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

The role of the serotonergic system at the interface of aggression and suicide.

http://eatingdisorders.ucsd.edu/research/pub/imaging/doc/2010/Selby2010.pdf

Habitual starvation and provocative behaviors: Two potential routes to extreme suicidal behavior in anorexia nervosa

Suicide is the second leading cause of death among youth aged 10–25 years, and approximately one in six adolescents reported serious suicidal ideation in the past year (Centers for Disease Control and Prevention [CDC] in Web-based Injury Statistics Query and Reporting System (WISQARS). http://webappa.cdc.gov/cgi-bin/broker.exe
 , 2017). Schools are a unique environment in which to identify and respond to youth suicide risk, yet the research base for school-based suicide prevention programs is limited due to challenges with implementation and evaluation. The purpose of this article is to review best practice approaches and existing empirical support for school-based suicide prevention and to present a framework for how these efforts can be embedded within multi-tiered systems of support (MTSS). In line with the Substance Abuse and Mental Health Services Administration [SAMHSA] (Preventing suicide: a toolkit for high schools. https://store.samhsa.gov/shin/content//SMA12-4669/SMA12-4669.pdf
 , 2012) framework for suicide prevention in schools, the article overviews existing programs for student education, staff training, and screening, noting where these programs may be situated across tiers of intervention. This is followed by a review of school-related outcomes of existing suicide prevention programs, which highlights the limitations of existing research. Because there are only two school-based prevention programs with evidence for reducing suicide risk in students, the authors encourage school staff to implement best practice recommendations in collaboration with school mental health professionals who can provide ongoing evaluation of program effectiveness, as well as with researchers who are able to design and conduct outcome studies addressing the limitations of current research. Findings also underscore the need for greater integration of suicide prevention programming with existing school initiatives such as MTSS, which aligns with a growing focus in the field of suicide prevention on “upstream approaches.”

School-Based Suicide Prevention: A Framework for Evidence-Based Practice

Impulsive suicide attempts: A systematic literature review of definitions, characteristics and risk factors

Previous research and popular conceptualizations of suicide have posited that many suicides are the result of impulsive, "on a whim" decisions. However, recent research demonstrates that most suicides are not attempted impulsively, and in fact involve a plan. Legally, suicide has historically been considered to be a superseding intervening cause of death that exonerates other parties from liability, but currently there are two general exceptions to this view. Specifically, another party may be found responsible for a suicide if that party either caused the suicide or failed in its duty to prevent the suicide from occurring. Both of these exceptions assume that the resulting suicide was foreseeable. Given that recent research has indicated that most suicides are planned, and thereby foreseeable to a certain extent under many circumstances, this article discusses issues of foreseeability as they pertain to litigation involving third party liability for the suicide of university students, prison inmates, and mental health patients. The authors contend that the surest way for universities, prison staff, and mental health practitioners to avoid being held liable for a suicide is to appropriately assess for suicidal intent.

Tracy K. Witte

Papers

Revisiting impulsivity in suicide: implications for civil liability of third parties.