This article reviews the literature on the association between impulsivity aggression and suicide. The key words impulsivity, aggression, and suicide were entered into the pubmed, psychlit, and proqest databases. Significant articles were scrutinized for relevant information. Impulsivity and aggression are highly correlated with suicidal behavior across psychiatric samples, nosological borders, and non-psychiatric populations. Impulsivity and aggression are related but the nature of this relationship remains unclear. The literature is confusing and contradictory. This is probably due to the difficulty in defining and separating out these concepts and the fact that there is much overlap between them. Future research should aim at clarifying and refining these concepts as well as their link to all the different forms of suicidal behavior.

Aggression, Impulsivity, and Suicide Behavior: A Review of the Literature

Why do people die by suicide? Dr. Thomas Joiner and his colleagues attempt to answer this age-old question by exploring two obvious yet insightful assumptions: people die by suicide because they can - that is, they become desensitized to pain and habituated toward violence; people die by suicide because they want to - they typically have no sense of belonging to a valued group or relationship, and they feel that they have become a burden to loved ones.This book offers a new theoretical framework for diagnosis and risk-assessment of a patient's entry into the dark and obscure mental world of suicidality, and for the creation of preventive and public-health campaigns aimed at the disorder. More important, though, the book provides new, effective clinical guidelines for crisis intervention and for therapeutic alliances in psychotherapy and suicide prevention.

The Interpersonal Theory of Suicide: Guidance for Working with Suicidal Clients

With some prominent exceptions, much of the research designed to elucidate the nature, prevalence, and correlates of suicidal behavior has been conducted from an atheoretical perspective. Conversely, psychological theories to explain suicidal behavior are largely untested by rigorous experimental designs. We propose a cognitive model of suicidal behavior that is grounded in the empirical literature on cognitive and behavioral correlates of and risk factors for suicidal behavior. In addition, we demonstrate the manner in which the theoretical components are targeted in cognitive therapy for suicidal patients. We highlight aspects of the model with less empirical support, and we propose ways those constructs can be tested in future research.

A cognitive model of suicidal behavior: Theory and treatment

Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample.

It is widely accepted that suicidal behavior often occurs with little planning. We propose, however, that suicidal behavior is rarely if ever impulsive-that it is too frightening and physically distressing to engage in without forethought-and that suicidal behavior in impulsive individuals is accounted for by painful and fearsome behaviors capable of enhancing their capacity for suicide. We conducted a meta-analysis of the association between trait impulsivity and suicidal behavior and a critical review of research considering the impulsiveness of specific suicide attempts. Meta-analytic results suggest the relationship between trait impulsivity and suicidal behavior is small. Furthermore, studies examining a mediating role of painful and provocative behaviors have uniformly supported our model. Results from our review suggest that researchers have been unable to adequately measure impulsivity of attempts and that measures sensitive to episodic planning must be developed to further our understanding of this phenomenon.

Reconsidering the Link Between Impulsivity and Suicidal Behavior

Impulsivity in suicidal behavior can describe the attempt (state) or the attempter (trait). There are no studies simultaneously measuring attempt impulsivity and attempter impulsivity in representative samples of suicide attempts. A one-year study of 278 suicide attempts in a general hospital tested the continuous versus dichotomous relationship between attempter impulsivity (Barratt Impulsiveness Scale) and attempt impulsivity (low scores in the planning subscale of Beck's Suicidal Intent Scale). Attempter impulsivity was not a good predictor of attempt impulsivity independently of how both dimensions were measured (continuous or dichotomous ways). Impulsive attempts were associated with low lethality and lack of depression. Opportunities for prevention of suicide attempts in major depression and some personality traits may exist but require attentive monitoring of suicidal ideation and intent.

Suicide attempts and impulsivity

OBJECTIVE: This study explored the factors psychiatrists considered in deciding on hospitalization for a large sample of suicide attempters in the emergency department of a general hospital in Madrid, Spain, between 1996 and 1998. METHODS: Psychiatrists assessed 509 patients who had attempted suicide; 196 of these (39 percent) were hospitalized in the psychiatric unit, and 313 (61 percent) were discharged from the emergency department. The assessment included Beck's Suicidal Intent Scale (SIS) and a checklist of 47 clinical variables. RESULTS: Of the 32 clinical variables significantly associated with hospitalization that were introduced in a logistic regression model, 11 remained significant. Six variables were associated with an increased odds of hospitalization: intention to repeat the attempt, plan to use a lethal method, low psychosocial functioning before the suicide attempt, previous psychiatric hospitalization, a suicide attempt in the past year, and planning that nobody would try to save their li...

https://ps.psychiatryonline.org/doi/pdf/10.1176/appi.ps.55.7.792

Variables Associated With Hospitalization Decisions by Emergency Psychiatrists After a Patient's Suicide Attempt

If premenstrual symptoms (PMS) are temporally and specifically associated with suicidal attempts, suicide attempts in women with PMS should occur more frequently in the luteal phase. In a general hospital, 125 fertile female suicide attempters (and 83 blood donors as controls) with regular menstrual cycles were prospectively studied. A retrospective DSM-IV diagnosis of Premenstrual Dysphoric Disorder (PMDD) was made. Attempts during the luteal phase were not more frequent in females with PMDD (34%,23/68) than in those without PMDD (35%, 20/57). The sample had enough power to detect medium and large effect sizes. As expected, there was a significantly higher frequency of PMDD in suicide attempters than in the controls (54% vs 6%; Fisher’s exact test, p ≤ 0.001). This study was limited by the use of retrospective PMDD diagnosis but suggests that PMDD may not be associated with suicidal acts during the luteal phase,when PMS are present.

Eloy García Resa

Papers

Suicide attempts and impulsivity

Variables Associated With Hospitalization Decisions by Emergency Psychiatrists After a Patient's Suicide Attempt

Premenstrual symptoms and luteal suicide attempts