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

Does unstable mood increase risk of suicide? Theory, research and practice

BACKGROUND

Suicide represents a substantial problem, with significant societal and personal impact. The identification of factors influencing suicide risk is an important step in preventing self-harming behaviour. In this article the authors explore whether emotional instability increases risk of suicide, beyond that of mood intensity.

METHOD

This article provides a summary of existing theory and indirect evidence in support of an association between emotional instability and suicidality. A systematic literature search (Embase, Medline, PsychInfo) was carried out on literature conducted up to October, 2011. Meta-analysis was used to assess the strength of the proposed association.

RESULTS

The systematic search identified 20 journal articles meeting the inclusion criteria, including retrospective questionnaire design studies and research conducted across several time-points. Meta-analysis revealed a moderate association, which remained statistically significant even when only including studies conducted over multiple time-points. This effect was attenuated, but remained significant, when controlling for study selection bias.

LIMITATIONS

Retrospective questionnaire studies failed to adequately control for mood level. Little is still currently understood about the types of emotional instability (e.g., dysoria, anxiety) most associated with suicidality.

CONCLUSIONS

Future avenues of investigation include micro- to macro-longitudinal research and the differentiation of emotion subtypes and instability metrics. Momentary assessment techniques may help to detect subtle fluctuations in mood leading to more effective and immediate intervention. Psychosocial intervention strategies for treating unstable emotions are discussed.

Longitudinal risk profiling for suicidal thoughts and behaviours in a community cohort using decision trees

BACKGROUND

While associations between specific risk factors and subsequent suicidal thoughts or behaviours have been widely examined, there is limited understanding of the interplay between risk factors in the development of suicide risk. This study used a decision tree approach to develop individual models of suicide risk and identify the risk factors for suicidality that are important for different subpopulations.

METHODS

In a population cohort of 6656 Australian adults, the study examined whether measures of mental health, physical health, personality, substance use, social support, social stressors and background characteristics were associated with suicidal ideation and suicidal behaviours after four-year follow-up.

RESULTS

Previous suicidality, anxiety symptoms, depression symptoms, neuroticism and rumination were the strongest predictors of suicidal ideation and behaviour after four years. However, divergent factors were predictive of suicidal thoughts and behaviours across the spectrum of mental health. In particular, substance use was only associated with suicidal thoughts and behaviours in those with moderate levels of anxiety or depression.

LIMITATIONS

Most of the measurements were based on self-report. Further research is required to assess whether changes in risk factors lead to changes in suicidality.

CONCLUSIONS

Examining suicide risk factors using decision trees is a promising approach for developing individualised assessments of suicide risk and tailored intervention programs.

Childhood trajectories of anxiousness and disruptiveness explain the association between early-life adversity and attempted suicide

BACKGROUND

Suicidal behavior is frequently associated with a history of childhood abuse yet it remains unclear precisely how early life adversity may increase suicide risk later in life. As such, our aim was to examine whether lifetime trajectories of disruptiveness and anxiousness trait dysregulation explain the association between childhood adversity and suicidal behavior; and moreover, to test the potential modifying effects of mental disorders on these associations.

METHOD

A sample of 1776 individuals from a prospective school-based cohort followed longitudinally for over 22 years was investigated. We tested the influence of disruptiveness and anxiousness trajectories from age 6 to 12 years on the association between childhood adversity (i.e. sexual and physical abuse) and history of suicide attempts (SA) using logistic regression models. Both adolescent externalizing and internalizing Axis I disorders and gender were tested as potential modifiers of these associations.

RESULTS

Four distinct longitudinal trajectories were identified for both disruptiveness and anxiousness. The high disruptiveness trajectory accounted for the association between childhood adversity and SA, but only for females. The high anxiousness trajectory also explained the association between adversity and SA; however, in this case it was not sex but mental disorders that influenced the potency of the mediating effect. More specifically, anxiousness fully explained the effect of adversity on SA in the presence of externalizing disorders, whereas in the absence of these disorders, this effect was significantly attenuated.

CONCLUSIONS

This study provides evidence that both disruptiveness and anxiousness play an important role in explaining the relationship between childhood adversity and SA.

Temperament and character traits in patients with bipolar disorder and associations with attempted suicide

OBJECTIVE

This study was intended to investigate temperament and character traits in bipolar disorder patients with or without a history of attempted suicide.

METHODS

One hundred nineteen patients diagnosed with euthymic bipolar disorder based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, and with no accompanying Axis I and II comorbidity, and 103 healthy controls were included. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I and II disorders were used to exclude Axis I and II comorbidity. Temperament and character traits of bipolar patients with a history attempted suicide (25.2%, n = 30) or without (74.8%, n = 89) and of the healthy volunteers were determined using the Temperament and Character Inventory. The association between current suicide ideation and temperament and character traits was also examined.

RESULTS

Bipolar patients with or without a history of attempted suicide had higher harm avoidance (HA) scores compared with the healthy controls. Persistence scores of bipolar patients with no history of attempted suicide were lower than those of the healthy controls. Self-directedness (SD) scores of the bipolar patients with a history of attempted suicide were lower than those of patients with no such history. Self-transcendence scores of bipolar patients with no history of attempted suicide were lower than those of both the healthy controls and of those patients with a history of attempted suicide. A positive correlation was determined between current suicidal ideation scale scores and HA, and a negative correlation between SD and cooperativeness was determined.

CONCLUSIONS

High harm avoidance may be a temperament trait specific to bipolar disorder patients. However, it may not be correlated with attempted suicide in such patients. These may have low persistence, high SD and low self-transcendence temperament and character traits that protect against attempted suicide. Harm avoidance, SD, and cooperativeness may be correlated with current suicidal ideation.

Suicide and Impossible Worlds

Background: Suicide has a devastating impact on both survivors and society, and many obstacles to improving prevention efforts stem from our inadequate understanding of suicidality. A potential source of this shortcoming is that the majority of empirical studies focus only on a single specified etiology of suicide. Aims: To address this limitation, we present a further promising way to understand the suicidal state. We do so (1) by providing a brief review of something known as worlds theory ( Bergner, 2006 ), and (b) by presenting the results of a study exploring the relationship between a person’s taking it that his or her world is impossible/nonviable and his or her suicidal state. Methods: In this research, participants were asked to assess the perceived levels of world viability (vs. impossibility/nonviability) of 12 actual persons depicted in clinical vignettes. Results: As predicted, participants judged the worlds of suicidal committers significantly more nonviable than those of suicide attempters, and these in turn significantly more nonviable than those of mentally disordered but nonsuicidal persons. Conclusions: These findings indicate that the worlds of suicidal persons are unlivable – in worlds terms: impossible. We discuss implications of these findings for understanding the suicidal state and for intervening therapeutically.

Testing the relations between impulsivity-related traits, suicidality, and nonsuicidal self-injury: a test of the incremental validity of the UPPS model

Borderline personality disorder (BPD) has received significant attention as a predictor of suicidal behavior (SB) and nonsuicidal self-injury (NSSI). Despite significant promise, trait impulsivity has received less attention. Understanding the relations between impulsivity and SB and NSSI is confounded, unfortunately, by the heterogeneous nature of impulsivity. This study examined the relations among 4 personality pathways to impulsive behavior studied via the UPPS model of impulsivity and SB and NSSI in a residential sample of drug abusers (N = 76). In this study, we tested whether these 4 impulsivity-related traits (i.e., Negative Urgency, Sensation Seeking, Lack of Premeditation, and Lack of Perseverance) provide incremental validity in the statistical prediction of SB and NSSI above and beyond BPD; they do. We also tested whether BPD symptoms provide incremental validity in the prediction of SB and NSSI above and beyond these impulsivity-related traits; they do not. In addition to the main effects of Lack of Premeditation and Negative Urgency, we found evidence of a robust interaction between these 2 personality traits. The current results argue strongly for the consideration of these 2 impulsivity-related domains--alone and in interaction--when attempting to understand and predict SB and NSSI.

Combined effects of neuroticism and extraversion: findings from a matched case control study of suicide in rural China

Neuroticism and extraversion are potentially important markers of personality vulnerability to suicide. Whereas previous studies have examined these traits independently, we examined their combined effects. Data were collected from family members and/or friends of individuals 18 years or older who died by suicide (n = 64) in rural China and from age-, sex-, and geographically matched controls (n = 64). Personality was assessed with the NEO-Five Factor Inventory. Individuals with a personality style characterized by high neuroticism and low extraversion were at 3.07 (95% confidence interval [CI], 1.44-6.55) times greater risk for suicide than were individuals without this personality style; in contrast, a style characterized by low neuroticism and high extraversion conferred decreased suicide risk (odds ratio, 0.41; 95% CI, 1.44-6.55). We conclude that it may be clinically inadequate to conceptualize neuroticism, by itself, as a risk marker for suicide. However, when the negative affect characteristic of neuroticism is combined with the joylessness, pessimism, and hopelessness characteristic of low extraversion, risk for suicide is elevated.

Predicting future suicide attempts among depressed suicide ideators: a 10-year longitudinal study

Suicidal ideation and attempts are a major public health problem. Research has identified many risk factors for suicidality; however, most fail to identify which suicide ideators are at greatest risk of progressing to a suicide attempt. Thus, the present study identified predictors of future suicide attempts in a sample of psychiatric patients reporting suicidal ideation. The sample comprised 49 individuals who met full DSM-IV criteria for major depressive disorder and/or dysthymic disorder and reported suicidal ideation at baseline. Participants were followed for 10 years. Demographic, psychological, personality, and psychosocial risk factors were assessed using validated questionnaires and structured interviews. Phi coefficients and point-biserial correlations were used to identify prospective predictors of attempts, and logistic regressions were used to identify which variables predicted future attempts over and above past suicide attempts. Six significant predictors of future suicide attempts were identified - cluster A personality disorder, cluster B personality disorder, lifetime substance abuse, baseline anxiety disorder, poor maternal relationship, and poor social adjustment. Finally, exploratory logistic regressions were used to examine the unique contribution of each significant predictor controlling for the others. Comorbid cluster B personality disorder emerged as the only robust, unique predictor of future suicide attempts among depressed suicide ideators. Future research should continue to identify variables that predict transition from suicidal thoughts to suicide attempts, as such work will enhance clinical assessment of suicide risk as well as theoretical models of suicide.

Deliberate self-harm behavior among Italian young adults: correlations with clinical and nonclinical dimensions of personality

This study aims to explore rates of deliberate self-harm (DSH) behaviors and their psychological and psychopathological correlates within a sample of nonclinical young adults (N = 365; 63% women; M age = 23 ± 4.06). Participants completed the Deliberate Self-Harm Inventory and other self-report questionnaires assessing clinical (borderline personality, dissociative, and depersonalization traits) and nonclinical (body perception, behavioral inhibition and activation, cognitive emotional regulation, and the Big Five traits) dimensions of their personality. The rate of DSH in the present sample was 39%, comparable to that found in previous studies of young adults in other countries. Further, consistent with past research, DSH was found to be associated with clinical dimensions of personality pathology, including borderline personality and dissociative symptoms. Finally, results revealed an association between DSH and nonclinical dimensions of personality, including the behavioral activation dimension of fun-seeking, more negative body perception and lower body protection, the use of more nonadaptive cognitive strategies for regulating emotions, higher levels of openness to experience, and lower levels of emotional stability. This pattern of results is consistent with those found for other impulsive behaviors and impulse control disorders.

Analysis of OPCRIT results indicate the presence of a novel 'social functioning' domain and complex structure of other dimensions in the Wielkopolska (Poland) population

OBJECTIVE

The main goal of our study was to examine factor structure of schizophrenia and bipolar affective disorder in the Wielkopolska population, using dimension reduction techniques.

METHODS

Schizophrenia (n=443) and bipolar affective disorder (n=499) patients were assessed using Operational Criteria Checklist (OPCRIT). Principal component analysis and Maximum Likelihood Factor analysis were carried out to obtain factor structure with significance level for the factor loadings exceeding 0.4. Varimax and promax rotations were used to identify the meaningful factors.

RESULTS

Rotated solution indicated multidimensional structure for depression and excitement as well as positive domains in the schizophrenia sample. Negative and disorganized dimensions existed as single factors, with item composition similar to that already described. Additionally, a new "social functioning" dimension was identified. In bipolar affective disorder sample, the interpretable dimensions included: depression, psychotic, atypical depression, negative, substance use, excitement and "social functioning". Factor structure of the combined sample consisted of depression, excitement, disorganization, delusions, substance use, negative and social functioning factors.

CONCLUSIONS

Our results indicated multidimensional and hierarchical structures for some of the previously described dimensions. Additional use of items not exactly related to disease symptoms lead to discovery of "substance use" and "social functioning" dimensions.

Perfectionistic self-presentation, socially prescribed perfectionism, and suicide in youth: a test of the perfectionism social disconnection model

The role of interpersonal components of perfectionism in suicide outcomes among youth was assessed and the Perfectionism Social Disconnection Model (PSDM) was tested by determining whether the links between socially prescribed perfectionism (SPP) and perfectionistic self-presentation (PSP) and suicide outcomes are mediated by experiences of social disconnection, as indicated by social hopelessness and being bullied. PSP, trait perfectionism, suicide outcomes, and experiences of being bullied and social hopelessness were measured in 152 psychiatric outpatient children and adolescents. Correlational tests confirmed that PSP and SPP were associated with suicide outcomes and these interpersonal perfectionism components were associated significantly with bullying and social hopelessness. Support was also obtained for the PSDM. The relationship between the PSP facets, particularly nondisplay of imperfections, and suicide outcomes were mediated by being bullied. Additionally, the relationship between all interpersonal components of perfectionism and suicide risk was mediated by social hopelessness. Theoretical and clinical implications of interpersonal components of perfectionism and social disconnection in suicide outcomes for youth are discussed.

The gender paradox in suicidal behavior and its impact on the suicidal process

BACKGROUND

An important gender difference has been reported regarding suicidal behavior with an overrepresentation of females in nonfatal suicidal behavior and a preponderance of males in completed suicide, also known as the 'gender paradox of suicidal behavior'. The concept of a 'suicidal process' classifies suicidal behavior chronologically; this process starts with suicidal ideation and then implies a progression of suicidality ranging from suicidal ideation over plans to suicide attempts and finally fatal suicide.

AIMS/METHODS

The current paper aims to deepen the knowledge on the gender paradox by collecting and discussing the recent literature on this topic: the most relevant, impacting gender-related factors will be discussed within the suicidal process concept.

RESULTS

Several factors had a gender-dependent impact on suicidal behavior: psychosocial life stressors such as stressful life events but also sociodemographical or socio-economical factors, and sexual abuse. The gender differences in psychiatric (co)morbidity and in response to or attitude towards antidepressant treatment also appear to have an impact. Furthermore, not only suicide methods but also the gender-dependent variation in reporting suicide has an influence. Finally, the gender differences in help seeking behavior as well as region-dependent cultural beliefs and societal attitudes are discussed.

CONCLUSIONS

Especially life-events seem to exert an important influence at the beginning of a suicidal process, whereas the other factors occur at a further stage in the process, however without a fixed chronology. Also, the duration of the suicidal process is much shorter in male than in females. Finally, some implications with regard to clinical practice and suicide prevention are suggested.

A systematic review of social factors and suicidal behavior in older adulthood

Suicide in later life is a global public health problem. The aim of this review was to conduct a systematic analysis of studies with comparison groups that examined the associations between social factors and suicidal behavior (including ideation, non-fatal suicidal behavior, or deaths) among individuals aged 65 and older. Our search identified only 16 articles (across 14 independent samples) that met inclusion criteria. The limited number of studies points to the need for further research. Included studies were conducted in Canada (n = 2), Germany (n = 1), Hong Kong (n = 1), Japan (n = 1), Singapore (n = 1), Sweden (n = 2), Taiwan (n = 1), the U.K. (n = 2), and the U.S. (n = 3). The majority of the social factors examined in this review can be conceptualized as indices of positive social connectedness-the degree of positive involvement with family, friends, and social groups. Findings indicated that at least in industrialized countries, limited social connectedness is associated with suicidal ideation, non-fatal suicidal behavior, and suicide in later life. Primary prevention programs designed to enhance social connections as well as a sense of community could potentially decrease suicide risk, especially among men.

The role of genetic variability in the SLC6A4, BDNF and GABRA6 genes in anxiety-related traits

OBJECTIVE

The aims of this study were to test the individual association of the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor gene (BDNF) and the GABA(A) α(6) receptor subunit gene (GABRA6) with anxiety-related traits and to explore putative gene-gene interactions in a Spanish healthy sample.

METHOD

A sample of 937 individuals from the general population completed the Temperament and Character Inventory questionnaire to explore Harm Avoidance (HA) dimension; a subsample of 553 individuals also filled in the Big Five Questionnaire to explore the Neuroticism dimension. The whole sample was genotyped for the 5-HTTLPR polymorphism (SLC6A4 gene), the Val66Met polymorphism (BDNF gene) and the T1521C polymorphism (GABRA6 gene).

RESULTS

Homozygous individuals for the T allele of the T1512C polymorphism presented slightly higher scores for HA than C allele carriers (F = 2.96, P = 0.019). In addition, there was a significant gene-gene interaction on HA between the 5-HTTLPR and Val66Met polymorphisms (F = 3.4, P = 0.009).

CONCLUSION

GABRA6 emerges as a candidate gene involved in the variability of HA. The effect of a significant gene-gene interaction between the SLC6A4 and BDNF genes on HA could explain part of the genetic basis underlying anxiety-related traits.

[Recommendations for the prevention and management of suicidal behaviour]

INTRODUCTION

Suicidal behaviour is a major public health issue. Suicidal behaviour is one of the main causes of years of life lost and it is the third leading cause of death among young adults. This project was initiated by the Spanish Society of Psychiatry and the Spanish Society of Biological Psychiatry with the aim of providing a document containing the main recommendations on the prevention and management of suicidal behaviour; these recommendations should be based on the best available evidence and the experts' opinion.

MATERIAL AND METHODS

In this article we summarize the review of the available evidence on the epidemiology and impact of suicidal behaviour, risk and protective factors, evaluation tools for the assessment of suicide risk, international and local preventive protocols, educational interventions for health professionals, and potential interventions for at risk populations.

RESULTS

Based on this review, a panel of psychiatrists summarized and agreed a set of recommendations about the impact, prevention and management of suicidal behaviour.

CONCLUSION

The recommendations on the prevention and management of suicidal behaviour were summarized in the ten conclusions reported in this article.

Predicting self- and other-directed violence among discharged psychiatric patients: the roles of anger and psychopathic traits

BACKGROUND

We examined the extent to which trait anger and psychopathic traits predicted post-discharge self-directed violence (SDV) and other-directed violence (ODV) among psychiatric patients.

METHOD

Participants were 851 psychiatric patients sampled from in-patient hospitals for the MacArthur Violence Risk Assessment Study (MVRAS). Participants were administered baseline interviews at the hospital and five follow-up interviews in the community at approximately 10-week intervals. Psychopathy and trait anger were assessed with the Psychopathy Checklist: Screening Version (PSC:SV) and the Novaco Anger Scale (NAS) respectively. SDV was assessed during follow-ups with participants and ODV was assessed during interviews with participants and collateral informants. Psychopathy facets and anger were entered in logistic regression models to predict membership in one of four groups indicating violence status during follow-up: (1) SDV, (2) ODV, (3) co-occurring violence (COV), and (4) no violence.

RESULTS

Anger predicted membership in all three violence groups relative to a non-violent reference group. In unadjusted models, all psychopathy facets predicted ODV and COV during follow-up. In adjusted models, interpersonal and antisocial traits of psychopathy predicted membership in the ODV group whereas only antisocial traits predicted membership in the COV group.

CONCLUSIONS

Although our results provide evidence for a broad role for trait anger in predicting SDV and ODV among discharged psychiatric patients, they suggest that unique patterns of psychopathic traits differentially predict violence toward self and others. The measurement of anger and facets of psychopathy during discharge planning for psychiatric patients may provide clinicians with information regarding risk for specific types of violence.

Fats and factors: lipid profiles associate with personality factors and suicidal history in bipolar subjects

Polyunsaturated fatty acids (PUFA) have shown efficacy in the treatment of bipolar disorder, however their specific role in treating the illness is unclear. Serum PUFA and dietary intakes of PUFA associate with suicidal behavior in epidemiological studies. The objective of this study was to assess serum n-3 and n-6 PUFA levels in bipolar subjects and determine possible associations with suicidal risk, including suicidal history and relevant personality factors that have been associated with suicidality. We studied 27 bipolar subjects using the NEO-PI to assess the big five personality factors, structured interviews to verify diagnosis and assess suicidal history, and lipomics to quantify n-3 and n-6 PUFA in serum. We found positive associations between personality factors and ratios of n-3 PUFA, suggesting that conversion of short chain to long chain n-3s and the activity of enzymes in this pathway may associate with measures of personality. Thus, ratios of docosahexaenoic acid (DHA) to alpha linolenic acid (ALA) and the activity of fatty acid desaturase 2 (FADS2) involved in the conversion of ALA to DHA were positively associated with openness factor scores. Ratios of eicosapentaenoic acid (EPA) to ALA and ratios of EPA to DHA were positively associated with agreeableness factor scores. Finally, serum concentrations of the n-6, arachidonic acid (AA), were significantly lower in subjects with a history of suicide attempt compared to non-attempters. The data suggest that specific lipid profiles, which are controlled by an interaction between diet and genetics, correlate with suicidal history and personality factors related to suicidal risk. This study provides preliminary data for future studies to determine whether manipulation of PUFA profiles (through diet or supplementation) can affect personality measures and disease outcome in bipolar subjects and supports the need for further investigations into individualized specific modulations of lipid profiles to add adjunctive value to treatment paradigms.

A trait-interpersonal perspective on suicide risk in criminal offenders

Despite elevated rates of suicide among offenders, research has yet to adequately address theoretically driven risk models in this population. The present study addresses such a gap by investigating a synthesized framework using 2 well-developed theoretical models, the Five-Factor Model (FFM) of personality and the interpersonal-psychological theory of suicide (IPTS). Archival data from mitigation evaluations for pre-sentenced criminal offenders (n = 307) were analyzed using structural equation modeling (SEM). Results supported a hypothesized personality-IPTS-suicide framework in which neuroticism and extraversion predict IPTS components, namely perceived burdensomeness, thwarted belongingness, and acquired capability. IPTS constructs subsequently directly and indirectly (via suicidal ideation) predicted suicide potential. Findings have important implications for suicide theory, research, and risk assessment with offenders.

The neurodevelopmental origins of suicidal behavior

Suicide and related behaviors are complex phenomena associated with different risk factors. Although most individuals who display suicidal behavior do not have a history of early-life adversity, a significant minority does. Recent animal and human data have suggested that early-life adversity leads to epigenetic regulation of genes involved in stress-response systems. Here, we review this evidence and suggest that early-life adversity increases risk of suicide in susceptible individuals by influencing the development of stable emotional, behavioral and cognitive phenotypes that are likely to result from the epigenetic regulation of the hypothalamic-pituitary-adrenal axis and other systems involved in responses to stress.

The next generation of psychological autopsy studies. Part I. Interview content

The psychological autopsy (PA) is a systematic method to understand the psychological and contextual circumstances preceding suicide. The method requires interviews with one or more proxy respondents (i.e., informants) of decedents. The methodological challenges that need to be addressed when determining the content of these research interviews for PA studies are described and recommendations are made for meeting these challenges in future PA investigations. Ways to improve the data collected about mental disorders and life events--domains that are assessed in almost all PA studies--are discussed at length. Other understudied content areas considered include the role of personality traits, medical illness and functional limitations, availability of lethal agents, medications, and select distal variables including child maltreatment and family history of mental disorders and suicide. The benefits and challenges to using common protocols across studies are also discussed.

Seasonality of suicide in Shandong China, 1991-2009: associations with gender, age, area and methods of suicide

BACKGROUNDS

Whether suicide in China has significant seasonal variations is unclear. The aim of this study is to examine the seasonality of suicide in Shandong China and to assess the associations of suicide seasonality with gender, residence, age and methods of suicide.

METHODS

Three types of tests (Chi-square, Edwards' T and Roger's Log method) were used to detect the seasonality of the suicide data extracted from the official mortality data of Shandong Disease Surveillance Point (DSP) system. Peak/low ratios (PLRs) and 95% confidence intervals (CIs) were calculated to indicate the magnitude of seasonality.

RESULTS

A statistically significant seasonality with a single peak in suicide rates in spring and early summer, and a dip in winter was observed, which remained relatively consistent over years. Regardless of gender, suicide seasonality was more pronounced in rural areas, younger age groups and for non-violent methods, in particular, self-poisoning by pesticide.

CONCLUSIONS

There are statistically significant seasonal variations of completed suicide for both men and women in Shandong, China. Differences exist between residence (urban/rural), age groups and suicide methods. Results appear to support a sociological explanation of suicide seasonality.

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss-Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.

NCAM1, TACR1 and NOS genes and temperament: a study on suicide attempters and controls

Suicide, one of the leading causes of death among young adults, seems to be plausibly modulated by both genetic and personality factors. The aim of this study was to dissect the potential association between genetics and temperament in a sample of 111 suicide attempters and 289 healthy controls. We focused on 4 genes previously investigated in association with suicide on the same sample: the nitric oxide synthase 1 and 3 (NOS1 and NOS3), the neuronal cell adhesion molecule 1 (NCAM1), and the tachykinin receptor 1 (TACR1) genes. In particular, we investigated whether a set of genetic variants in these genes (NOS1: rs2682826, rs1353939, rs693534; NOS3: rs2070744, rs1799983, rs891512; NCAM1: rs2301228, rs1884, rs1245113, rs1369816, rs2196456, rs584427; TACR1: rs3771810, rs3771825, rs726506, rs1477157) were associated with temperamental traits at the Temperament and Character Inventory (TCI). No strong evidence was found for the association between TCI personality traits and the polymorphisms considered in the 4 genes, with the exception of an association between reward dependence trait and the rs2682826 SNP in NOS1 in the healthy sample. However, this result could be plausibly interpreted as a false-positive finding. In conclusion, our study did not support the thesis of a direct modulation of these genes on temperament; however, further studies on larger samples are clearly required in order to confirm our preliminary findings and to exclude any possible minor influence.

Suicidal behavior and related traits among inpatient adolescents with first-episode schizophrenia

PURPOSE

Suicide is a major cause of death in adolescents with first-episode schizophrenia (FES). The aim of this pilot study was to compare suicide-related traits between subjects with FES and those with other psychopathologies to evaluate risk factors for suicidal behavior.

METHOD

Twenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for sex and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk, and potential.

RESULTS

The adolescents with FES had significantly lower depression (P = .003), anger (P = .025), and criminal behavior (P = .022) than did the controls. However, although suicide ideation was greater in the subjects with FES (P = .003), suicide risk was significantly lower than that in controls (P = .004).

CONCLUSION

Decreased levels of both depression and anger as part of affective constriction in the group with schizophrenia could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients. This study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia.

Suicidal ideation in Huntington disease: the role of comorbidity

Huntington disease (HD) is a neurodegenerative condition characterized by cognitive impairments, motor abnormalities, and psychiatric disturbance. An increased risk for suicide has been documented. The majority of HD research has focused on cognitive and motor features of HD; the implications of psychiatric manifestations have received less consideration. Recent studies have sought to identify the stages of HD in which patients are at increased risk to experience suicidal ideation, though no study has examined possible risk factors for suicidality. The current study examines the presence of psychiatric comorbidity and its involvement in suicidal ideation. Suicidal ideation was examined in 1941 HD patients enrolled in the Huntington Study Group. Of those, 19% (N=369) endorsed current suicidal ideation. Logistic regression analyses indicated that depression/anxiety and aggression/irritability are significant predictors of suicidal ideation. In a subsample with the greatest suicidal ideation, alcohol and drug abuse were also predictive. It is recommended that all individuals with HD (specifically those with features of depression, aggression, substance abuse) have routine suicide assessment; further research is needed to understand the high rate of suicide in HD.

The suicidal mind and brain: a review of neuropsychological and neuroimaging studies

OBJECTIVES. We aimed at reviewing studies exploring dysfunctional cognitive processes, and their neuroanatomical basis, in suicidal behaviour, and to develop a neurocognitive working model. Methods. A literature search was conducted. RESULTS. Several limitations were found. The main reported neuropsychological findings are a higher attention to specific negative emotional stimuli, impaired decision-making, lower problem-solving abilities, reduced verbal fluency, and possible reduced non-specific attention and reversal learning in suicide attempters. Neuroimaging studies mainly showed the involvement of ventrolateral orbital, dorsomedial and dorsolateral prefrontal cortices, the anterior cingulate gyrus, and, to a lesser extent, the amygdala. In addition, alterations in white matter connections are suggested. CONCLUSIONS. These studies support the concept of alterations in suicidal behaviour distinct from those of comorbid disorders. We propose that a series of neurocognitive dysfunctions, some with trait-like characteristics, may facilitate the development of a suicidal crisis during stressful circumstances: (1) an altered modulation of value attribution, (2) an inadequate regulation of emotional and cognitive responses, and (3) a facilitation of acts in an emotional context. This preliminary model may represent a framework for the design of future studies on the pathophysiology, prediction and prevention of these complex human behaviours.

Extraversion predicts individual differences in face recognition

In daily life, one of the most common social tasks we perform is to recognize faces. However, the relation between face recognition ability and social activities is largely unknown. Here we ask whether individuals with better social skills are also better at recognizing faces. We found that extraverts who have better social skills correctly recognized more faces than introverts. However, this advantage was absent when extraverts were asked to recognize non-social stimuli (e.g., flowers). In particular, the underlying facet that makes extraverts better face recognizers is the gregariousness facet that measures the degree of inter-personal interaction. In addition, the link between extraversion and face recognition ability was independent of general cognitive abilities. These findings provide the first evidence that links face recognition ability to our daily activity in social communication, supporting the hypothesis that extraverts are better at decoding social information than introverts.

The anxiety disorders and suicidal ideation: accounting for co-morbidity via underlying personality traits

BACKGROUND

The anxiety disorders are robust correlates/predictors of suicidal ideation, but it is unclear whether (a) the anxiety disorders are specifically associated with suicidal ideation or (b) the association is due to co-morbidity with depression and other disorders. One means of modeling co-morbidity is through the personality traits neuroticism/negative emotionality (N/NE) and extraversion/positive emotionality (E/PE), which account for substantial shared variance among the internalizing disorders. The current study examines the association between the internalizing disorders and suicidal ideation, after controlling for co-morbidity via N/NE and E/PE.

METHOD

The sample consisted of 327 psychiatric out-patients. Multiple self-report and interview measures were collected for internalizing disorders [depression, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, panic and specific phobia] and suicidal ideation, as well as self-report measures for N/NE and E/PE. A model was hypothesized in which each disorder and suicidal ideation was regressed on N/NE, and depression and social anxiety were regressed on E/PE. Structural equation modeling (SEM) was used to examine the unique association of suicidality with each disorder, beyond shared variance with N/NE and E/PE.

RESULTS

The hypothesized model was an acceptable fit to the data. Although zero-order analyses indicated that suicidal ideation was moderately to strongly correlated with all of the disorders, only depression and PTSD remained significantly associated with suicidal ideation in the SEM analyses.

CONCLUSIONS

In a latent variable model that accounts for measurement error and a broad source of co-morbidity, only depression and PTSD were uniquely associated with suicidal ideation; panic, GAD, social anxiety and specific phobia were not.

The role of child sexual abuse in the etiology of suicide and non-suicidal self-injury

OBJECTIVE

To address the best available scientific evidence on the role of child sexual abuse in the etiology of suicide and non-suicidal self-injury.

METHOD

Seven databases were searched, supplemented with hand-search of reference lists from retrieved papers. The author and a psychiatrist independently evaluated the eligibility of all studies identified, abstracted data, and assessed study quality. Disagreements were resolved by consensus.

RESULTS

Four reviews, including about 65,851 subjects from 177 studies, were analyzed. There is evidence that child sexual abuse is a statistically significant, although general and non-specific, risk factor for suicide and non-suicidal self-injury. The relationship ranges from small to medium in magnitude and is moderated by sample source and size. Certain biological and psychosocial variables, such as serotonin hypoactivity and genes, family dysfunction, other forms of maltreatment, and some personality traits and psychiatric disorders, may either act independently or interact with child sexual abuse to promote suicide and non-suicidal self-injury in abuse victims, with child sexual abuse conferring additional risk, either as a 'distal' and indirect cause or as a 'proximal' and direct cause.

CONCLUSION

Child sexual abuse should be considered one of the several risk factors for suicide and non-suicidal self-injury and included in multifactorial etiological models.

The possible contributory role of the S allele of 5-HTTLPR in the emergence of suicidality

Suicide is a complex and challenging human phenomenon, and, although knowledge is expanding concerning its risk factors, its background is still not fully understood. There is currently an increasing interest in genetic factors associated with suicide, since these may lead to the emergence of personality traits and temperaments that may be long-term predictors of suicidal behaviour. One of the most likely genetic candidates in the background of suicide is the 5-HTTLPR polymorphism of the serotonin transporter gene. This review focused on papers published on the association of the 5-HTTLPR polymorphism of the serotonin transporter gene and suicidal behaviour as well as research on possible endophenotypes related to suicide. Although there are contradictory results, several studies and meta-analyses support the idea that the S allele plays a role in the background of violent suicide. However, in order to be able to delineate the genetic background of suicide, different types of suicidal behaviour should be distinguished, since studies indicate that these may have different genetic factors. Also, personality traits and temperaments should be identified that may play a modulating role between genetic factors and suicidal behaviour. So far, neuroticism, affective temperaments, and impulsive aggression have been found to be associated with both the S allele and suicidal behaviour. This study aimed to integrate findings concerning possible endophenotypes modulating between genetic factors and manifested suicidal behaviour.

The interaction between serotonin receptor 2A and catechol-O-methyltransferase gene polymorphisms is associated with the novelty-seeking subscale impulsiveness

OBJECTIVE

Novelty seeking is a trait that has been consistently associated with problem behaviours. There is evidence for heritability of novelty seeking, but the molecular genetic basis of the trait is still widely unclear.

METHODS

The interaction between polymorphisms of catechol-O-methyltransferase (COMT) and serotonin receptor 2A genes was examined in relation to novelty seeking and its different subscales in healthy Finnish adults. A subsample of 1214 participants derived from a population-based sample was genotyped for the COMT Val158Met (rs4680) and HTR2A T102C (rs6313) genes. Novelty seeking was measured twice, with a 4-year interval, using Cloninger's Temperament and Character Inventory.

RESULTS

The interaction between COMT Val158Met and HTR2A T102C polymorphisms was found to be associated with subscale impulsiveness. T/T carriers of HTR2A T102C polymorphism, that also had Met/Met genotype of COMT Val158Met single nucleotide polymorphism, scored significantly higher on impulsiveness than Val allele carriers (P=0.005).

CONCLUSION

Our results suggest that the interaction between dopaminergic and serotonergic genes might underlie impulsiveness. Together with earlier research our results also stress the importance of considering novelty seeking as a heterogeneous trait with its subscales having different genetic backgrounds.

The influence of childhood trauma on the onset and repetition of suicidal behavior: an investigation in a high risk sample of male prisoners

BACKGROUND AND AIMS

Childhood trauma is a well recognized risk factor for attempting suicide. However, its relationship to the age of onset of first suicide attempt and the repetition of attempts has been little studied.

METHODS

One thousand five hundred and fifty-three prisoners underwent a psychiatric interview which included the Brown-Goodwin Lifetime History of Aggression (BGHA) interview. The prisoners completed the Childhood Trauma Questionnaire (CTQ) and the Buss-Durkee Hostility Inventory (BDHI).

RESULTS

Two hundred prisoners (12.9%) had a history of attempting suicide. Subjects who had attempted suicide had significantly higher CTQ scores than subjects who had never attempted. Childhood traumas were also significantly associated with the early onset of suicidal behavior, while repeated attempts were predicted by sexual abuse only. Early suicidal behavior was further associated with young age, psychiatric disease, aggressive traits and violent behavior. Early age at onset of suicidal behavior was also associated with repetition of suicide attempts. Repetition of suicide attempt was further associated with other self-injurious behaviors (self-harm).

CONCLUSIONS

These results confirm that a history of attempting suicide is frequent among prisoners. Childhood trauma is a risk factor not only for suicidal behavior but also for its early onset as is having a psychiatric disorder and aggressive traits. Sexual abuse may increase the risk for multiple attempts, which strongly correlated with age at onset and other self-harm behaviors.

Prospective Predictors of Suicidal Ideation during Depressive Episodes among Older Adolescents and Young Adults

Suicide is a leading cause of death among older adolescents and young adults; however, few studies have prospectively examined risk for suicidal ideation. The present study in older adolescents and young adults investigated whether two personality traits previously implicated in risk for suicidal ideation, neuroticism and extraversion, as well as certain aspects of interpersonal functioning, prospectively predicted endorsement of suicidal ideation during depressive episodes. Participants (n=117) are a subset of the Northwestern-UCLA Youth Emotion Project sample, which started with a group of high school juniors oversampled for high neuroticism. Baseline interpersonal functioning was measured using the Life Stress Interview. Baseline personality trait composite scores were created from multiple inventories. Depressive disorders and suicidal ideation were assessed at the baseline and three annual follow-up interviews using the SCID. Cox regression was employed to predict suicidal ideation during depressive episodes diagnosed at any follow-up interview. Results showed that baseline extraversion inversely predicts suicidal ideation in males only, and that baseline interpersonal problems in one's social circle, regardless of gender, predict suicidal ideation during depressive episodes.

Perceived racism, discrimination, and acculturation in suicidal ideation and suicide attempts among black young adults

During young adulthood the suicide rate among Blacks rises dramatically and approaches that of the U.S. general population, requiring that prevention efforts include a focus on Black young adults. Although most research on suicidality among Blacks has focused on risk factors observed in the dominant culture, in this study the authors examined associations between perceived discrimination, racism, and acculturation with lifetime suicidal ideation (SI) and suicide attempt (SA) among Black young adults. Two hundred fifty Black or African American individuals aged 18-24 residing in a midsize northeastern city were recruited to participate through advertisements. Participants filled out self-report questionnaires. Logistic regressions were used to examine the association of each predictor with SI and SA. Greater perceived acculturation was associated with SI in univariate and multivariate models. There were no other statistically significant results concerning the predictors of interest. The link between perceived acculturation and SI is consistent with limited available data, indicating the need for further study including the potential mechanism(s) for the association. Limitations include the cross-sectional design and reliance on subjective measures.

Affective variability predicts suicidal ideation in individuals at ultra-high risk of developing psychosis: an experience sampling study

OBJECTIVE

There is a suggestion in the literature that more variable affect increases suicidal ideation through the repeated re-activation of latent suicidal cognitions. The hypothesis that affective variability would be a better predictor of suicidal ideation and related behaviour than affect level was tested in individuals at ultra-high risk of developing psychosis. This study also examined the prediction that affective variability is a suicide-specific mechanism and would not predict levels of attenuated psychotic phenomena.

METHOD

Twenty-seven ultra-high risk individuals were required to complete ambulant ratings of their affect when prompted by an electronic wristwatch for six days (the experience sampling method). In the debriefing session, participants were assessed with a semi-structured interview (the Comprehensive Assessment of At-Risk Mental State), which assessed the severity and frequency of suicidality and psychosis-related phenomena.

RESULTS

The variability of negative and positive affect was predictive of the frequency of suicidal thoughts and behaviour. More variable negative, but not positive affect, was also associated with more severe suicidal ideation and related behaviour. Affect variability was not significantly related to the severity of attenuated psychotic phenomena.

CONCLUSION

Affective variability appears to be a specific risk factor for suicidal ideation in individuals at ultra-high risk of developing psychosis. Early intervention should focus on providing individuals with skills for regulating their own affect.

Gender differences in emotional risk for self- and other-directed violence among externalizing adults

OBJECTIVE

Women and men generally differ in how frequently they engage in other- and self-directed physical violence and may show distinct emotional risk factors for engagement in these high-impact behaviors. To inform this area, we investigated gender differences in the relationship of emotional tendencies (i.e., anger, hostility, and anhedonic depression) that may represent risk for other-directed violence (i.e., physical fighting, attacking others unprovoked) and self-directed violence (i.e., self-injury, suicide attempts).

METHOD

The ethnically diverse sample consisted of 372 adults (252 men and 120 women age 18-55) with a history of criminal convictions. Facets of emotional risk assessed with the Aggression Questionnaire (Buss & Warren, 2000) and Mood and Anxiety Symptom Questionnaire (Watson et al., 1995) were entered simultaneously as explanatory variables in regression analyses to investigate their unique contributions to other- and self-directed physical violence in men and women.

RESULTS

Analyses revealed that anhedonic depressive tendencies negatively predicted other-directed violence and positively predicted self-directed violence in men and women, consistent with a model of depression in which aggression is turned inward (Henriksson et al., 1993). Gender differences, however, emerged for the differential contributions of anger and hostility to other- and self-directed violence. Trait anger (i.e., difficulty controlling one's temper) was associated with other-directed violence selectively in men, whereas trait hostility (i.e., suspiciousness and alienation) was associated with self- and other-directed violence among women.

CONCLUSIONS

The divergent findings for trait anger and hostility underscore the need to examine gender-specific risk factors for physical violence to avoid excluding potentially useful clinical features of these mental health outcomes.

The neuroscience of suicidal behaviors: what can we expect from endophenotype strategies?

Vulnerability to suicidal behavior (SB) is likely mediated by an underlying genetic predisposition interacting with environmental and probable epigenetic factors throughout the lifespan to modify the function of neuronal circuits, thus rendering an individual more likely to engage in a suicidal act. Improving our understanding of the neuroscience underlying SBs, both attempts and completions, at all developmental stages is crucial for more effective preventive treatments and for better identification of vulnerable individuals. Recent studies have characterized SB using an endophenotype strategy, which aims to identify quantitative measures that reflect genetically influenced stable changes in brain function. In addition to aiding in the functional characterization of susceptibility genes, endophenotypic research strategies may have a wider impact in determining vulnerability to SB, as well as the translation of human findings to animal models, and vice versa. Endophenotypes associated with vulnerability to SB include impulsive/aggressive personality traits and disadvantageous decision making. Deficits in realistic risk evaluation represent key processes in vulnerability to SB. Serotonin dysfunction, indicated by neuroendocrine responses and neuroimaging, is also strongly implicated as a potential endophenotype and is linked with impulsive aggression and disadvantageous decision making. Specific endophenotypes may represent heritable markers for the identification of vulnerable patients and may be relevant targets for successful suicide prevention and treatments.

Suicide-related events among child and adolescent patients during short-term antidepressant therapy

AIMS

Antidepressants have been of limited use for adolescent subjects with depression because of drug-induced suicide-related events (SRE). Therefore, we investigated actual suicidality and its risk factors during antidepressant therapy among child and adolescent patients in clinical settings.

METHODS

The risks of SRE, consisting of suicidal ideation, self-mutilation and suicide attempt, were prospectively monitored among 70 child and adolescent patients (15.4 ± 2.8 years) during the first 3 months of antidepressant therapy.

RESULTS

The proportion of SRE decreased from 47.1% to 22.9% after the treatment. Subjects with persistent risks of SRE were significantly characterized by female sex (P < 0.05), psychotic features (P < 0.001), borderline personality disorder (P < 0.01), previous SRE (P < 0.001), and such baseline psychopathology as anhedonia (P < 0.005), irritability (P < 0.005) and hopelessness (P < 0.001). Discriminant analysis showed that baseline severity of SRE, borderline personality disorder and psychotic features were closely associated with SRE during antidepressant therapy. Total scoring using those three pretreatment factors predicted risks of SRE with sufficient sensitivity (81%)/specificity (98%) as well as high positive likelihood ratio (43.9).

CONCLUSIONS

These findings suggest that deteriorated risk of SRE in child and adolescent patients receiving antidepressants should not be overestimated while some pretreatment characteristics may be useful to predict the outcome of SRE after antidepressant therapy.

Suicidality in male prisoners: influence of childhood adversity mediated by dimensions of personality

This study aims to study the influence of childhood adversity on suicidal behavior in male prisoners. Including a random sample of 899 male prisoners (French National Mental Health Prison Survey, 2003), this paper studied suicidal ideations and suicide attempts using MINI criteria, and personality using Temperament and Character Inventory. Risk factors of suicidality were examined, and structural equations studied the influence of childhood trauma on suicidality, mediated by personality dimensions. The prisoners reported high levels of childhood adversity. More than a third reported recent suicidal ideations. Childhood adversity and dimensions of personality were associated with suicidality. Structural equations showed that childhood adversity was positively associated with suicidality, mediated by poor dimensions of character (affective stability, self-cooperativeness, and self-transcendence). In conclusion, these results confirm the importance of screening and treatment of childhood trauma among male prisoners. They suggest the importance to study dimensions of personality and tailor treatment to specific needs.

Neurocognitive functioning and suicidality in schizophrenia spectrum disorders

OBJECTIVE

The aim of this study was to investigate whether suicide attempters had higher IQ, better executive functioning, or were more impulsive as measured by neuropsychological tests than non-attempters in a group of patients with schizophrenia spectrum disorders.

METHOD

One hundred seventy-four patients with schizophrenia spectrum disorders were assessed with a clinical interview for diagnosis, suicidality, symptoms and function, and underwent an extensive neurocognitive test battery.

RESULTS

There were no statistically significant differences in any neurocognitive domains between lifetime suicide attempters and non-attempters, or between patients with different rates of suicide attempts. Currently suicidal patients were significantly more impulsive (had poorer inhibitory control) than currently non-suicidal patients, but this difference was mediated by positive psychotic symptoms.

CONCLUSION

The findings indicate that among patients with schizophrenia spectrum disorders, there are no significant differences in IQ or neurocognitive functioning between suicide attempters and non-attempters.

Childhood physical abuse, aggression, and suicide attempts among criminal offenders

Childhood physical abuse (CPA) has numerous short and long-term negative effects. One of the most serious consequences of CPA is an increased risk for suicide attempts. Clarifying the mechanisms by which CPA increases risk for suicidal behavior may enhance preventive interventions. One potential mechanism is a tendency toward aggression. In a sample of 266 criminal offenders, ages 18-62, we examined the relationships among CPA, lifetime aggression, and suicide attempts and tested lifetime history of aggression as a mediator of the relationship between CPA and suicide attempts. Results indicated that CPA and aggression were associated with suicide attempts. Consistent with our hypothesis, lifetime aggression mediated the CPA and suicide attempts relationship. Findings suggest that aggression may be an important mediator of the relationship between CPA and suicide attempts among criminal offenders, and are consistent with the possibility that treating aggression may reduce risk for suicide attempts.

Psychosocial influences on prisoner suicide: a case-control study of near-lethal self-harm in women prisoners

We examined the psychosocial influences on female prisoner suicide by carrying out a study of near-lethal self-harm. We interviewed 60 women prisoners who had recently engaged in near-lethal self-harm (cases) and 60 others who had never carried out near-lethal acts in prison (controls) from all closed female prison establishments in England and Wales, using mixed quantitative and qualitative methods. We gathered information on socio-demographic and criminological variables, life events and childhood trauma, exposure to suicidal behaviour, contributory and precipitating factors for near-lethal self-harm, social support and psychological characteristics. While socio-demographic factors were only modestly associated with near-lethal self-harm, being on remand, in single cell accommodation, and reporting negative experiences of imprisonment were strong correlates. Recent life events and past trauma, including different forms of childhood abuse, were also significantly associated with near-lethal self-harm, as were a family history of suicide and high scores on measures of depression, aggression, impulsivity and hostility, and low levels of self-esteem and social support. Our findings underline the importance of both individual and prison-related factors for suicide in custody, and hence the need for a comprehensive approach to suicide prevention in women's prisons. Given the multiple needs of female prisoners at-risk of self-harm and suicide, complex psychosocial interventions are likely to be required, including interventions for abused and bereaved women, and initiatives to improve staff-prisoner relationships and reduce bullying. The findings of this research may provide insights into factors leading to suicidal behaviour in other forensic and institutional settings, such as detention centres and psychiatric hospitals, and may assist in developing suicide prevention policies for prisoners and other at-risk populations.

Resilience to suicidality: the buffering hypothesis

Recent years have seen a growing interest into resilience to suicidality, which has been described as a perception or set of beliefs which buffer individuals from suicidality in the face of stressors. The current review extends this research by introducing the buffering hypothesis, a framework for the investigation of resilience to suicidality. The key proposal of this is that psychological resilience factors should be viewed as existing on a separate dimension to risk which acts to moderate the impact of risk on suicidality. Furthermore, like risk factors, resilience factors are bipolar, with their positive pole conferring resilience and their negative pole acting to amplify suicidality. Seventy-seven studies were identified which investigated (a) whether psychological moderators of risk exist and (b) the particular psychological constructs which may act as moderators. The review found strong support for the existence of psychological moderators and indicated a moderating impact of attributional style, perfectionism, agency and hopelessness. These findings support the buffering hypothesis and suggest that a range of psychological factors may confer resilience to suicidality. These results suggest that the identification of moderators may improve estimates of suicide risk and that the development of buffering factors could be a key focus of suicide interventions.

Jumping, lying, wandering: analysis of suicidal behaviour patterns in 1,004 suicidal acts on the German railway net

Current knowledge on behavioural patterns and personal characteristics of subjects who choose the railway as means of suicide is sparse. The aim of this study was to determine the frequency of three distinct behaviour patterns (jumping, lying, wandering) in railway suicides and to explore associated variables. Cases were derived from the National Central Registry of person accidents on the German railway net covering the period from 2002 to 2006. A retrospective analysis of registry protocols of all 4127 suicidal acts allowed classification of behaviour patterns in 1004 cases. Types of suicidal behaviour occurred with nearly equal frequencies; jumping in 32.2%, lying in 32.6% and wandering in 34.2% of cases. Age and sex were not associated with type of suicidal behaviour. The proportion of jumping was highest during 9:01 am to 6:00 pm while at night, lying was used most frequently. Jumping predominated in the station area, while lying and wandering on the open track. Fatality was highest in liers and lowest in jumpers. The frequency of jumping decreased during the study period by 12.6% (p < .05). These findings may help to elucidate differential risk features of this highly lethal suicide method.

Psychosocial Distress and Suicide Ideation in Chinese and Philippine Adolescents

Objective: The purpose of this study was to identify associations between suicide ideation and indicators of psychological distress and health behaviors in Chinese and Philippine adolescents. Method: Global School Health Surveys consisting of 9015 Chinese and 7338 Philippine students aged 11 to 17 years were analyzed using logistic regression to determine demographic, psychosocial, and health/risk behavioral determinants of suicide ideation. Results: In both samples, suicide ideation was associated with substance use, physical activity, feelings of loneliness, hopelessness/sadness, and worrying. Chinese girls were more likely to than boys to report suicide ideation and suicide planning, whereas Philippine girls were more likely to report suicide planning. Overweight status and sedentary behaviors were associated with increased risk of suicide ideation in Chinese adolescents, but the same influences were observed to be protective for Philippine adolescents. Conclusions: Psychosocial, demographic, and health/risk behaviors factors appear to impact suicide ideation and suicide planning in both of these youth populations.

Test of a clinical model of drinking and suicidal risk

BACKGROUND

There are few data on the role of drinking patterns in suicidal thoughts or behavior among alcohol-dependent individuals (ADIs) and meager data on variables that may influence the role of drinking in suicidal thoughts and behavior. This study tested a heuristic model that predicts that drinking promotes suicidal thoughts and behavior, the association is mediated (accounted for) by depressive symptoms, and that anger moderates (increases) the risk associated with intense drinking.

METHODS

Data from Project MATCH, a multisite alcohol use disorders treatment trial, were analyzed using structural equation modeling. There were 1,726 participants including 24% women and a mean age of 40.2 ± 11.0 years. Subjects were assessed at baseline and at 3-, 9-, and 15-month follow-up. Two categorical measures (presence/absence) of suicidal ideation (SI) were used that were analyzed in separate models. Predictors of interest were continuous assessments of average drinking intensity (i.e., drinks per drinking day or DDD), drinking frequency (i.e., percent days abstinent or PDA), depression, and anger.

RESULTS

Both DDD and PDA were associated with SI at a statistically significant level, with PDA showing an inverse association. Depression scores served as a partial mediator or a full mediator of the drinking-SI relationship depending on the measure of SI used in the analysis. The models testing anger scores as a moderator fit the data poorly and did not support that anger serves as a moderator of the drinking-SI association.

CONCLUSIONS

Greater drinking intensity and drinking frequency predict SI among ADIs and depression serves as a mediator of these associations, but anger does not appear to serve as a moderator. Further research is required to clarify whether depression serves as a partial or full mediator and to see whether the results herein extend to suicidal behavior (i.e., suicide attempt, suicide).

Genome-wide association study of increasing suicidal ideation during antidepressant treatment in the GENDEP project

Suicidal thoughts during antidepressant treatment have been the focus of several candidate gene association studies. The aim of the present genome-wide association study was to identify additional genetic variants involved in increasing suicidal ideation during escitalopram and nortriptyline treatment. A total of 706 adult participants of European ancestry, treated for major depression with escitalopram or nortriptyline over 12 weeks in the Genome-Based Therapeutic Drugs for Depression (GENDEP) study were genotyped with Illumina Human 610-Quad Beadchips (Illumina, San Diego, CA, USA). A total of 244 subjects experienced an increase in suicidal ideation during follow-up. The genetic marker most significantly associated with increasing suicidality (8.28 × 10(-7)) was a single-nucleotide polymorphism (SNP; rs11143230) located 30 kb downstream of a gene encoding guanine deaminase (GDA) on chromosome 9q21.13. Two suggestive drug-specific associations within KCNIP4 (Kv channel-interacting protein 4; chromosome 4p15.31) and near ELP3 (elongation protein 3 homolog; chromosome 8p21.1) were found in subjects treated with escitalopram. Suggestive drug by gene interactions for two SNPs near structural variants on chromosome 4q12, one SNP in the apolipoprotein O (APOO) gene on chromosome Xp22.11 and one on chromosome 11q24.3 were found. The most significant association within a set of 33 candidate genes was in the neurotrophic tyrosine kinase receptor type 2 (NTRK2) gene. Finally, we also found trend for an association within genes previously associated with psychiatric phenotypes indirectly linked to suicidal behavior, that is, GRIP1, NXPH1 and ANK3. The results suggest novel pathways involved in increasing suicidal ideation during antidepressant treatment and should help to target treatment to reduce the risk of this dramatic adverse event. Limited power precludes definitive conclusions and replication in larger sample is warranted.

Predictors of suicidality across the life span: the Isle of Wight study

BACKGROUND

Data from a representative community sample were used to explore predictors of lifetime suicidality and to examine associations between distal adolescent and more proximal adult risks.

METHOD

Data are from a midlife follow-up of the Isle of Wight study, an epidemiological sample of adolescents assessed in 1968. Ratings of psychiatric symptoms and disorder, relationships and family functioning and adversity were made in adolescence; adult assessments included lifetime psychiatric history and suicidality, neuroticism and retrospective reports of childhood sexual abuse and harsh parenting.

RESULTS

A wide range of measures of childhood psychopathology, adverse experiences and interpersonal difficulties were associated with adult suicidality; associations were particularly strong for adolescent irritability, worry and depression. In multivariate analyses, substantial proportions of these effects could be explained by their association with adult psychopathology and neuroticism, but additional effects remained for adolescent irritability and worry.

CONCLUSIONS

Factors of importance for long-term suicidality risk are evident in adolescence. These include family and experiential adversities as well as psychopathology. In particular, markers of adolescent worry and irritability appeared both potent risks and ones with additional effects beyond associations with adult disorder and adult neuroticism.