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

Executive function and suicidality: A systematic qualitative review

To die by suicide, one must think about suicide, make a plan, and then carry it out. Prior research has examined the presence and predictors of these outcomes; however, virtually no studies have characterized how these steps unfold along the pathway to suicide. A novel instrument was administered to 30 recent suicide attempters. Results revealed that although the median onset for suicidal ideation occurs 1 to 5 years prior to attempting, the median for 6 of the 10 steps measured was within 6 hours of attempting. Overall, 86.5% of proximal planning steps took place within 1 week of attempting and 66.6% occurred within 12 hours.

Describing and Measuring the Pathway to Suicide Attempts: A Preliminary Study

Objective Suicide attempts are more lethal in men than in women and this sex difference is more pronounced in old age, when suicide rates in men are highest in most countries, including the United States. To understand this sex difference, the authors assessed correlates of suicide attempt lethality in older men and women. Method Our cross-sectional study enrolled 125 adults (84 aged 50–69 and 41 aged 70 and older) with major depression and a suicide attempt admitted to community and university hospitals in Rochester, NY. and Pittsburgh, PA. Assessments included a structured diagnostic interview, the Lethality Scale, the Suicide Intent Scale, the Cumulative Illness Rating Scale (CIRS) measuring burden of physical illness, and the Mini-Mental Status Examination (MMSE). Results Attempt lethality was higher in older (70+) than in younger (50–69) men and lower in older than in younger women. Association between suicidal intent and attempt lethality was the strongest in older men compared with the other groups. Higher attempt lethality in older men was partly explained by their higher levels of intent, and not by CIRS, MMSE, substance use disorders, or living alone. In younger, but not in older women, suicide intent was correlated with attempt lethality. Conclusion Older men act more decisively on their suicidal intent than older women and this difference is more pronounced with increasing age. These findings might partially explain the sex differences in suicide deaths worldwide.

/pdf/sex-differences-in-correlates-of-suicide-attempt-lethality-crvzgmsuvp.pdf

Sex Differences in Correlates of Suicide Attempt Lethality in Late Life

Prevalence of suicidal ideation and planning in patients with major depressive disorder: A meta-analysis of observation studies.

Planning of suicide attempts among depressed inpatients ages 50 and over

Background: Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients. Methods: A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R. Results: Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses. Limitations: This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients’ depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted. Conclusions: Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance. D 2005 Elsevier B.V. All rights reserved.

Research report Personality and reports of suicide ideation among depressed adults 50 years of age or older

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Planning of suicide attempts among depressed inpatients ages 50 and over

Research report Personality and reports of suicide ideation among depressed adults 50 years of age or older