry that this intervention ignores the deeper issues driving suicide and might even intensify restrictions on employees. But in the Chinese context, where suicide is frequently linked to impulsiveness and not illness, these modest steps likely prevent some loss of life by hindering the short-lived, destructive impulses of employees in distress (Lin and Zhang, 2017). Less well studied, however, is the possibility that nets and locked windows trigger thoughts of suicide by reminding employees of the expected risk of new suicides. ...
We seek to tackle myriad problems of a global production system in which China is the world's largest producer and exporter of consumer electronics products. Dying for an iPhone simultaneously addresses the challenges facing Chinese workers while locating them within the global economy through an assessment of the relationship between Foxconn (the largest electronics manufacturer) and Apple (one of the richest corporations). Eight researchers from Asia, Europe and North America discuss two main questions: How do tech behemoths and the Chinese state shape labor relations in transnational manufacturing? What roles can workers, public sector buyers, non-governmental organizations and consumers play in holding multinational corporations and states accountable for human rights violations and assuring the protection of worker interests? We also reflect on the possibility that national governments, the electronics industry and civil society groups can collaborate to contribute to improved labor rights in China and the world.
... But the current result still highly suggested that being male, rural, less educated, never married, living alone and nonsuperstitious were most likely to the lethality factors of suicide deaths. This conclusion is consistent with many previous studies [9,[22][23][24][25][26]. Many previous studies [17,27,28] have indicated that being female was a risk factor for suicide and suicide attempts, but the current study indicated that if suicide behaviour is carried out, males are more inclined to suicide death rather than suicide attempts. ...
Aim:
This study was aimed to compare the psychological strains between suicides and suicide attempters, so as to verify the hypothesis whether the stronger psychological strains increase the odds of suicide death.
Method:
The suicide data were collected by a psychological autopsy (PA) study, and the suicide attempt data were from the same rural areas in China. Information was obtained with face to face structured questionnaires interviews. A social value conflict scale, measures of aspiration and deprivation, and Moos's Coping Response Inventory (CRI) were used to measure psychological strains. The Spearman correlation and Logistic regression method were applied to analyse and estimate the odds ratio (OR) of fatality of suicide behaviours from psychological strains.
Results:
The value strain, aspiration strain, deprivation strain, and coping strain were all significantly stronger among the suicides than suicide attempters (P < 0.001). Each psychological strain had statistical correlation with suicide behaviour (P < 0.001). The univariable and multivariable Logistic regressions all indicated that rural residence, being never married, and the psychological strains were the independent lethality factors of suicidal behaviours.
Conclusions:
Psychological strains were the independent lethality factors of suicide behaviours. Stronger psychological strains increase the odds of suicide death. The intervention based on the Strain Theory of Suicide could decrease the odds risk of suicide death.
... Mental illness is a key antecedent to suicide. Indeed, estimates of the proportion of people experiencing a mental illness at the time of their suicide range from ~90% in North America to 30-70% in East Asia [89][90][91][92] , with individual reports citing rates as low as 7% in some countries 93 . These disorders can be detected through retrospective interviews with family and friends of the deceased using psychological autopsy methods; however, they are not always diagnosed or treated before death, and likely represent one of the key modifiable aspects of an individual's suicide risk. ...
Although recent years have seen large decreases in the overall global rate of suicide fatalities, this trend is not reflected everywhere. Suicide and suicidal behaviour continue to present key challenges for public policy and health services, with increasing suicide deaths in some countries such as the USA. The development of suicide risk is complex, involving contributions from biological (including genetics), psychological (such as certain personality traits), clinical (such as comorbid psychiatric illness), social and environmental factors. The involvement of multiple risk factors in conveying risk of suicide means that determining an individual’s risk of suicide is challenging. Improving risk assessment, for example, by using computer testing and genetic screening, is an area of ongoing research. Prevention is key to reduce the number of suicide deaths and prevention efforts include universal, selective and indicated interventions, although these interventions are often delivered in combination. These interventions, combined with psychological (such as cognitive behavioural therapy, caring contacts and safety planning) and pharmacological treatments (for example, clozapine and ketamine) along with coordinated social and public health initiatives, should continue to improve the management of individuals who are suicidal and decrease suicide-associated morbidity. Suicide and suicidal behaviour continue to present key challenges for public policy and health services. This Primer discusses the global burden of suicide and suicidal behaviours, and provides an overview of our current understanding of the mechanisms of suicide, including risk factors for suicidal ideation and the transition from ideation to suicide attempt.
... Psychological strain as the source of psychache (hopeless, helpless, unbearable, intolerable or inescapable pain) leads to suicidal mentality, which progresses towards suicidal behavior through a path moderated and intervened by social and psychological factors such as disconnectedness, capability and personality (Joiner, 2005). Other moderators in this model include personality, such as impulsivity (Lin & Zhang, 2017), and attitudes and beliefs, such as religion (Stack & Kposowa, 2011). This notion is illustrated in Figure 1. ...
Suicide is a global public health problem, but very few theories have been developed for its etiology and effective prevention. Presented in this article is a comprehensive and parsimonious theory explaining the socio-psychological mechanism prior to suicidal behavior. Strain, resulting from conflicting and competing pressures in an individual’s life, is hypothesized to precede suicide. The strain theory of suicide (STS) proposes four sources of strain leading to suicide: (1) value strain from differential values; (2) aspiration strain from the discrepancy between aspiration and reality; (3) deprivation strain from the relative deprivation, including poverty; and (4) coping strain from deficient coping skills in the face of a crisis. This new model is built on previous notions of anomie (Durkheim, 1897/1951), strain theories of deviance (Merton, 1957) and crime (Agnew, 1992), although suicide is not a major target for explanation in those theories. Future research with rigorous quantitative data needs to be conducted to further test STS on a more comprehensive level.
... Impulsivity is one of the diathesis of suicidal ideation (Klonsky and May, 2010), which has been defined as a predisposition toward rapid unplanned reactions to internal or external stimuli without regarding to the negative consequences of these reactions to themselves or others (Moeller et al., 2001). A study by Lin and Zhang (2015) proved that impulsivity was strongly related with suicidal behaviors for both groups of participants who are normal and those who have a mental disorder, indicating that impulsivity was a vulnerable diathesis of suicidal ideation. It suggested that the occurrence of suicidal behaviors was the result of the interaction between impulsivity and stress events (Mann et al., 1999). ...
Impulsivity, interpersonal problems, and family environment are important factors in the development of suicidal ideation, but the pathway of these factors on suicidal ideation is not clear. This study constructed a moderated mediation model to examine whether interpersonal problems mediated the relationship between impulsivity and suicidal ideation and whether this mediating process was moderated by family environment. For this purpose, 902 college students from Tianjin Normal University located in the north of China were recruited to participate in this study with Barratt Impulsiveness Scale, Adolescent Self-Rating Life Events Check List, Family Environment Scale, and Beck Scale for Suicidal Ideation. Impulsivity could significantly predict suicidal ideation, and the relationship between impulsivity and suicidal ideation was significantly mediated by interpersonal problems; furthermore, the mediating effect and the directing effect were significantly moderated by family environment. These findings contribute to our understanding of a comprehensive interpretation of both environmental and individual factors' impacts on suicidal ideation.
... Regarding the overall association observed between greater ADHD symptomatology and an increased risk for suicidal behavior, it is possible that ADHD/ADHD symptoms might have an effect through several mechanisms. For example, impulsivity, which has been related to 'actions that are poorly conceived, prematurely expressed, unduly risky, or inappropriate to the situation and that often result in undesirable outcomes,' 34 is not only one of the core symptoms of ADHD 30 but has also been linked to an increased risk for suicidal behavior, 35,36 possibly by predisposing individuals to act in response to suicidal thoughts/feelings. 37 The burden associated with ADHD that may have a cumulative effect across adults' lives 38 might also be important for suicidal behavior. ...
Aims
To examine the association between attention‐deficit/hyperactivity disorder (ADHD) symptoms and suicidal behavior in psychiatric outpatients and whether this association differs among patients with different psychiatric disorders.
Methods
Cross‐sectional data came from the Japan Prevalence Study of Adult ADHD at Psychiatric Outpatient Care (the J‐PAAP study) which included psychiatric outpatients aged 18‐65 years recruited from one university hospital and three general psychiatric outpatient clinics in Kitakyushu City, Fukuoka, Japan in April 2014 to January 2015 (N=864). The Adult ADHD Self‐Report Scale (ASRS) Screener was used to collect information on ADHD symptoms. Reports of current and lifetime suicidal behavior were also obtained. A multivariable Poisson regression analysis was used to examine the association between ADHD symptoms and suicidal behavior.
Results
After adjusting for covariates there was a strong association between possible ADHD (ASRS ≥ 14) and suicidal behavior with prevalence ratios ranging from 1.17 (lifetime suicidal ideation) to 1.59 (lifetime suicide attempt) and 2.36 (current suicidal ideation). When ASRS strata were used, there was a dose‐response association between increasing ADHD symptoms and suicidal ideation and suicide attempts. Analyses of individual ICD‐10 psychiatric disorders showed that associations varied across disorders and that for anxiety disorder ADHD symptoms were significantly linked to all forms of suicidal behavior.
Conclusion
ADHD symptom severity is associated with an increased risk for suicidal behavior in general psychiatric outpatients. As ADHD symptoms are common among adult psychiatric outpatients, detecting and treating ADHD in this population may be important for preventing suicidal behavior.
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... Maladaptive expression of impulsivity is often observed in psychiatric disorders such as attention-deficit/hyperactivity disorder (Malloy-Diniz et al., 2007;Dang et al., 2014) antisocial personality disorder (Swann et al., 2009), borderline personality disorder (Cackowski et al., 2014), affective disorders (Peters et al., 2015), and substance abuse and addiction (Gray and MacKillop, 2015). Since most studies of impulsivity are rather focusing on its undesirable, dysfunctional consequences (Malloy-Diniz et al., 2007;Lage et al., 2013;Lin and Zhang, 2015;Nederkoorn et al., 2015). Thus, the instruments designed to measure impulsivity are biased toward its negative outcomes. ...
Impulsivity has mainly been described as a negative or dysfunctional characteristic associated with several disorders. However, impulsivity is not only related to dysfunctional outcomes and may explain individual differences in optimal human functioning as well. The Dickman Impulsivity Inventory (DII) is a self-report instrument measuring both the dysfunctional and the functional aspects of impulsivity. In this study, we performed the translation and cultural adaptation of the DII to the Brazilian context and analyzed its psychometric properties. Translation and cultural adaptation followed a rigorous process, which relied on an expert panel in the cross-cultural adaptation of psychological instruments. Data from 405 undergraduate students were obtained for the Brazilian version of the DII (Br-DII). The 23 items of the Br-DII was considered unsuitable according to model fit indices of the Confirmatory Factor Analysis (both for Oblique and Orthogonal models). Exploratory Factor Analysis showed an 18 items version of the Br-DII to be suitable (CFI = 0.92; TLI = 0.90, and RMSEA = 0.057). The DII’s 18 items version also showed adequate Cronbach’s alpha, intraclass correlation coefficient, and convergent and discriminant validity with the BIS-11. Therefore, the Br-DII demonstrated reliability and validity in the measurement of functional and dysfunctional impulsivity.
... Psychological strain as the source of psychache (hopeless, helpless, unbearable, intolerable or inescapable pain) leads to suicidal mentality, which progresses towards suicidal behavior through a path moderated and intervened by social and psychological factors such as disconnectedness, capability and personality (Joiner, 2005). Other moderators in this model include personality, such as impulsivity (Lin & Zhang, 2017), and attitudes and beliefs, such as religion (Stack & Kposowa, 2011). This notion is illustrated in Figure 1. ...
While suicidologists have interpreted the motives and risk factors of suicide in numerous ways, the ultimate objective is to find a theory that explains the majority of the variance in suicidal behaviors. Durkheim's (1951 [1897]) classical theory of social integration and regulation, explaining egoistic, altruistic, anomic and fatalistic suicide, is in theoretical and practical conflict with the psychopathological theories prevalent in today's world. However, substantial numbers of suicides, East and West, are carried out by individuals who appear to be socially integrated (Zhang, 2000; Zhang & Jin, 1998), and only a very small percentage of mentally ill people kill themselves (Mann, et al., 1999), although over 90% of suicides in the West have been diagnosed with mental disorders including major depression and alcohol or substance use disorders (NIMH, 2003). Also, in the Western world, individuals who are male, white or older are more likely to kill themselves than individuals who are female, black or younger. If the psychiatric model were valid, men, whites and older persons should be more abnormal psychologically than women, blacks and younger persons which is, of course, far from the truth (Thio, 2004). A psychiatric disorder may be a necessary condition for suicide, but it is definitely not sufficient, and in order to identify suicide risk factors, it is necessary to look beyond the presence of a major psychiatric syndrome (Mann, et al., 1999). Furthermore, most previous studies of suicide have been restricted to one domain of possible risk factors such as the social (Brent, et al., 1993; Chiles, et al., 1989; Daly, et al., 1986; Maris, 1997; Roy, 1985; Roy & Segal, 1995; Schulsinger & Kety, 1979; Zhang & Thomas, 1991), psychiatric (Kaplan & Harrow, 1996; Rich & Runeson, 1995; Strakowski, et al., 1996), or psychological (Beck, et al, 1985; Nordstrom, et al., 1995; Pokorny, 1983; Zhang & Jin, 1998). Most of those studies are generally from medical perspectives and are exploratory in nature. Mann and colleagues (1999) developed and tested a stress-diathesis theory of suicide, but it is only a clinical model based on and for psychiatric patients. Heeringen's (2003) psychobiological model of suicidal behavior that focuses on a state-trait interaction seems more generalizable, but again is neurobiological in nature. In order to overcoming these deficiencies, this chapter proposes a basic paradigm that incorporates the available theories, hypotheses and findings explaining suicide in the world today. The new paradigm is built on previous notions of anomie and strain (Durkheim 1951 [1897]), although Merton's (1957) strain theory of deviance and crime and Agnew's (1992) general strain theory have not in the past included suicide as a target for explanation.
Objectives
Co-occurrence of Anorexia Nervosa (AN) and borderline personality disorder (BPD) is frequent (8%–40%) and associated with specificities that impact the treatment process. Lifetime history of suicide attempt (HAS), substance use disorder (SUD) and the binge-purging subtype (B-P) might be good markers of such comorbidity. We made the hypothesis that in patients with AN, the presence of HAS, SUD and B-P have sufficient predictive power to efficiently detect an associated BPD comorbidity.
Methods
After a case report analysis on a pilot sample of 119 patients with AN, we performed a cross-sectional analysis on a confirmatory sample of 84 patients with AN in a single center specialized in eating disorders systematically assessing HAS, SUD, B-P and BPD using the Mini International Neuropsychiatric Interview for DSM-5 and the Diagnostic Interview for Borderline (DIB-R).
Results
B-P had a 100% negative predictive value, and the combination of SUD plus HAS had a 100% positive predictive value. On a quantitative level, B-P, HAS and SUD were independent explanatory factors of the DIB-R total score.
Conclusions
The main limitations were the low number of patients, the single center analyses, the potential overlapping of assessments and the fact that data were exclusively declarative. In this study, every patient with B-P, SUD and HAS had been diagnosed with BPD.
Previous research has found that attention-deficit/hyperactivity disorder (ADHD) in children is related to bullying perpetration. This study examined the correlation between ADHD and bullying perpetration, and aimed to identify which factors, including bullying victimization, predicted bullying. Forty-nine elementary school students, aged 6-12, participated voluntarily in a comparative study between children with ADHD and non-ADHD control children; none of them had previously undergone psychiatric treatment. Both parents’ and participants’ social demographic information (gender, age) and clinical variables were obtained from self-report questionnaires. The participants’ bullying victimization experience, impulsivity, and parents’ history of ADHD had significant relationships with bullying. The status of ADHD and other self-reported scales had no significant relationships with bullying. The association between bullying victimization and bullying perpetration was notable among all factors examined. This was consistent with the claims of prior studies that past victimization led to perpetration of bullying. Therefore, it seems that when treating victims of bullying, care should be taken, through proper intervention, to ensure the incident is neither repeated nor replicated. Characteristics associated with ADHD, including impulsivity and parents’ history of ADHD, were significantly related to bullying. However, we could not confirm our hypothesis that ADHD itself might be associated with bullying behavior.
Background
Psychiatric disorders are reported to be present in 80% to 90% of suicide deaths in high-income countries (HIC), but this association is less clear in low- and middle-income countries (LMIC). There has been no previous systematic review of this issue in LMIC. The current study aims to estimate the prevalence of psychiatric morbidity in individuals with suicidal behaviour in LMIC.
Methods and findings
PubMed, PsycINFO, and EMBASE searches were conducted to identify quantitative research papers (any language) between 1990 and 2018 from LMIC that reported on the prevalence of psychiatric morbidity in suicidal behaviour. We used meta-analytic techniques to generate pooled estimates for any psychiatric disorder and specific diagnosis based on International classification of disease (ICD-10) criteria. A total of 112 studies (154 papers) from 26 LMIC (India: 25%, China: 15%, and other LMIC: 60%) were identified, including 18 non-English articles. They included 30,030 individuals with nonfatal suicidal behaviour and 4,996 individuals who had died by suicide. Of the 15 studies (5 LMIC) that scored highly on our quality assessment, prevalence estimates for psychiatric disorders ranged between 30% and 80% in suicide deaths and between 3% and 86% in those who engaged in nonfatal suicidal behaviour. There was substantial heterogeneity between study estimates. Fifty-eight percent (95% CI 46%–71%) of those who died by suicide and 45% (95% CI 30%–61%) of those who engaged in nonfatal suicidal behaviour had a psychiatric disorder. The most prevalent disorder in both fatal and nonfatal suicidal behaviour was mood disorder (25% and 21%, respectively). Schizophrenia and related disorders were identified in 8% (4%–12%) of those who died by suicide and 7% (3%–11%) of those who engaged in nonfatal suicidal behaviour. In nonfatal suicidal behaviour, anxiety disorders, and substance misuse were identified in 19% (1%–36%) and 11% (7%–16%) of individuals, respectively. This systematic review was limited by the low number of high-quality studies and restricting our searches to databases that mainly indexed English language journals.
Conclusions
Our findings suggest a possible lower prevalence of psychiatric disorders in suicidal behaviour in LMIC. We found very few high-quality studies and high levels of heterogeneity in pooled estimates of psychiatric disorder, which could reflect differing study methods or real differences. There is a clear need for more robust evidence in order for LMIC to strike the right balance between community-based and mental health focussed interventions.
Suicide is the fifth most important cause of death in China and the leading cause of death among young adults aged 15-34 years. The suicide rate in rural China is three times higher than the urban suicide rate, and the rate in women is higher than in men.
Sixteen counties from three provinces were selected as sampling sites in which 392 suicide cases and 416 community living controls were obtained. For each suicide case and control there were two informants who provided the target person's information. A structured questionnaire including demographics, social and familial environments, and personal characteristics was administered to the informants.
Mental disorders and high hopelessness were found to be strongly related to suicide among Chinese rural young adults. Other suicide risk factors among this population were negative life events, never married but dating, suicide history in family, lack of positive coping skills, lack of social support, dysfunctional impulsivity, and not being a Communist Party/League member.
The prevalence of mental disorders, although the strongest risk factor among rural young adult suicides in this study, was markedly lower than that in Western countries. Some of the risk factors found in the comprehensive analyses are specific to Chinese culture. "Being a Communist Party/League member" as a protective factor for suicide among Chinese rural youths requires further study and appropriate interpretation.
Research has demonstrated that impulsivity is strongly associated with suicide-related ideation and behaviour among young adults. However, to date, the potential importance of impulsivity as a predictor of suicide-related ideation in later life has yet to be determined. Our study examined impulsivity, hopelessness, depressive symptomatology, and sociodemographic factors vis-à-vis suicide-related ideation among older adults at risk of self-harm.
A sample (n = 117) of older adults was recruited from multiple sources for this study over a 1-year period. Suicide-related ideation was measured with the Geriatric Suicide Ideation Scale, a multidimensional measure of suicide-related ideation developed for use with older adults.
Canonical correlation identified 2 pairings of linear composites in which impulsivity emerged along both as significantly associated with facets of suicide-related ideation. Of note, the greater proportion of variance in impulsivity was subsumed along the second set of vectors with somatic depressive symptoms.
Our findings suggest that the impulse to self-harm may be even more pronounced among older adults less likely to present as typically depressed. It is further suggested that impulsivity is more broadly associated with suicide-related ideation than hopelessness, and that screening for impulsivity as well as hopelessness may increase clinicians' ability to identify older adults at greatest risk of self-harm.
E. S. Barratt proposed the term
impulsive aggression
to define a kind of aggression that is characterized by acting without thinking because of high levels of impulsivity. Previous research using psychometric measures has shown that impulsivity and aggression are related as far as psychometric measures are concerned. Nevertheless, most of the research has been done with samples of university students. Our research tests whether this relationship is stable across different samples; university students, teenagers and workers. Our results show that impulsivity and aggression have a consistent pattern of relationships across these samples, with impulsivity being specially related to emotional and instrumental aspects of aggression. Furthermore, the effects of anger on aggression seem to show a pattern of relationship that depends on age, with a tendency to physical aggression in young people and verbal aggression in adults.
Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study.
Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed.
Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters.
The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.
Few studies of suicide have simultaneously examined the individual and combined effects of psychosocial and psychiatric risk factors.
To do so in a representative sample of suicides.
A case-control psychological autopsy was conducted among 113 consecutive suicides and 226 living controls matched for age, gender, ethnicity and area of residence in Taiwan.
Five major risk factors (loss event, suicidal behaviour in first-degree relatives, ICD-10 major depressive episode, emotionally unstable personality disorder and substance dependence) were found to have independent effects on suicide from multivariate conditional logistic regression analysis.
Effective intervention and management for loss event and major depressive episode among emotionally unstable subjects with a family tendency of suicidal behaviour, frequently also comorbid with alcohol or other substance dependence, may prove to be most effective for suicide prevention in different populations.
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.
Suicide is the fifth most important cause of death in China, but the reasons for the high rate and unique pattern of characteristics of those who kill themselves are unknown.
We pretested, and then administered a comprehensive interview to family members and close associates of 519 people who committed suicide and of 536 people who died from other injuries (controls) randomly selected from 23 geographically representative sites in China.
After adjustment for sex, age, location of residence, and research site, eight significant predictors of suicide remained in the final unconditional logistic regression model. In order of importance they were: high depression symptom score, previous suicide attempt, acute stress at time of death, low quality of life, high chronic stress, severe interpersonal conflict in the 2 days before death, a blood relative with previous suicidal behaviour, and a friend or associate with previous suicidal behaviour. Suicide risk increased substantially with exposure to multiple risk factors: none of the 265 deceased people who were exposed to one or fewer of the eight risk factors died by suicide, but 30% (90/299) with two or three risk factors, 85% (320/377) with four or five risk factors, and 96% (109/114) with six or more risk factors died by suicide.
Despite substantial differences between characteristics of people who commit suicide in China and the west, risk factors for suicide do not differ greatly. Suicide prevention programmes that concentrate on a single risk factor are unlikely to reduce suicide rates substantially; preventive efforts should focus on individuals exposed to multiple risk factors.
Lower serotonergic activity correlates with high-lethality suicide attempts in major depression. Postmortem studies of serotonin receptors in suicides localize changes to the ventral prefrontal cortex (PFC). We studied serotonergic response in ventral PFC in depressed patients surviving a high-lethality suicide attempt.
Depressed patients with a history of a high-lethality suicide attempt (n = 16) were compared with those with low-lethality attempts (n = 9) for level of depression, suicidal intent and ideation, impulsivity, aggression, and neuropsychological test performance. Subjects were scanned while medication free after a single-blind placebo and after fenfluramine hydrochloride administration on a second day. Brain responses were measured by positron emission tomography imaging of fludeoxyglucose F 18 and serial prolactin levels. Scans were compared by means of statistical parametric mapping. Correlations of changes in relative regional cerebral uptake (rCMRglu) with clinical and neuropsychological measures were assessed.
Depressed high-lethality suicide attempters had lower rCMRglu in ventral, medial, and lateral PFC compared with low-lethality attempters. This difference was more pronounced after fenfluramine administration. Lower ventromedial PFC activity was associated with lower lifetime impulsivity, higher suicidal intent (planning), and higher-lethality suicide attempts. Higher verbal fluency was positively correlated with rCMRglu in the same regions.
Prefrontal localized hypofunction and impaired serotonergic responsivity are proportional to the lethality of the suicide attempt and may mediate the effects of suicide intent and impulsivity on lethality. Positron emission tomographic neuroreceptor studies are needed to determine whether postmortem serotonin receptor findings are also present in vivo and contribute to the abnormal rCMRglu responses.
This study examined the reliability and validity of the instruments as used in the psychological autopsy method in China. With data from 130 informants on 66 completed suicides and 130 informants on 66 normal community controls and 66 controls themselves, the validity was examined by comparing the responses of informants and the responses (gold standards) of the target participants in the control group. All the tested instruments were shown to be reliable, and proxy respondents were generally good judges of targets' suicidal intention, social support, depression, life events, personality traits, and mental disorders. Additionally, interrater reliabilities of the five interviewers were very good on selected scales. This study has laid a partial foundation for future psychological autopsy projects to be held in Chinese culture.
When there exists no single source of information (informant) to validly measure a characteristic, it is typically recommended that data from multiple informants be used. In psychiatric assessment and research, however, multiple informants often provide discordant data, which further confuse the measurement. Strategies such as arbitrarily choosing one informant or using the data from all informants separately generate further problems. This report proposes a theory to explain observed patterns of interinformant discordance and suggests a new approach to using data from multiple informants to measure characteristics of interest.
Using the example of assessment of developmental psychopathology in children, the authors propose a model in which the choice of informants is based on conceptualizing the contexts and perspectives that influence expression of the characteristic of interest and then identifying informants who represent those contexts and perspectives in such a way as to have the weaknesses of one informant canceled by the strengths of another.
Applications of this approach to several datasets indicate that when these principles are followed, a more reliable and valid consensus measure is obtained, and failure to obtain a reliable, valid measure is indicative of some deviation from the principles.
In obtaining a consensus measure, the issue is not determining how many informants are needed but choosing the right set of informants.
It is unclear whether the association between impulsive-aggressive behaviours and suicide exists across different ages.
Via psychological autopsy, we examined a total of 645 subjects aged 11-87 years who died by suicide. Proxy-based interviews were conducted using the SCID-I & SCID-II or K-SADS interviews and a series of behavioural and personality-trait assessments. Secondarily, 246 living controls were similarly assessed.
Higher levels of impulsivity, lifetime history of aggression, and novelty seeking were associated with younger age of death by suicide, while increasing levels of harm avoidance were associated with increasing age of suicide. This effect was observed after accounting for age-related psychopathology (current and lifetime depressive disorders, lifetime anxiety disorders, current and lifetime substance abuse disorders, psychotic disorders and cluster B personality disorders). Age effects were not due to the characteristics of informants, and such effects were not observed among living controls. When directly controlling for major psychopathology, the interaction between age, levels of impulsivity, aggression and novelty seeking predicted suicide status while controlling for the independent contributions of age and these traits.
Higher levels of impulsive-aggressive traits play a greater role in suicide occurring among younger individuals, with decreasing importance with increasing age.
The main objective of the present study is to enrich our understanding regarding the role of personality traits in the explanation of suicide attempt behavior. More specifically, it employs Cloninger's three personality dimensions as a tool for predicting suicide attempt behavior among psychiatric patients. A total of 172 psychiatric outpatients, 80 with a history of suicide attempt and 92 without, participated in the study. Multivariate analysis of variance (MANOVA) suggests that psychiatric patients with a history of suicide attempt express higher levels of both novelty seeking and harm avoidance than do those without such a history. The findings of the present study confirm the major role played by personality traits in the understanding of suicide attempt behavior among psychiatric patients.
As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.
The contribution of a series of measures of personality and/or cognitive style to serious suicide attempt risk in young people was examined in a case-control study. Individuals making suicide attempts had elevated odds of hopelessness, neuroticism, introversion, low self-esteem, impulsiveness, and external locus of control. When allowance was made for intercorrelations between these measures, hopelessness, neuroticism, and external locus of control remained significant risk factors for serious suicide attempt; self-esteem, extraversion, and impulsiveness were not significantly associated with suicide attempt risk. Nonsignificant findings were explained by the presence of substantial correlations between these measures and measures of hopelessness, neuroticism, and external locus of control.
A total of 1320 Ss (559 males and 761 females) completed the I6 Impulsiveness Questionnaire. Reliabilities, scale intercorrelations, means and standard deviations as well as age means are given after some item changes from the original I5 Questionnaire. The resulting I7 Impulsiveness Questionnaire is reproduced in the Appendix, together with the scoring key. A further 589 Ss (383 males and 206 females) completed the new I7, together with the EPQ and intercorrelations of the seven factors obtained are given (i.e. Psychoticism, Extraversion, Neuroticism, Lie score, impulsiveness Venturesomeness and Empathy). A table of means and standard deviations for this second sample of Ss is also given for the sake of completeness.
Impulsivity is a multidimensional construct assessed by a variety of behavioural and self-report measures. Each measure is thought to assess a separate component, but the inter-relationship between these measures in relation to the functional and dysfunctional nature of this psychological construct remains unclear. In addition, cognitive attributes of functional and dysfunctional impulsivity have not yet been identified. The present study addressed these issues by examining the inter-relationships between impulsivity measured using the delay discounting task and self-report questionnaires, alongside a measure of cognitive distortions. The results showed that delay discount rates were positively correlated with both functional and dysfunctional impulsivity measures, non-planning-impulsiveness and total scores of the Barratt Impulsiveness Scale (BIS-11). These findings are consistent with the idea that discounting the value of delayed rewards may be related to some, not necessarily dysfunctional, forms of impulsive behaviour. Furthermore, the present study suggests that negative cognitive attributes may operate as cognitive processing associated with some subtypes of impulsivity, i.e., dysfunctional impulsivity, non-planning and cognitive impulsiveness.
We used exploratory factor analysis to determine the factorial structure of the Spanish adaptation of Dickman's impulsivity inventory in a sample of 355 university students. Our results showed the two impulsivity factors, functional and dysfunctional, described by Dickman (1990). We applied consensus direct oblimin rotation to the Spanish, American and Dutch versions of the inventory and obtained a high congruence between the three factorial solutions which seems to suggest that they are quite stable across languages and populations. Both kinds of impulsivity showed relationships to the extraversion and psychoticism dimensions of the EPQ-R although extraversion was more related to functional impulsivity and psychoticism was more related to dysfunctional impulsivity.
This study examined the component structure of impulsivity, by Principal Components Analysis of 12 subscales, from four widely used self-report measures of impulsivity. Two hundred and forty five subjects from the UK general population completed the Eysenck Impulsiveness Scale (Eysenck, Pearson, Easting, & Allsopp, 1985), the Dickman Impulsiveness Scale (Dickman, 1990), Barratt's Impulsiveness Scale (Patton, Stanford, & Barratt, 1995) and the BIS/BAS scales (Carver & White, 1994). Analysis of the subscales provided evidence in support of a three-component structure of impulsivity. Components were labelled Non-Planning Dysfunctional, Functional Venturesomeness and Drive/Reward Responsiveness.
We are not aware of any of impulsivity trait for Chinese rural youths. This study evaluated the psychometric properties of Dickman Impulsivity Instrument in suicide cases and living controls in rural China.
The participants, 392 suicide victims and 416 controls were respectively selected, and the psychological autopsy method was used to collect information. The Exploratory Factor Analysis was processed to evaluate the construct validity. The Cronbach's alpha was computed to evaluate the internal consistency, and the Spearman rank correlation coefficients between STAI Trait Anxiety Inventory, Coping Responses Inventory and Dickman Impulsivity Instrument were calculated to evaluate the convergent validity.
Dysfunctional and Functional impulsivity were extracted for both samples. The mean of DI scores in suicide cases was larger than that in controls, but it was reversed for FI. There were no significant differences between DI and FI in suicide cases, but in controls the mean of DI scores was significantly smaller than that of FI. The Cronbach's alpha was around .863 and .779 respectively for DI and FI scales in suicides, and it was around .746 and .680 in controls. The DI and FI were significantly correlated with each other. Both the DI and FI were correlated with Approach and Avoidance Coping Response Inventory, and both of the scales were grossly independent with Trait Anxiety Inventory in two samples.
The results indicated that the Dickman Impulsivity Instrument was adequate to measure impulsivity trait for suicide victims and living controls through proxy data in rural China.
The authors examined the prevalence and distribution of mental disorders in rural Chinese 15-34 years of age who committed suicide. They hypothesized that mental illness is a risk factor for suicide in this population and that the prevalence of mental illness is lower in females than in males.
In this case-control psychological autopsy study, face-to-face interviews were conducted to collect information from proxy informants for 392 suicide victims and 416 living comparison subjects. Five categories of DSM-IV mental disorders (mood disorders, schizophrenia and other psychotic disorders, substance use disorders, anxiety disorders, and other axis I disorders) at the time of death or interview were assessed using the Chinese version of the Structured Clinical Interview for DSM-IV. Sociodemographic variables, social support, and life events were also assessed.
The prevalence of current mental illness was 48.0% for suicide victims and 3.8% for comparison subjects. Among suicide victims, mental illness was more prevalent in males than in females (55.1% compared with 39.3%). A strong association between mental illness and suicide was observed after adjustment for sociodemographic characteristics. Other risk factors included having a lower education level, not being currently married, having a lower level of social support, and having a history of recent and long-term life events. Additive interactions were observed between mental illness and lower level of social support.
Although mental illness is a strong risk factor for suicide, it is less prevalent among rural Chinese young people who committed suicide, particularly females, in comparison with other populations in China and in the West.
Essential knowledge on suicide is derived from studies that include interviews with survivors. In this paper, we discuss methodological and ethical issues pertaining to the interview method known as "psychological autopsy"; the discussion is based on our application of the method to three studies of suicides in Sweden and on a review of other investigations. Interviewing a survivor is a delicate matter, and the integrity of the deceased, the integrity and health of the informant, and the psychological strain on the interviewer must all be taken into consideration. The interviewer should have clinical experience in order to be prepared to deal with interviewees in grief. Contact by telephone, followed by an introductory letter, provides an opportunity to meet survivors in an empathic manner and has a low rejection rate. A 2- to 6-month interval between suicide and interview is recommended. The survivor's reactions to the interview should be evaluated in order to expand the empirical base for ethical considerations. Studies on the validity and reliability of the method are necessary.
The 3 studies reported here were designed to clarify the nature of the personality trait of impulsivity. Two types of impulsivity were distinguished. Dysfunctional impulsivity is the tendency to act with less forethought than most people of equal ability when this tendency is a source of difficulty; most previous work on impulsivity appears to have focused on this trait. Functional impulsivity, in contrast, is the tendency to act with relatively little forethought when such a style is optimal. The present work indicates that these two tendencies are not highly correlated and that they bear different relations both to other personality traits and to the manner in which certain basic cognitive processes are executed.
There appears to be an association between a "global" mode of perceptual processing and a cluster of personality traits, one of which is impulsivity. The goal of the present study was to clarify this relationship. Subjects differing in impulsivity (as measured by a self-report inventory) performed speeded cardsorting tasks. They sorted stimuli consisting of large letters made up of smaller letters. Highly impulsive subjects had no more difficulty than other subjects in ignoring the large, "global," letters when they tried to attend to the smaller, "local," letters of which they were composed, nor were they more vulnerable than other subjects to Stroop-like response interference produced by the global letters. High impulsives did have particular difficulty when the task required that they integrate the information provided by the local and global letters. This finding can be explained in terms of individual differences in the value placed on speed relative to accuracy in information processing.
Psychiatric illness is a potent risk factor for suicide, rates of which differ markedly with age. The purpose of this study was to examine whether the psychiatric diagnoses of suicide victims vary predictably with age.
DSM-III-R axis I diagnoses of 141 persons aged 21 to 92 years who had completed suicide were established by the psychological autopsy method. Multiple logistic regression analyses were used to determine whether age, gender, or their interaction predicted the presence of specific disorders.
One or more axis I conditions were diagnosable in 90.1% of the suicide victims. Substance use disorders were most frequent, followed by mood disorders and primary psychotic illness. Younger age at death was a significant predictor of substance abuse or dependence and primary psychoses, while older age predicted major mood disorders. Comorbidity of substance use and mood disorders was common. Among victims with substance abuse or dependence, older age at death predicted major depression; among victims with mood disorders, younger age at death predicted comorbid substance abuse or dependence.
The distribution of psychiatric illnesses in suicide victims differs across the life course. Age-related patterns of addictive and psychotic disorders echo their prevalence in the general population. In contrast, the relationship between age and mood disorders among suicide victims is distinctly different from that of the general population. These findings suggest that risk for suicide increases with age in individuals with major affective illness. Depressed elderly men are particular targets for suicide prevention strategies.
This study focuses on clinical impulsivity in depressed patients, regarding suicide attempts.
Fifty depressed in-patients were assessed for impulsivity with the Impulsivity Rating Scale and the Baratt Impulsivity Scale, at admission (W0) and after 4 weeks of treatment (W4), with special attention to suicide attempts.
In the whole sample, impulsivity scores decreased significantly between W0 and W4. The scale and the questionnaire correlated slightly with each other, suggesting some differences in impulsivity assessment between patients and clinicians. The two subgroups of patients, suicide attempters (SA) (n = 16) and non-suicide attempters (NSA) (n = 34), were different neither in terms of sample characteristics and antidepressant treatments nor in terms of depression and general psychopathology assessments. However, SA patients scored higher on the impulsivity scale and questionnaire than NSA patients, both at W0 and W4. These results suggest first that impulsivity may be both a trait and a state in depressed suicide attempters and second that it may be relevant in terms of suicide attempts in depression.
The aims of this paper are (i) to describe the specific characteristics of suicide in China and compare it with that in a western country, Denmark: and (ii) to discuss the accuracy of suicide data and the possible explanations for suicide behaviour in China.
Data for the study are obtained from the World Health Statistics Annual based on official records in China and the Danish Cause-of-Death Register, and standardized according to the age-specified population of China in 1990.
The specific characteristics of suicide in China differed strikingly from the general pattern of suicide in other western countries as well as in Denmark: suicide rates in females were higher than in males; rural rates were more than three times higher than urban rates; suicide rates peaked for those aged 75 + years, but with a minor peak in females for those aged 15-24 years old.
These specific characteristics of suicide in China may possibly be interpreted in terms of traditional culture, social forces, political environment and economic status.
Impulsivity has been found to be an important trait of personality, whose consequences are not always negative although available questionnaires focused on its 'dysfunctional' aspect.
Dickman's Functional and Dysfunctional Impulsivity questionnaire has been translated into French, and filled out by students. The tetrachoric correlation matrices were factor analysed.
The psychometric properties are very close to those of the English version, and we recovered both factors in males and females. The factor similarities between the genders (in our sample) and between the languages (English vs. French) are very good. The Dysfunctional scale is correlated with the Motor Impulsivity subscale of the Barratt Impulsiveness Scale, and both scales are grossly independent from Spielberger's Trait-Anxiety Inventory.
Our results support a two-factor solution similar to the English one. Nevertheless, the validity of the functional factor remains to be investigated in further studies.
Traumatic brain injury (TBI) is associated with psychiatric illness, suicidal ideation, suicide attempts, and completed suicide. We investigated the relationship between mild TBI and other risk factors for suicidal behavior in major depressive episode. We hypothesized that mild TBI would be associated with suicidal behavior at least partly because of shared risk factors that contribute to the diathesis for suicidal acts. Depressed patients (N = 325) presenting for treatment were evaluated for psychopathology, traumatic history, and suicidal behavior. Data were analyzed using Student t -test, chi-square statistic, or Fisher exact test. A backward stepwise logistic regression model (N = 255) examined the relationship between attempter status and variables that differed in the TBI and non-TBI patients. Forty-four percent of all subjects reported mild TBI. Subjects with TBI were more likely to be male, have a history of substance abuse, have cluster B personality disorder, and be more aggressive and hostile compared with subjects without TBI. They were also more likely to be suicide attempters, although their suicidal behavior was not different from that of suicide attempters without TBI. Attempt status was mostly predicted by aggression and hostility, but not the presence of TBI. Of note, for males, a history of TBI increased the likelihood of being a suicide attempter, whereas the risk was elevated for females regardless of TBI history. Our data suggest that suicidal behavior and TBI share antecedent risk factors: hostility and aggression. Future studies may yield confirmation using a prospective design.
Involvement of personality traits in susceptibility to suicidality has been the subject of research since the 1950s. Because of the diversity of conceptual and methodological approaches, the extent of their independent contribution has been difficult to establish. Here, we review conceptual background and empirical evidence investigating roles of traits in suicidal behaviors.
We selected original studies published in English in MEDLINE and PsycINFO databases, focusing on suicidal ideation, suicide attempts, or suicide completions, and using standardized personality measures.
Most studies focused on investigating risk for suicide attempts. Hopelessness, neuroticism, and extroversion hold the most promise in relation to risk screening across all three suicidal behaviors. More research is needed regarding aggression, impulsivity, anger, irritability, hostility, and anxiety.
Selected personality traits may be useful markers of suicide risk. Future research needs to establish their contributions in relation to environmental and genetic variation in different gender, age, and ethnocultural groups.
Impulsivity is a personality trait thought to be linked to suicide. Yet, not all suicides are highly impulsive. We aimed to better understand clinical, behavioral and psychosocial correlates of the association between suicide and impulsive behavior.
One hundred sixty four suicide cases with impulsivity scores based on the Barratt Impulsivity Scale (BIS) were investigated. To examine the most extreme phenotypes, one hundred suicide cases, representing subjects with BIS scores above the 70th percentile and below the 30th percentile, were compared on clinical, behavioral and psychosocial suicide risk factors assessed by way of structured psychological autopsy methods with best informants.
The impulsive suicide cases were significantly younger, exhibited higher measures of aggressive behavior, and were more likely to have a cluster B diagnosis as well as lifetime and 6-month prevalence of alcohol and drug abuse/dependence. They also differed significantly from their non-impulsive counterparts on all subscales of the TCI except for Harm Avoidance and Reward Dependence. Impulsive suicide completers were more likely to have had a history of childhood abuse and to have experienced a triggering life event up to a week preceding their death. A multivariate analysis indicated that 6-month prevalence of substance abuse/dependence and high aggressive behavior remained significant even after controlling for other significant variables.
This study was carried out using proxy-based interviews.
Most of the known clinical and behavioral risk factors commonly associated with suicide are particularly valid for impulsive suicide completers. Further, triggering and adverse life events seem to play a role primarily in impulsive suicide.
Impulsive symptoms occur across neuropsychiatric disorders, with important ramifications for everyday functioning and quality of life. This article considers recent developments in the neuropsychological assessment of impulsivity with a focus on the ability to suppress motor responses (response inhibition).
Using objective tests, response inhibition deficits were identified in several neuropsychiatric conditions associated with impulsivity, namely attention deficit hyperactivity disorder, trichotillomania, obsessive-compulsive disorder, and chronic substance abuse. Deficits were also found in unaffected first-degree relatives of attention deficit hyperactivity disorder and obsessive-compulsive disorder patients. Evidence from patients with focal brain lesions and from healthy volunteers using functional MRI and transcranial stimulation implicated the right inferior frontal gyrus in response inhibition. Pharmacological manipulations of the serotonin system had no detectable behavioural effects on response inhibition, whereas manipulations of the noradrenaline system did.
Neuropsychological assessment shows great promise in the investigation of impulsivity and its brain substrates. These results support a key role for response inhibition, a function linked to the right inferior frontal gyrus, in the manifestation of impulsivity. Measures of response inhibition will contribute to the search for psychiatric endophenotypes, novel treatments, and more optimal diagnostic classification systems for neuropsychiatric disorders.
As China opens its door to the world, suicide research is making rapid progress using methods and instruments developed in the West. This is a feasibility study of the psychological autopsy methodology applied in China, with its emphasis on the social and cultural environments. With samples of 66 completed suicides and 66 community normal living controls, the authors found that it is feasible to interview at least two informants for each suicide case and each control, between 2 and 6 months after the suicide. With the Chinese-cultivated contacting method of recruiting cases, the refusal rate is nearly zero. The Western-developed methodology per se proved to be valid in the Chinese culture. Ethical considerations in the context of Chinese culture are as important as in the West. Psychological autopsy technique is shown to be an equally applicable method for the study of completed suicides in Chinese culture as it is in the West. Future epidemiological research on Chinese suicide should use the psychological autopsy method to collect data from larger samples in order to increase our understanding of the risk factors for Chinese suicides.
Suicide is a leading cause of death worldwide, among the top 10 causes of death in every country, and one of the three leading causes of death for people aged 15 to 34 years. It has been increasingly recognized in recent years that people who attempt or commit suicide have a certain individual predisposition, part of which is given by personality traits, and in particular, impulsive-aggressive behaviors. This article reviews evidence suggesting that impulsive-aggressive traits are part of a developmental cascade that increases suicide risk among a subset of suicides. These personality traits, which do not appear to be a consequence of psychiatric disorder, seem to play a larger role among younger suicides and may mediate familial transmission of suicidal behavior. However, not all suicides are associated with impulsive-aggressive behaviors, and we need to better understand vulnerability to suicide among non-impulsive-aggressive suicide.
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