Personality traits as correlates of suicidal ideation, suicide attempts, and suicide completions: a systematic review

Association between personality traits and suicidality by age groups in a nationally representative Korean sample

Suicide is a leading health issue, which substantially contributes to the causes of death worldwide. Personality traits are some of the major risk factors for suicidality. We sought to identify the relationships between personality traits and suicidality by age group.The Big-Five Inventory-10 traits were measured in community-dwelling individuals in a nationally representative sample in the Republic of Korea. Because personality traits are long-standing patterns throughout one's lifetime, suicidality was measured based on lifetime history, rather than in a recent period. To comprehensively examine independent influences of personality traits on suicidality, psychiatric comorbidity and sociodemographic data were adjusted for.A total of 6022 subjects (3714 females and 2308 males) were included. Agreeableness (odds ratio (OR) [95% confidential intervals (CI)] = 0.79 [0.64-0.98]) was negatively associated with suicidal ideation, whereas neuroticism (1.27 [1.05-1.54]) and openness (1.36 [1.11-1.67]) were positively associated with suicidal ideation among young adults. Openness (1.25 [1.10-1.43]) had a positive association, and conscientiousness (0.86 [0.75-0.98]) had a negative association with suicidal ideation among the middle-aged group. Neuroticism is the only influencing factor for suicidal attempts among the young adult (1.88 [1.24-2.86]) and older (1.65 [1.24-2.20]) groups.Given the differential associations between personality traits and suicidality by age groups, future studies are needed to comprehensively identify possible roles of personality in suicide by age.

Lifetime and prospective associations among personality trait domains and suicide-related behaviors in patients with severe mental illness

BACKGROUND

Despite extensive research and clinical efforts, the suicide rate in the United States continues to rise, driving the need for more research to identify latent factors that increase risk for suicide and to guide treatment decision-making.

METHODS

The current study examined a large cohort (N = 1,219) of high-risk psychiatric inpatients to explore associations between personality traits and suicide-related variables measured retrospectively (lifetime history prior to hospital admission) and prospectively (at discharge and 12-month follow-up).

RESULTS

Lifetime suicide-related behavior (SRB: combination of ideational severity, aborted, interrupted, actual attempts, and non-suicidal self-injury) was associated with age (younger), gender (female), and elevated scores on the Personality Inventory for DSM-5 (PID-5) negative affectivity, borderline trait composite score, and five-factor model traits of conscientiousness and neuroticism. Patients who manifested persistent suicidal ideation throughout a 6-8 week inpatient treatment (n = 162; 16.9%) tended to be younger, female, and to have elevated PID-5 borderline trait composite scores. Twelve-month post-discharge SRB was predicted by elevated PID-5 borderline trait composite scores.

LIMITATIONS

Personality traits accounted for a small amount of variance in the overall model, thus limiting prediction based on individual traits.

CONCLUSIONS

This large sample of high-risk inpatients with longitudinal outcomes provides a rare assessment of proximal personality traits in predicting lifetime SRB, persistent suicidal ideation observed during the course of a 6-8-week intensive inpatient treatment, and SRB outcomes within 12 months after discharge from hospitalization. Personality traits should be included in future attempts to create predictive algorithms that include relevant biological data (neuroimaging, genetic, microbiome).

Suicide amongst the Inuit of Nunavut: An Exploration of Life Trajectories

This article reports results of the life trajectories from 92 Inuit who died by suicide, matched for age and gender with 92 living-controls. A proxy-based procedure and semi-structured interviews with informants were conducted to obtain trajectories of developmental events occurring over the life course for suicide and community-matched controls. Results from this research indicate two different trajectories that differentiate the control-group from the suicide-group throughout the life course. Even though the number of suicide attempts are similar between both groups, the suicide-group had a more important burden of adversity, which seemed to create a cascading effect, leading to suicide.

Are social conflicts at work associated with depressive symptomatology? Results from the population-based LIFE-Adult-Study

Background

Psychosocial stressors in the workplace can be detrimental to mental health. Conflicts at work, e.g. aggression, hostility or threats from coworkers, supervisors or customers, can be considered a psychosocial stressor, possibly increasing risk for depressive symptoms. Existing studies, however, differ in the assessment of social conflicts, i.e. as individual- or job-level characteristics. Here, we investigated the association between conflicts at work assessed as objective job characteristics, and depressive symptomatology, using data from a large population-based sample. Additionally, we investigated gender differences and the impact of personality traits and social resources.

Methods

We used data from the population-based LIFE-Adult-Study from Leipzig, Germany. Information on conflicts at work, assessed as job characteristics, were drawn from the Occupational Information Network, depressive symptoms were assessed via the Center for Epidemiological Studies Depression Scale. Multilevel linear regression models with individuals and occupations as levels of analysis were applied to investigate the association between conflicts at work and depressive symptoms.

Results

Our sample included 2164 employed adults (age: 18-65 years, mean: 49.3, SD: 7.9) in 65 occupations. No association between conflicts s at work and depressive symptomatology was found (men: b = - 0.14; p = 0.74, women: b = 0.17, p = 0.72). Risk for depression was mostly explained by individual-level factors like e.g. neuroticism or level of social resources. The model showed slightly higher explanatory power in the female subsample.

Conclusion

Conflicts at work, assessed as objective job characteristics, were not associated with depressive symptoms. Possible links between interpersonal conflict and impaired mental health might rather be explained by subjective perceptions of social stressors and individual coping styles.

Suicide and Personality Traits: A Multicenter Study of Austrian and Italian Psychiatric Patients and Students

OBJECTIVE

The aim of this multicenter study was to investigate the differences in personality traits, particularly Neuroticism, in three clinical samples and three student samples in Austria and Italy and their impact on suicide.

METHODS

In total, 1,043 people (410 psychiatric inpatients and 633 university students) were tested in three regions of Europe: central Italy, northeast Italy, and eastern Austria. Psychiatric diagnoses were evaluated using the Mini-International Neuropsychiatric Interview, and the following instruments were used: Sociodemographic Questionnaire, Columbia-Suicide Severity Rating Scale-B, Symptom-Checklist-90-Standard, and Big Five Inventory.

RESULTS

The study found that the intensity of Suicidal Ideation was associated with the personality traits of Neuroticism, Anxiety, and Extraversion but also with Depression.

CONCLUSIONS

In conclusion, without the presence of Depression symptoms, neuroticism was a protective factor against Suicidal Ideation, whereas neuroticism when comorbid with Depression symptoms increased suicide risk in psychiatric patients. In all three regions, the clinical samples had higher scores for Neuroticism and for Depression symptoms than the student sample and consequently higher scores for Suicide. Furthermore, we demonstrated an interaction between gender and culture on personality traits, supporting the hypothesis that the distribution of self-reported personality traits is organized geographically.

Stress, cortisol and suicide risk

Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.

Prevalence of suicidal behaviors and associated factors among Peruvian adolescent students: an analysis of a 2010 survey

Introduction

Adolescence is one of the stages in life most affected by suicide. In Peru, 22% of suicides occur in people 10 to 19 years old. However, mental health overall and factors associated with suicidal behaviors have not been well studied.

Objective

To determine the prevalence of suicidal behaviors (ideation and ideation plus suicidal planning) and associated factors in Peruvian adolescent students.

Methods

A cross-sectional study analyzing data from the Global School-based Student Health Survey for Peru in 2010 was conducted to measure the prevalence of suicidal behaviors (ideation and ideation plus suicidal planning) and associated factors in Peruvian adolescent students.

Results

Of the 2521 students evaluated, 19.9% (95% CI: 17.8 to 22.2) presented suicidal ideation and 12.7% (95% CI: 11.1 to 14.5) presented suicidal planning in the last 12 months. Females had a higher prevalence of both ideation (27.5%, 95% CI: 24.9 to 30.4) and ideation plus suicidal planning (18.5%, 95% CI: 16.4 to 20.7). Multivariate analysis found that being female, having little parental support, having felt loneliness, having suffered from physical aggression, having been bullied, and alcohol consumption, were associated with ideation and ideation plus suicidal planning in adolescent students.

Conclusion

Ideation and ideation plus suicidal planning is a problem in the Peruvian adolescent population and is associated with several factors. Strategies are needed to identify and register suicide in adolescents in Peru and to develop prevention programs.

Evaluation of clinical and suicidal behavior characteristics among urban, Turkish middle-age depressive patients with comorbid attention deficit hyperactivity disorder

BACKGROUND

In the presence of attention deficit hyperactivity disorder (ADHD) together with additional psychiatric diseases, the treatment process and prognosis of both ADHD and psychiatric comorbidity are adversely affected.

AIMS

The aim of this study is to compare the characteristics concerning suicidal behavior of the patients diagnosed with major depressive disorder either having (ADHD+) or not having (ADHD-) adult ADHD comorbidity and their responses to depression treatment.

MATERIALS AND METHODS

Ninety-six inpatients were included in the study. Sociodemographic data form, the Hamilton Depression Rating Scale (HDRS), the Wender Utah Rating Scale (WURS), the Adult ADD/ADHD DSM IV-Based Diagnostic Screening and Rating Scale, and the Personal and Social Performance Scale (PSP) were applied to the cases.

RESULTS

HDRS scores were found to be significantly high (P < 0.000) in the ADHD+ group during admission and discharge. However, there was no difference found in terms of PSP scores (P = 0.46) during discharge. In the ADHD+ group, the depressive episode started at an earlier age (P < 0.011). The idea of suicide (P < 0.018) and suicidal attempts (P < 0.022) was found to be higher in this group compared to the ADHD- group. ADHD+ patients had more suicidal attempts requiring more medical intervention (P < 0.001).

CONCLUSION

Depression starts at an early age in individuals with comorbid ADHD diagnosis, and the progress of the depression treatment changes negatively. This patient group is at greater risk in terms of suicidal behavior. Therefore, it should be considered by the clinicians that ADHD can associate with depression while making the follow-up plans for the cases diagnosed with depression.

Impulsivity facets and perceived likelihood of future suicide attempt among patients who recently attempted suicide

BACKGROUND

Given the substantial heterogeneity of both impulsivity and suicidality, increased specificity in studying relations between these variables is needed. One aspect of suicidality that may be especially important for predicting future risk among those with a recent suicide attempt is self-perceived likelihood of making a future attempt (suicide likelihood). Presently, little is known about the extent to which impulsivity is related to this important aspect of suicidality. We examined whether three distinct impulsivity facets (i.e., deficits in conscientiousness, negative urgency, and sensation seeking) would differentially predict suicide likelihood.

METHODS

Participants included 155 psychiatric inpatients who presented to a Level-1 trauma hospital after a recent suicide attempt. Structural Equation Modeling (SEM), in which demographic and clinical covariates were controlled, was conducted to examine whether each impulsivity facet would uniquely predict suicide likelihood.

RESULTS

Deficits in conscientiousness was the only robust predictor of suicide likelihood, with an association that persisted after accounting for demographic and clinical covariates.

LIMITATIONS

The cross-sectional design and unknown predictive validity of suicide likelihood are study limitations.

CONCLUSION

This was a preliminary investigation of impulsivity facets with suicide likelihood. Clinical implications of this study suggest that deficits in conscientiousness and suicide likelihood may be important factors to consider when identifying and intervening with patients at high-risk for suicide.

Effects of ketamine treatment on suicidal ideation: a qualitative study of patients' accounts following treatment for depression in a UK ketamine clinic

OBJECTIVE

It is recognised that ketamine treatment can reduce suicidal ideation (SI) in people with depression, at least in the short term. However, information is lacking on patients' perspectives on such effects. Studying these can contribute to greater understanding of the mechanisms underlying impact of ketamine treatment on SI. The aim of this study was to investigate patients' reports of the impact of treatment on their SI, the duration of effects and possible mechanisms.

DESIGN AND SETTING

This qualitative study consisted of semi-structured interviews with patients who had received ketamine treatment for depression. Interview data were analysed thematically.

PARTICIPANTS

Fourteen patients (8 females, 6 males, aged 24-64 years) who had received treatment with ketamine for treatment-resistant depression, and had SI at the initiation of treatment. Two participants also had a diagnosis of bipolar type 1 and two of emotionally unstable personality disorder. Eight had a history of self-harm.

RESULTS

SI reduced following ketamine treatment in 12 out of 14 participants for periods of a few hours following a single treatment to up to three years with ongoing treatment. Reduction of SI was variable in terms of extent and duration, and re-emergence of suicidal thoughts often occurred when treatment ceased. Participants' accounts indicated that reduced SI was associated with improved mood and reduced anxiety, as were clarity of thought, focus and concentration, and ability to function. Participants reported experiencing some or all of these effects in various orders of occurrence.

CONCLUSION

Generally, ketamine treatment was experienced as effective in reducing SI, although duration of effects varied considerably. Patients' perspectives indicated similarities in the mechanisms of reduction in SI, but some differences in their manifestation, particularly in relation to chronology. Experiences of this cohort suggest that reduced anxiety and improvement in ability to think and function were important mechanisms alongside, or in some cases independently of, improvement in mood. Further studies of patients' experiences are required to gain enhanced understanding of the variability of effects of ketamine on SI and functionality.

Reconsideration of the factorial structure of the Barratt Impulsiveness Scale (BIS-11): Assessment of impulsivity in a large population of euthymic bipolar patients

BACKGROUND

Impulsivity is commonly assessed using the Barratt Impulsiveness Scale (BIS-11). Some studies challenged the reliability of its three dimensional structure and proposed a bi-dimensional structure.

METHODS

The psychometric reliability of the BIS-11 scale was studied in a sample of 580 euthymic bipolar patients. An alternative structure of the scale was conceived, using confirmatory factorial analysis (CFA) in the first half (N = 290) and cross-validated in the second half of our sample. Associations between the newly defined shortened scale and predefined clinical variables were computed.

RESULTS

The original three dimensional structure did not fit in our sample according to statistical criteria in CFA. A 12 items Impulsivity Scale (IS-12) was designed with strong indices of fitting in the first half of our sample and replicated in the second half of our sample. The IS-12 evidences two dimensions: "behavioral impulsivity" and "cognitive impulsivity". Associations between "behavioral impulsivity" and both presence of past suicide attempts and number of suicide attempts were observed. Substance misuse was strongly associated with both subscores of the new scale.

LIMITATIONS

The rating of the items assessing the two dimensions of the IS-12 is reversed. The population is restricted to euthymic bipolar patients.

CONCLUSIONS

The Impulsivity Scale assesses two distinct dimensions named behavioral and cognitive impulsivity. It was reliable and valid in our sample and associated with the existence of suicidal behavior and with substance misuse (alcohol and cannabis). Further studies are needed to demonstrate its predictive validity.

Suicidal ideation in military veterans with alcohol dependence and PTSD: The role of hostility

BACKGROUND AND OBJECTIVES

Suicide is a significant public health problem among US military Veterans with rates exceeding civilian samples. Alcohol dependence (AD) and posttraumatic stress disorder (PTSD) are both associated with increases in suicidality. Given that risk of suicide is higher among those with both disorders, the study of relevant risk factors among those in this group is important. The current investigation focused on one such factor, hostility, and examined both overt hostility (ie, hostility that is more behavioral in nature and directed outwardly) and covert hostility (ie, hostility that is cognitive in nature and introspective) and their relationships to suicidal ideation.

METHODS

Ninety-three Veterans participating in a randomized, double-blind, placebo-controlled treatment study evaluating the efficacy of the alpha-adrenergic agonist prazosin completed measures assessing overt hostility, covert hostility, and suicidal ideation at baseline. Depression symptoms and PTSD symptom severity also were assessed.

RESULTS

Of the total sample, 60 participants (63.8%) indicated that they experienced suicidal ideation at some point in their lives. Covert hostility, in addition to PTSD symptom severity were found to be associated with the presence of lifetime suicidal ideation. Furthermore, depression symptoms were found to be associated with greater intensity of that ideation.

CONCLUSION AND SCIENTIFIC SIGNIFICANCE

Findings highlight the importance of covert hostility as it relates to suicidal ideation among those with comorbid PTSD and AD and provides information which may help inform treatment approaches for high-risk military Veterans. (Am J Addict 2018;27:124-130).

Autistic traits in adults who have attempted suicide

Background

An emerging literature suggests that autistic adults are at increased risk of experiencing suicidal thoughts, making suicidal plans and attempts, and dying by suicide. However, few studies have investigated whether autistic traits are related to suicidal behaviour. The current study examined autistic traits in a sample of adults who reported at least one suicide attempt.

Methods

An online questionnaire was advertised between June and September 2017 on suicide prevention websites, research databases, and social media. Participants reported whether they had ever attempted suicide (yes/no), and if so, how many times they had attempted (once/more than once). They also reported diagnosed and suspected mental health or neurodevelopmental conditions, and completed the Autism Spectrum Quotient (AQ). Two hundred forty-five adults accessed the survey; 132 reported having attempted suicide and also completed the AQ. It was hypothesised that AQ total scores and subscale scores would be higher in adults who had attempted suicide more than once compared to adults who had attempted once. These hypotheses were tested using an independent samples t test, Mann-Whitney U tests, and binary logistic regression.

Results

Most participants were female (83.3%, male = 12.9%, other = 3.8%), and ages ranged from 18 to 65 (median = 36.00; IQR = 19.00). Total AQ scores, as well as communication and imagination subscale scores were significantly higher in adults who had attempted suicide more than once compared to adults who had attempted suicide once. Even after removing participants with diagnosed or suspected autism (n = 34), 40.6% had an AQ score indicative of clinical concern (≥ 26).

Conclusions

The findings suggest that high levels of autistic traits may frequently be present in adults who have attempted suicide, and that AQ scores are higher in those with a history of more than one suicide attempt. It may be possible to better identify suicide risk by screening autistic adults with mental health conditions for suicidal thoughts and behaviours, and by screening people with suicidal thoughts and/or behaviours for autism.

Proactive Suicide Prevention Online (PSPO): Machine Identification and Crisis Management for Chinese Social Media Users With Suicidal Thoughts and Behaviors

BACKGROUND

Suicide is a great public health challenge. Two hundred million people attempt suicide in China annually. Existing suicide prevention programs require the help-seeking initiative of suicidal individuals, but many of them have a low motivation to seek the required help. We propose that a proactive and targeted suicide prevention strategy can prompt more people with suicidal thoughts and behaviors to seek help.

OBJECTIVE

The goal of the research was to test the feasibility and acceptability of Proactive Suicide Prevention Online (PSPO), a new approach based on social media that combines proactive identification of suicide-prone individuals with specialized crisis management.

METHODS

We first located a microblog group online. Their comments on a suicide note were analyzed by experts to provide a training set for the machine learning models for suicide identification. The best-performing model was used to automatically identify posts that suggested suicidal thoughts and behaviors. Next, a microblog direct message containing crisis management information, including measures that covered suicide-related issues, depression, help-seeking behavior and an acceptability test, was sent to users who had been identified by the model to be at risk of suicide. For those who replied to the message, trained counselors provided tailored crisis management. The Simplified Chinese Linguistic Inquiry and Word Count was also used to analyze the users' psycholinguistic texts in 1-month time slots prior to and postconsultation.

RESULTS

A total of 27,007 comments made in April 2017 were analyzed. Among these, 2786 (10.32%) were classified as indicative of suicidal thoughts and behaviors. The performance of the detection model was good, with high precision (.86), recall (.78), F-measure (.86), and accuracy (.88). Between July 3, 2017, and July 3, 2018, we sent out a total of 24,727 direct messages to 12,486 social media users, and 5542 (44.39%) responded. Over one-third of the users who were contacted completed the questionnaires included in the direct message. Of the valid responses, 89.73% (1259/1403) reported suicidal ideation, but more than half (725/1403, 51.67%) reported that they had not sought help. The 9-Item Patient Health Questionnaire (PHQ-9) mean score was 17.40 (SD 5.98). More than two-thirds of the participants (968/1403, 69.00%) thought the PSPO approach was acceptable. Moreover, 2321 users replied to the direct message. In a comparison of the frequency of word usage in their microblog posts 1-month before and after the consultation, we found that the frequency of death-oriented words significantly declined while the frequency of future-oriented words significantly increased.

CONCLUSIONS

The PSPO model is suitable for identifying populations that are at risk of suicide. When followed up with proactive crisis management, it may be a useful supplement to existing prevention programs because it has the potential to increase the accessibility of antisuicide information to people with suicidal thoughts and behaviors but a low motivation to seek help.

Psychopathy and Suicidal Thoughts and Behaviors Revisited: Results From a Statewide Population of Institutionalized Youth

Suicide is the leading cause of death for incarcerated youth, and up to half of all juveniles in confinement experience suicidal ideation in addition to other psychopathology, including psychopathic personality features. Unfortunately, limited research has investigated the psychopathy-suicidality link among juvenile delinquents and using newer psychopathy measures. Based upon a statewide population of incarcerated juvenile offenders, we found that psychopathy was a significant risk factor for suicidal ideation and lifetime suicide attempts, but the latter relationship was attenuated by lifetime depression diagnosis. In addition, certain affective psychopathic features such as Stress Immunity conferred protection against suicidality, whereas behavioral and lifestyle components including Carefree Nonplanfulness, Blame Externalization, and Rebellious Nonconformity were positively linked to suicidal thoughts among the youth offenders. As these risk factors are routinely screened for in juvenile justice settings, this study's findings have considerable implications to applied practice and prevention among juvenile justice involved youth.

Consistency of trajectories of suicidal ideation and depression symptoms: Evidence from a randomized controlled trial

BACKGROUND

Depression is a risk factor for suicidal ideation. However, suicidal ideation can occur in the absence of depression and treating depression may not reduce suicidal thinking. This study tested whether trajectories of suicidal thinking are concordant with trajectories of depressive symptoms and sought to identify factors associated with these trajectories.

METHODS

Participants were community-based Australian adults (N = 418, 77% female) enrolled in a randomized controlled trial evaluating the effectiveness of an online cognitive-behavioral intervention for suicidal ideation. Separate linear growth mixture models were estimated across 12 months of follow-up to identify longitudinal trajectories of suicidal ideation and depression symptoms. Predictors of latent class membership were tested using logistic regression models.

RESULTS

Two-class models were found to have optimal fit for both suicidal thinking and depressive symptoms. Trajectory classes of suicidal ideation were: (1) moderate severity decreasing over time; and (2) high severity remaining stable over time. Depression trajectories were: (1) moderate severity with a small decrease over time; and (2) high severity that decreased moderately over time. Lower perceived burdensomeness was associated with having a greater decrease in both suicidal thinking and depression. More severe mental health symptoms were associated with less decrease in depression symptoms but not with suicidal ideation trajectory.

CONCLUSION

Class membership across the two outcomes and predictors of class membership were found to be largely independent. The lack of coupling in trajectories and predictors suggests that changes in suicidal thinking may occur independently of changes in depression.

Adolescent personality traits, low self-esteem and self-harm hospitalisation: a 15-year follow-up of the Norwegian Young-HUNT1 cohort

Affective disorders are closely related to self-harm and suicidal behaviours. Less is known about how adolescent personality traits and self-esteem influence the development of later self-harm. We examined associations between personality traits such as neuroticism, psychoticism and extroversion, and self-esteem, in adolescence, and the risk of future self-harm hospitalisation. Baseline information from 13 to 19-year-old participants in the Norwegian Young-HUNT1 study in 1995-97 (n = 8965) was linked to endpoint data recorded from participants' hospital records, describing self-harm hospitalisation episodes within the catchment area. Crude and adjusted hazard ratios (HR) were estimated by Cox regression analyses. A one-unit increase on the 0-6 scale for neuroticism was associated with a HR of 1.29, 95% confidence interval (CI) 1.14-1.47. Corresponding HR for psychoticism was 1.30, 95% CI 1.03-1.63 per unit increase, and for extroversion risk was reduced (HR 0.89, 95% CI 0.77-1.04). Positive perception of self-esteem was more strongly associated with reduced risk of self-harm hospitalisation (HR per unit increase on the 0-12 scale was 0.74, 95% CI 0.68-0.82). Additional adjustment for alcohol use and symptoms of combined anxiety and depression symptoms attenuated effect estimates, in particular for neuroticism (HR 1.13, 95% CI 0.96-1.32) and psychoticism (HR 1.07, 95% CI 0.82-1.40). In contrast, self-esteem associations remained largely the same after adjustment. Our results indicate that brief assessments of personality and self-esteem might add additional relevant information, and could be included as a supplement to standard suicidal risk assessment in adolescents.

Association between personality traits and risk of suicidal ideation in Chinese university students: Analysis of the correlation among five personalities

The purpose of our study was to determine the incidence of suicidal ideation among Chinese college students and to explore the risk factors for suicidal ideation. A large-sample epidemiological survey was conducted in 13 colleges in Chongqing, China (n = 69,790). Suicidal ideation was reported by 13.03% of the college students who were surveyed. The participants with suicidal ideation were more likely to be female, to come from rural areas, and to have poor life quality and psychological disorder compared to those without suicidal ideation. Moreover, this study revealed that neuroticism, psychoticism, impulsivity, and aggression are risk factors for suicidal ideation, while extroversion has a protective effect on suicidal ideation. We found that four personality traits of students with suicidal ideation, including impulsivity, aggression, psychoticism, and neuroticism, are positively correlated. However, there is a negative correlation between extroversion and the other four traits. These findings highlight the need for further exploration of personality traits in the risk of suicidal ideation.

The Level of Hopelessness and Psychological Distress among Abused Women in A Women's Shelter in Turkey

Hopelessness prevents abused women from participating in social life and increases the risk of suicide. The aim of this study was to determine the level of hopelessness and psychological distress among abused women admitted to shelter in a conservative country. The sample included 40 abused women. A questionnaire, Beck Hopelessness Scale and the General Health Questionnaire were used to collect data. Chi-square, the Pearson correlation analysis test, and variance analysis were performed. Half of the women experienced moderate and severe hopelessness. Higher levels of hopelessness were found to be associated with higher psychological distress. Women had problems with decision-making, concentrating on a job, felt unhappiness, and depression. The results of the study would be useful in designing training programs for nurses, social workers and counselors as well as policy makers who assist women facing domestic violence to provide better physiological and psychological care for sheltered women in conservative countries.

Adult Mental Health Outcomes of Preterm Survivors Experiencing Suicidal Ideation in Adolescence

The aim of this study was to examine the link between suicidal ideation in adolescence (age 12-16) and symptoms of psychopathology in adulthood (age 22-26) in a birth cohort of extremely low birth weight (ELBW; <1000g) survivors and matched normal birth weight (NBW; >2500 g) control participants. This study utilized data from a longitudinally followed cohort of 129 ELBW survivors and 116 NBW individuals born in Ontario, Canada between the years 1977 and 1982. Participants self-reported suicidal ideation via questionnaire during adolescence (age 12-16). The depression, anxiety, inattention, and antisocial behavior subscales of the Young Adult Self Report (YASR) were used to assess symptoms of psychopathology during adulthood (age 22-26). Associations were examined in each birth weight group separately prior to and after adjustment for covariates. Before and after adjustment for covariates, suicidal ideation in NBW adolescents predicted symptoms of depression, anxiety, inattention, and antisociality in adulthood. Suicidal ideation among ELBW adolescents predicted inattentive and depressive symptoms, and antisocial behavior only before adjustment. Adolescents born at NBW who endorse suicidal ideation are at elevated risk for developing symptoms of anxiety, depression, inattention, and antisocial problems in adulthood even after adjustment. Among ELBW survivors, the risks were lower and appear to be due to confounding factors.

The role of neuroticism in self-harm and suicidal ideation: results from two UK population-based cohorts

BACKGROUND

Self-harm is common, debilitating and associated with completed suicide and increased all-cause mortality, but there is uncertainty about its causal risk factors, limiting risk assessment and effective management. Neuroticism is a stable personality trait associated with self-harm and suicidal ideation, and correlated with coping styles, but its value as an independent predictor of these outcomes is disputed.

METHODS

Prior history of hospital-treated self-harm was obtained by record-linkage to administrative health data in Generation Scotland:Scottish Family Health Study (N = 15,798; self-harm cases = 339) and by a self-report variable in UK Biobank (N = 35,227; self-harm cases = 772). Neuroticism in both cohorts was measured using the Eysenck Personality Questionnaire-Short Form. Associations of neuroticism with self-harm were tested using multivariable regression following adjustment for age, sex, cognitive ability, educational attainment, socioeconomic deprivation, and relationship status. A subset of GS:SFHS was followed-up with suicidal ideation elicited by self-report (n = 3342, suicidal ideation cases = 158) and coping styles measured by the Coping Inventory for Stressful Situations. The relationship of neuroticism to suicidal ideation, and the role of coping style, was then investigated using multivariable logistic regression.

RESULTS

Neuroticism was positively associated with hospital-associated self-harm in GS:SFHS (per EPQ-SF unit odds ratio 1.2 95% credible interval 1.1-1.2, p_FDR 0.0003) and UKB (per EPQ-SF unit odds ratio 1.1 95% confidence interval 1.1-1.2, p_FDR 9.8 × 10^-17). Neuroticism, and the neuroticism-correlated coping style, emotion-oriented coping (EoC), were also associated with suicidal ideation in multivariable models.

CONCLUSIONS

Neuroticism is an independent predictor of hospital-treated self-harm risk. Neuroticism and emotion-orientated coping styles are also predictive of suicidal ideation.

Maladaptive beliefs as mediators of the relationship between personality traits and Borderline Personality Disorder symptoms

Abstract The present study analyzes the relationship between maladaptive beliefs, personality traits, and Borderline Personality Disorder symptoms by focusing in the mediating role of beliefs in the prediction between personality and psychiatric disorders. The sample consisted of 823 adults aged between 18 and 39 years (M = 24.09, SD = 4.71), who answered a questionnaire of symptoms and beliefs for Borderline Personality Disorder and Big Five Personality Inventory. The predictive model that fit better to the data indicates Neuroticism and Conscientiousness as predictors of Borderline Personality Disorder symptoms, mediated by maladaptive belief patterns. In this sense, it is possible to conclude that both personality traits and maladaptive beliefs are important for the understanding of Borderline Personality Disorder. The theoretical implications of this result and the limitations of the study are discussed.

Predicting suicidal ideation by interpersonal variables, hopelessness and depression in real-time. An ecological momentary assessment study in psychiatric inpatients with depression

OBJECTIVE

To extend evidence on the short-term variability of passive and active suicidal ideation (SI) and the association with suggested proximal risk factors such as interpersonal variables (perceived burdensomeness [PB], thwarted belongingness [TB], hopelessness, and depression) in real-time.

METHODS

This is an observational study using a prospective design applying ecological momentary assessments (EMA). Eligible for study inclusion were inpatients with unipolar depression, current or lifetime suicidal ideation, and fluent German. Over six days, 74 participants rated their momentary level of passive and active SI, PB, TB, depressiveness, and hopelessness up to 10 times per day on smartphones. Data was collected from August 2015 to July 2017. Compliance was excellent (89.7%).

RESULTS

Mean squared successive differences supported temporal instability for all variables. According intra-class correlations, between 25% and 47% of variance was accounted for by within-person variability. Multilevel analysis demonstrated significant positive associations between hopelessness, depressiveness, PB, and TB with passive SI. Prospectively, hopelessness and PB remained predictors of passive SI. For active SI, hopelessness, depression, PB, and TB were significantly associated cross-sectionally. Prospectively, hopelessness, PB, and the interaction PBxTB predicted active SI. All models were controlled for previous level of SI.

CONCLUSIONS

This study provides further evidence on the short-term variability of SI in very short time frames implying the need of assessing SI repeatedly in clinical and research settings. The associations between interpersonal variables and passive and active SI were only partial in line with assumptions of the Interpersonal Theory of Suicide. Overall, the effects were small warranting further investigation.

Impulsivity and Saliva Cortisol in Patients with Suicide Attempt and Controls

OBJECTIVES

The objective of this study was to prove concepts in the characterization of suicidal patients and the possible usefulness of those markers to potentially identify patients with a higher risk for suicidality.

METHODS

Patients with a recent suicide attempt were compared with patients suffering from depression, adjustment disorder, anxiety, or eating disorders without suicidality, healthy controls and remitted patients with a history of at least 1 suicide attempt (≥1 year). We analyzed impulsivity (Barratt Impulsivity Scale, BIS) and saliva cortisol concentrations.

RESULTS

Independently of suicidality and disease state patients display higher BIS scores than healthy controls. Saliva cortisol levels tend to be higher in patients in the acute disease state than in remitted patients and healthy controls.

CONCLUSIONS

Saliva cortisol may be a useful marker that reveals alterations in nonsuicidal patients suffering from depression, adjustment disorder, anxiety, or eating disorders who might be at risk.

Distinct psychopathology of patients who attempted suicide with rodenticide in Taiwan: a comparative study with patients of suicide with paraquat

OBJECTIVE

Rodenticide as a means of suicide has been documented for centuries. However, this method is often discussed in conjunction with other pesticides. Thus, we aimed to focus on patients who committed suicide with rodenticide and compared them with those who used paraquat for suicide, another frequently used yet lethal method, to highlight the different psychopathology of patients who choose rodenticide as their means of suicide.

METHODS

A 12-year retrospective chart review was conducted on the medical records of all patients admitted to Chang Gung Memorial Hospital due to attempted suicide by either rodenticide or paraquat. Psychiatric consultation sheets were collected to ascertain the psychiatric comorbidity and the major stressor for suicide, measured by the Social Readjustment Rating Scale. A χ2 test and logistic regression were used for group comparisons.

RESULTS

Seventeen rodenticide and 157 paraquat suicide attempts were identified. Compared with suicides by paraquat, suicides by rodenticide had a more even distribution in the gender ratio but a lower Social Readjustment Rating Scale score (p<0.001). Depressive disorder was the most common diagnosis in suicides by rodenticide and paraquat. However, schizophrenia and psychotic disorder (29.4%) was the second most common diagnosis and a significant predictor of suicide by rodenticide (odds ratio =9.21, 95% confidence interval =1.2-66.07, p=0.027).

CONCLUSION

High comorbidity of psychosis in suicide by rodenticide warrants disease-specific suicide prevention and additional large-scale research to confirm this association.

Neuroticism confers vulnerability in response to experimentally induced feelings of thwarted belongingness and perceived burdensomeness: Implications for suicide risk

OBJECTIVE

This study investigated the role of individual differences in neuroticism in conferring increased reactivity to the interpersonal antecedents for suicide proposed by the interpersonal theory of suicide.

METHOD

Undergraduate students (N = 113) were screened and selected to form high (n = 58) and low (n = 55) neuroticism groups, and an experimental computer task was used to manipulate participants' experience of thwarted belongingness and perceived burdensomeness. Participants' self-reported desire to persist in the face of this induced interpersonal adversity was measured.

RESULTS

Results indicate that high neuroticism confers increased reactivity to the experimental induction of the interpersonal antecedents of suicidal ideation: Thwarted belongingness and perceived burdensomeness. Furthermore, this vulnerability corresponds to a diminished desire to persist with the task in the face of interpersonal adversity.

CONCLUSIONS

Neuroticism confers vulnerability for suicidal desire via an increased reactivity to the proximal, causal risk factors proposed by the interpersonal theory of suicide. This has implications for considering how personality risk factors such as neuroticism may interact with proximal interpersonal risk factors to increase suicidal ideation.

Psychological distress in patients with obstructive sleep apnoea: The role of hostility and coping self-efficacy

We aimed to assess whether hostility and coping self-efficacy are associated with psychological distress in obstructive sleep apnoea patients. Furthermore, we examined whether coping self-efficacy mediates the association between hostility and psychological distress. We included 150 obstructive sleep apnoea patients (Apnoea-Hypopnoea Index ⩾5; 68% male; mean age: 48.9 ± 9.5 years). Regression models showed that hostility and poor coping self-efficacy were strongly associated with psychological distress in obstructive sleep apnoea patients. All assessed coping self-efficacy dimensions mediated the association between hostility and psychological distress. Coping self-efficacy for stopping unpleasant emotions and thoughts showed the strongest association with a lower level of psychological distress.

Prediction of major depressive episodes and suicide-related ideation over a 3-year interval among Japanese undergraduates

Background

Suicide has been a leading cause of death among young adult populations in Japan. The aim of this study was to predict major depressive episodes (MDEs) and suicide-related ideation among university students using the Patient Health Questionnaire-9 (PHQ-9) and the Temperament and Character Inventory (TCI).

Methods

The subjects were 2194 university students who completed the PHQ-9 and TCI in the 1st year (T1) and the PHQ-9 in the 4th year (T2) of university. Multiple logistic regression analysis was performed to predict MDEs and suicide-related ideation at T2. Moreover, recursive partitioning analyses were conducted to reveal the future risk of MDEs and suicide-related ideation.

Results

The multiple logistic regression analyses of MDEs and suicide-related ideation at T2 revealed that depressive episodes, suicide-related ideation, and low self-directedness(SD) scores at T1 were significant predictors. The area under the curve of the model for MDEs was 0.858 and that for suicide-related ideation was 0.741. The recursive partitioning analyses revealed that a PHQ-9 summary score ≥15 at T1 predicted a high risk of MDEs at T2 and that both a PHQ-9 summary score ≥5 and a PHQ-9 #9 score ≥1 predicted a high risk of suicide-related ideation at T2.

Conclusions

MDEs, suicide-related ideation, and low SD scores are significant predictors of future MDEs and suicide-related ideation.

The relationship of impulsivity and cortical thickness in depressed and non-depressed adolescents

Major Depressive Disorder (MDD) is recognized to be heterogeneous in terms of brain structure abnormality findings across studies, which might reflect previously unstudied traits that confer variability to neuroimaging measurements. The purpose of this study was to examine the relationships between different types of trait impulsivity and MDD diagnosis on adolescent brain structure. We predicted that adolescents with depression who were high on trait impulsivity would have more abnormal cortical structure than depressed patients or non-MDD who were low on impulsivity. We recruited 58 subjects, including 29 adolescents (ages 12-19) with a primary DSM-IV diagnosis of MDD and a history of suicide attempt and 29 demographically-matched healthy control participants. Our GLM-based analyses sought to describe differences in the linear relationships between cortical thickness and impulsivity trait levels. As hypothesized, we found significant moderation effects in rostral middle frontal gyrus and right paracentral lobule cortical thickness for different subscales of the Barratt Impulsiveness Scale. However, although these brain-behavior relationships differed between diagnostic study groups, they were not simple additive effects as we had predicted. For the middle frontal gyrus, non-MDD participants showed a strong positive association between cortical thickness and BIS-11 Motor scores, while MDD-diagnosed participants showed a negative association. For Non-Planning Impulsiveness, paracentral lobule cortical thickness was observed with greater impulsivity in MDD, but no association was found for controls. In conclusion, the findings confirm that dimensions of impulsivity have discrete neural correlates, and show that relationships between impulsivity and brain structure are expressed differently in adolescents with MDD compared to non-MDD.

The androgen model of suicide completion

Suicide is a devastating public health issue that imposes severe psychological, social, and economic burdens not only for the individuals but also for their relatives, friends, clinicians, and the general public. Among the different suicidal behaviors, suicide completion is the worst and the most relevant outcome. The knowledge of biological etiopathological mechanisms involved in suicide completion is limited. Hitherto, no objective markers, either alone or in combination, can reliably predict who will complete a suicide. However, such parameters are strongly needed to establish and optimize prediction and prevention. We introduce here a novel ideation-to-completion framework in suicide research and discuss the problems of studies aiming at identifying and validating clinically useful markers. The male gender is a specific risk factor for suicide, which suggests that androgen effects are implicated in the transition from suicidal ideation to suicide completion. We present multiple lines of direct and indirect evidence showing that both an increased prenatal androgen load (with subsequent permanent neuroadaptations) and increased adult androgen activity are involved in suicide completion. We also review data arguing that modifiable maternal behavioral traits during pregnancy contribute to the offspring's prenatal androgen load and increase the risk for suicide completion later in life. We conclude that in utero androgen exposure and adult androgen levels facilitate suicide completion in an synergistic manner. The androgen model of suicide completion provides the basis for the development of novel predictive and preventive strategies in the future.

Sluggish Cognitive Tempo and Personality: Links to BIS/BAS Sensitivity and the Five Factor Model

We evaluated sluggish cognitive tempo (SCT) symptoms in relation to personality as assessed via both the Reinforcement Sensitivity Theory (BIS/BAS) and Five Factor (Big 5) Model of personality. 3,172 students from five universities completed psychopathology, BIS/BAS, and Big 5 measures. Correlations and path models with SCT, attention-deficit/hyperactivity disorder (ADHD) dimensions, and anxiety/depression in relation to personality were examined. SCT evidenced a different pattern of relations to adult personality than ADHD and anxiety/depression. SCT was significantly uniquely associated with higher BIS and Neuroticism, as well as higher BAS Fun-Seeking. SCT was uniquely associated with lower Extraversion and Conscientiousness. This study provides the first evidence linking SCT to adult personality and underscores the importance of differentiating SCT from both ADHD and anxiety/depression.

Psychological Symptoms in Late Adolescence and Long-Term Risk of Suicide and Suicide Attempt

Mental disorders in the general population are associated with increased risk of suicidality, but less is known about the independent predictive ability of self-reported psychological symptoms. We followed 49,321 screened and interviewed Swedish conscripts through 36-year follow-up to test whether psychological symptoms predicted suicide and hospitalization for suicide attempts. There were 619 suicides and 1,230 suicide attempts during the follow-up period. After excluding subjects with any psychiatric diagnoses (n = 5,691, 12%) and controlling for other psychological symptoms, severe symptoms of anger, trouble falling asleep, and feeling down predicted suicide. Similarly anger, headaches, feeling down, and nervousness predicted suicide attempt. Self-reported psychological symptoms may have a predictive value beyond psychiatric diagnosis.

Personality and Suicidal Behavior in Old Age: A Systematic Literature Review

BACKGROUND

Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior.

METHODS

We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior via a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality," "suicide," and "elderly." Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained.

RESULTS

Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples.

CONCLUSION

Maladaptive personality manifests in milder, subthreshold, and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders.

Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders

Risks factors for suicide are multiple and highly prevalent in addicted patients (previous suicide attempts, substance abuse, impulsivity, history of sexual abuse and other factors). The aim of this study is to identify and to compare the clinical and socio-demographic profile of SUD outpatients with lifetime suicidal behavior (previous suicidal ideation and/or suicide attempts) and to analyze the factors related to it. A retrospective cohort study of 696 addicted patients, according to DSM-IV-TR criteria (APA, 2000) were collected from the Addiction Unit of Vall d'Hebron University Hospital. Lifetime suicidal ideation in addicted patients is associated with presence of: borderline personality disorder (BPD), depressive disorders, sexual abuse, polydrug abuse, attention-deficit hyperactivity disorder, and motor impulsivity. The factors associated with suicide attempts were: borderline personality disorder, lifetime abuse (whether emotional, physical or sexual), co-occurrent psychotic disorders, polydrug abuse, anxiety disorders and depressive symptoms. We conclude that previous suicidal ideation and lifetime suicide attempts should be considered in the clinical care of addicted patients. Factors related to both suicidal behaviors share similarities and differences according to our findings and need to be deeply explored in the future.

Patterns of psychological health problems and family maltreatment among United States Air Force members

OBJECTIVES

We sought to identify subgroups of individuals based on patterns of psychological health problems (PH; e.g., depressive symptoms, hazardous drinking) and family maltreatment (FM; e.g., child and partner abuse).

METHOD

We analyzed data from very large surveys of United States Air Force active duty members with romantic partners and children.

RESULTS

Latent class analyses indicated six replicable patterns of PH problems and FM. Five of these classes, representing ∼98% of survey participants, were arrayed ordinally, with increasing risk of multiple PH problems and FM. A sixth group defied this ordinal pattern, with pronounced rates of FM and externalizing PH problems, but without correspondingly high rates/levels of internalizing PH problems.

CONCLUSIONS

Ramifications of these results for intervention are discussed.

Neuroticism and suicide in a general population cohort: results from the UK Biobank Project

BACKGROUND

Neuroticism has often been linked to suicidal thoughts and behaviour.

AIMS

To examine whether neuroticism is associated with suicide deaths after adjusting for known risks.

METHOD

UK Biobank participants (n = 389 365) were assessed for neuroticism as well as social, demographic and health-related variables at study entry and followed for up to 10 years. Suicide risk was modelled using Cox regression stratified by gender.

RESULTS

Neuroticism increased the risk of suicide in both men (hazard ratio (HR) = 1.15, 95% CI 1.09-1.22) and women (HR = 1.16, 95% CI 1.06-1.27). In a subsample who were assessed for mood disorders, neuroticism remained a significant predictor for women (HR 1.25, 95% CI 1.03-1.51) but not for men.

CONCLUSIONS

Screening and therapeutic interventions for neuroticism may be important for early suicide prevention.

DECLARATION OF INTEREST

None.

Prevalence of suicide attempt and clinical characteristics of suicide attempters with obsessive-compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS)

OBJECTIVE

Obsessive-compulsive disorder (OCD) is associated with variable risk of suicide and prevalence of suicide attempt (SA). The present study aimed to assess the prevalence of SA and associated sociodemographic and clinical features in a large international sample of OCD patients.

METHODS

A total of 425 OCD outpatients, recruited through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network, were assessed and categorized in groups with or without a history of SA, and their sociodemographic and clinical features compared through Pearson's chi-squared and t tests. Logistic regression was performed to assess the impact of the collected data on the SA variable.

RESULTS

14.6% of our sample reported at least one SA during their lifetime. Patients with an SA had significantly higher rates of comorbid psychiatric disorders (60 vs. 17%, p<0.001; particularly tic disorder), medical disorders (51 vs. 15%, p<0.001), and previous hospitalizations (62 vs. 11%, p<0.001) than patients with no history of SA. With respect to geographical differences, European and South African patients showed significantly higher rates of SA history (40 and 39%, respectively) compared to North American and Middle-Eastern individuals (13 and 8%, respectively) (χ2=11.4, p<0.001). The logistic regression did not show any statistically significant predictor of SA among selected independent variables.

CONCLUSIONS

Our international study found a history of SA prevalence of ~15% in OCD patients, with higher rates of psychiatric and medical comorbidities and previous hospitalizations in patients with a previous SA. Along with potential geographical influences, the presence of the abovementioned features should recommend additional caution in the assessment of suicide risk in OCD patients.

Interpersonal trauma moderates the relationship between personality factors and suicidality of individuals with posttraumatic stress disorder

Individuals with posttraumatic stress disorder (PTSD) are more prone to suicidal ideation and behavior. While those who have experienced interpersonal trauma exhibit more suicidality than those who have experienced non-interpersonal trauma, it is unclear how the traumatic effects are related to an individual’s personality characteristics. This study examined the association between interpersonal trauma and personality factors with suicidality, and elucidated the moderating role of interpersonal trauma in individuals with PTSD. The study included 6,022 participants from the Korean Epidemiologic Catchment Area Study 2011. The Korean Version of Composite International Diagnostic Interview was used for the survey, including the participants’ history of suicidality, the traumas they have experienced, and their PTSD symptoms. The 11-item version of the Big Five Inventory (BFI-11) was used to assess the participants’ personality factors. 76 individuals were diagnosed with PTSD, while 810 had been exposed to trauma but were not diagnosed with any DSM-IV mental disorder. Among the individuals with PTSD, those who had experienced interpersonal trauma were more likely to have suicidal ideation than those who had experienced non-interpersonal trauma (p = .020; odds ratio [OR] = 3.643; 95% confidence interval of OR = [1.226, 10.825]). High agreeableness and conscientiousness predicted less suicidality in those exposed to non-interpersonal trauma, while predicting more suicidality in those exposed to interpersonal trauma. Clinicians examining individuals with PTSD should pay closer attention to the trauma that they have experienced, as well as their personality factors, to provide appropriate treatment.

Risk profiles of personality traits for suicidality among mood disorder patients and community controls

OBJECTIVE

To examine the associations between personality traits and suicidal ideation (SI) and attempt (SA) in mood disorder patients and community controls.

METHOD

We recruited 365 bipolar, 296 major depressive disorder patients, and 315 community controls to assess their lifetime suicidality. Participants filled out self-reported personality questionnaires to collect data of personality traits, including novelty seeking (NS), harm avoidance (HA), extraversion (E), and neuroticism (N). We used logistic regression models adjusted for diagnoses to analyze combinational effects of personality traits on the risk of suicide. Additionally, radar charts display personality profiles for suicidal behaviours by groups.

RESULTS

All personality traits were associated with the risk of suicidality with various effect size, except for E that showed protective effect. High N or HA had prominent and independent risk effects on SI and SA. Combinations of high N and low E, or high HA and NS were the risk personality profiles for suicidality. Higher N scores further distinguished SA from SI in mood disorder patients.

CONCLUSION

Introvert personality traits showed independent risk effects on suicidality regardless of diagnosis status. Among high-risk individuals with suicidal thoughts, higher neuroticism tendency is further associated with increased risk of suicide attempt.

Suicidal and Aggressive Ideation Associated with Feelings of Embitterment

BACKGROUND

Mental disorders can be associated with suicidal or aggressive ideation and behavior, especially in the context of embitterment. The aim of this study is to investigate the types, prevalence, and dangerousness of aggressive and suicidal ideations associated with embitterment.

METHODS

When therapists from the department of behavioral medicine detected signs of embitterment, aggression, or suicidal thoughts in their patients, they routinely filled out a questionnaire on aggressive ideation, assessed the embitterment, and contacted a senior psychiatrist. Additionally, patients answered an embitterment scale.

RESULTS

There were 127 patients (3.84% of all patients) with suicidal and/or aggressive ideation. They had an increased score of 2.93 (SD 0.74) on the embitterment scale, associated with personal vilification (62.7%), breach of trust (30.2%), public humiliation (25.4%), death/loss (5.6%), or attacks by another person (14.3%). We found that 83.5% of the patients harbored aggressive ideations; in 94.1% of this group, these were directed against the person who had caused the problem, 88.3% wanted to inflict severe damage, 38.8% to harm another person, 31.5% showed suicidal ideation, and 3.2% had fantasies of murder-suicide. Only 34.3% of the patients reported spontaneously about their current aggressive ideation. The limitations of the study are that the data come from an inpatient sample and patients were identified according to clinical judgement.

CONCLUSION

Aggressive ideation is regularly associated with embitterment. This deserves the attention of therapists for the prevention of aggressive acts.

Suicidality, self-stigma, social anxiety and personality traits in stabilized schizophrenia patients - a cross-sectional study

BACKGROUND AND AIM

Patients who have schizophrenia are more prone to suicidal behavior than the general population. This study aimed to find connections between suicidality and self-stigma, hope, and personality traits in patients with schizophrenia.

METHODS

Forty-eight stabilized outpatients with schizophrenia attended this cross-sectional study. Patients were diagnosed by the Mini International Neuropsychiatric Interview (MINI) using the ICD-10 research diagnostic criteria. The assessments included Positive and Negative Syndrome Scale, objective and subjective Clinical Global Impression, Liebowitz Social Anxiety Scale, Beck Depression Inventory-second edition, Internalized Stigma of Mental Illness, the Temperament and Character Inventory, and Adult Dispositional Hope Scale.

RESULTS

The individual rate of suicidality (suicidal index from MINI) strongly positively correlated with self-stigma, level of depression, social anxiety, and harm-avoidance, and negatively correlated with hope, self-directedness, and stigma resistance.

CONCLUSION

Individuals with additional symptoms of depression, social anxiety, trait-like anxiety, and self-stigma should be carefully monitored for suicidal ideation. On the opposite side, patients with sufficient hope, self-esteem, and goal-directed attitudes are less likely to have suicidal thoughts and may potentially be role models in group rehabilitation programs, motivating more distressed colleagues and showing them ways to cope.

Study on risk factors in adolescents admitted with deliberate self-harm in Tata main hospital, Jamshedpur

BACKGROUND

Suicide ranks as the second cause of death worldwide among 15-19 years olds, with at least one lakh adolescents dying by suicide every year. Therefore, research on understanding the dynamics of suicide attempts in adolescents can be used as a means of suicide prevention.

OBJECTIVE

The objective of this study is to understand the psychological, social, and personality factors contributing to deliberate self-harm/suicide attempt in patients of adolescent age group admitted to Tata Main Hospital, Jamshedpur.

MATERIALS AND METHODS

This study was carried out at Tata Main Hospital Jamshedpur. Consecutive suicide attempters up to the age of 19 years referred from medical or surgical wards over a period of 1 year are taken up for study. Data were collected on socio-demographic sheet and specific pro forma to collect various risk factors contributing to this behavior specifically designed for this study. Data were analyzed using descriptive statistics and Chi-square test.

RESULTS

Majority of the suicide attempters were females of younger age, lower-middle income status, urban background, and students. Two-third (68%) of the attempter had at least one psychiatric diagnosis. Nearly 75% of the suicide attempts were committed after a precipitating factor. The risk factors associated with suicide attempts in included increased family conflicts, peer-interpersonal problems, perceived humiliations and personality traits.

CONCLUSION

The early identification and treatment of vulnerable populations with risk factors for suicide across the lifespan will help in planning and implementing strategies for prevention.

Empirical extension of the interpersonal theory of suicide: Investigating the role of interpersonal hopelessness

The Interpersonal Theory of Suicide posits that hopelessness about thwarted belongingness and perceived burdensomeness is an important risk factor for the desire for suicide and suicide risk. Past research has indicated that general feelings of hopelessness interact with the constructs of thwarted belongingness and perceived burdensomeness to predict suicide ideation. However, no research has explicitly tested whether hopelessness specific to the interpersonal constructs of thwarted belongingness and perceived burdensomeness predicts suicide ideation and suicide risk. Participants in the current study (N = 173) were undergraduate students oversampled for history of suicide ideation, planning for suicide, and suicide attempt(s). Participants completed study measures online, including a new measure of hopelessness about thwarted belongingness and perceived burdensomeness. Results indicated that a three-way interaction of thwarted belongingness, perceived burdensomeness, and hopelessness about these interpersonal constructs, but not general hopelessness, predicted unique variance of suicide ideation and suicide risk. Results suggest that hopelessness about thwarted belongingness and perceived burdensomeness may be an important target for reducing suicidal desire.

Coping and suicide risk in high risk psychiatric patients

Background: A dysfunctional use of coping strategies has repeatedly been linked to suicidal behaviour in non-psychiatric populations. However, data regarding association between coping strategies and suicidal behaviour in psychiatric populations are limited.Aims: The aim of the study was to investigate the possible relationship between self-reported suicide risk, suicidal ideation and coping strategies in three psychiatric cohorts.Method: Three cohorts of psychiatric patients were involved in the study; recent suicide attempters (n = 55), suicide attempters at follow-up 12 years after a suicide attempt (n = 38) and patients with ongoing depression without attempted suicide (n = 72). Patients filled in the self-rating version of The Suicide Assessment Scale (SUAS-S) from which items no. 17-20 addressing current suicidal ideation were extracted. To investigate coping strategies, the Coping Orientation of Problem Experience Inventory (COPE) was used.Results: In all cohorts, regression analyses showed that only avoidant coping was significantly correlated with the scores of SUAS-S adjusted for covariates. The items no. 17-20 correlated significantly to avoidant coping but not with other coping strategies in all cohorts.Conclusion: The results of this study indicate that among coping strategies only avoidant coping may be associated with suicide risk in psychiatric patients independently of history of attempted suicide.

Distinguishing Levels of Suicide Risk in Depressed Male Veterans: The Role of Internalizing and Externalizing Psychopathology as Measured by the MMPI-2-RF

Suicide occurs at high rates among veterans, underscoring a need for improved identification of veterans at risk of engaging in suicidal behavior. Considering dimensions of psychopathology in the context of an ideation-to-action framework, the present study examined the utility of the Minnesota Multiphasic Personality Inventory–2–Restructured Form in distinguishing depressed, psychiatrically hospitalized male veterans ( N = 430) at varying levels of suicide risk. Analysis of variance and hierarchical logistic regression analyses indicated that internalizing scales differentiated depressed ideators ( n = 147) and depressed controls ( n = 143); and in line with expectations, both broad and narrowly focused externalizing scales provided incremental validity in distinguishing depressed attempters ( n = 140) from depressed ideators. Interactions between Suicidal/Death Ideation and externalizing scale scores were found to differentiate only depressed ideators from depressed controls. Clinical implications in the areas of suicide risk assessment and therapeutic interventions with suicidal veterans are discussed.

The Association Between Racial Discrimination and Suicidality among African-American Adolescents and Young Adults

This study assessed the association between racial discrimination and suicidality (ideation, plan, or attempt) in African-American adolescents and young adults (n = 806, mean age = 17.9 years). Structured psychiatric phone interviews were conducted in offspring and their mothers in a high-risk alcoholism family study. Logistic regression analyses using offspring's own racial discrimination as a predictor revealed elevated odds of suicidality, even after adjusting for correlated psychiatric conditions (OR = 1.76) but was reduced to non-significance after adjusting for maternal experiences of racial discrimination (OR = 3.19 in males), depression, and problem drinking. Findings support a link between racial discrimination and suicidality in African-American youth that, for males, is partially explained by maternal racial discrimination.

Clarifying the role of neuroticism in suicidal ideation and suicide attempt among women with major depressive disorder

BACKGROUND

Prior research consistently demonstrates that neuroticism increases risk for suicidal ideation, but the association between neuroticism and suicidal behavior has been inconsistent. Whereas neuroticism is recommended as an endophenotype for suicidality, the association of neuroticism with attempted suicide warrants clarification. In particular, prior research has not distinguished between correlates of attempted suicide, correlates of suicidal ideation, and correlates of comorbid psychopathology.

METHODS

The present study used the CONVERGE study, a sample of 5864 women with major depressive disorder (MD) and 5783 women without MD throughout China. Diagnoses, suicidal ideation, and attempted suicide were assessed with the Composite International Diagnostic Interview (CIDI). Neuroticism was assessed with the neuroticism portion of the Eysenck Personality Questionnaire.

RESULTS

Results replicate prior findings on the correlates of suicidal ideation, particularly elevated neuroticism among individuals who report prior suicidal ideation. Moreover, as compared with individuals who reported having experienced only suicidal ideation, neuroticism was associated with decreased likelihood of having attempted suicide.

CONCLUSIONS

The association of neuroticism with suicidality is more complicated than has been previously described. Whereas neuroticism increases risk for suicidal ideation, neuroticism may decrease risk for a suicide attempt among individuals with suicidal ideation. These results have implications for the assessment of risk for a suicide attempt among individuals who report suicidal ideation and addresses prior discordant findings by clarifying the association between neuroticism and attempted suicide.