Increased severity of suicidal behavior in impulsive aggressive patients exposed to familial adversities

Disrupted small-world white matter networks in patients with major depression and recent suicide plans or attempts

Suicide is a major concern for health, and depression is an established proximal risk factor for suicide. This study aimed to investigate white matter features associated with suicide. We constructed white matter structural networks by deterministic tractography via diffusion tensor imaging in 51 healthy controls, 47 depressed patients without suicide plans or attempts and 56 depressed patients with suicide plans or attempts. Then, graph theory analysis was used to measure global and nodal network properties. We found that local efficiency was decreased and path length was increased in suicidal depressed patients compared to healthy controls and non-suicidal depressed patients; moreover, the clustering coefficient was decreased in depressed patients compared to healthy controls; and the global efficiency and normalized characteristic path length was increased in suicidal depressed patients compared to healthy controls. Similarly, compared with those in non-suicidal depressed patients, nodal efficiency in the thalamus, caudate, medial orbitofrontal cortex, hippocampus, olfactory cortex, supplementary motor area and Rolandic operculum was decreased. In summary, compared with those of non-suicidal depressed patients, the structural connectome of suicidal depressed patients exhibited weakened integration and segregation and decreased nodal efficiency in the fronto-limbic-basal ganglia-thalamic circuitry. These alterations in the structural networks of depressed suicidal brains provide insights into the underlying neurobiology of brain features associated with suicide.

Risk factors and their association network for young adults' suicidality: a cross-sectional study

BACKGROUND

Understanding the intricate influences of risk factors contributing to suicide among young individuals remains a challenge. The current study employed interpretable machine learning and network analysis to unravel critical suicide-associated factors in Chinese university students.

METHODS

A total of 68,071 students were recruited between Sep 2016 and Sep 2020 in China. Students reported their lifetime experiences with suicidal thoughts and behaviors, categorized as suicide ideation (SI), suicide plan (SP), and suicide attempt (SA). We assessed 36 suicide-associated factors including psychopathology, family environment, life events, and stigma. Local interpretations were provided using Shapley additive explanation (SHAP) interaction values, while a mixed graphical model facilitated a global understanding of their interplay.

RESULTS

Local explanations based on SHAP interaction values suggested that psychoticism and depression severity emerged as pivotal factors for SI, while paranoid ideation strongly correlated with SP and SA. In addition, childhood neglect significantly predicted SA. Regarding the mixed graphical model, a hierarchical structure emerged, suggesting that family factors preceded proximal psychopathological factors, with abuse and neglect retaining unique effects. Centrality indices derived from the network highlighted the importance of subjective socioeconomic status and education in connecting various risk factors.

CONCLUSIONS

The proximity of psychopathological factors to suicidality underscores their significance. The global structures of the network suggested that co-occurring factors influence suicidal behavior in a hierarchical manner. Therefore, prospective prevention strategies should take into account the hierarchical structure and unique trajectories of factors.

Symptoms characteristics of personality disorders associated with suicidal ideation and behaviors in a clinical sample of adolescents with a depressive disorder

Introduction

Pathological personality traits have repeatedly been identified as important risk factors for suicidal ideation and behaviors. Moreover, impulsive-aggressive traits, have shown a consistent association with suicidal behaviors across the lifespan. Adolescence represents a critical period for the emergence of different personality traits, mood disorders, and suicidal behaviors, but the relationship between these variables remain poorly understood.

Methods

These variables were examined in a cross-sectional case-control design involving three groups: 30 adolescents with a depressive disorder and past suicide attempt (Mean Age = 16.2, Females = 26), 38 adolescents with a depressive disorder but without past suicide attempt (Mean age = 16.0, Females = 29), and 34 healthy adolescent controls (Mean age = 15.2, Females = 22). Suicidal ideations were indexed using Suicidal Behavior Questionnaire (SBQ-R), psychiatric disorder assessed using a semi-structured questionnaire (K-SADS-PL), depressive symptoms with the Beck Depressive Inventory (BDI), symptoms characteristics of personality disorders with the Scheduled Clinical Interview for the DSM-IV (SCID-II) screening questionnaire, and impulsivity with the Barratt Impulsivesness Scale (BIS).

Results

Findings showed that impulsivity (F = 11.0, p < 0.0001) and antisocial symptoms characteristics of personality disorders (p < 0.001, d = 0.70) displayed the most robust association with adolescent suicide attempts. Borderline symptoms characteristics of personality disorders did not discriminate attempters from non-attempters but presented high correlations with suicidal ideation and depression severity. In an item-wise analysis, suicide attempt status was uniquely correlated with symptoms characteristics of an antisocial personality disorder. Suicide attempt status also correlated with non-suicidal self-injury and a chronic feeling of emptiness.

Discussion

The caveats of this cross-sectional study include the stability of symptoms characteristics of personality disorders in adolescence and the limited sample size. In sum, suicidal behaviors were characteristically correlated with increased impulsivity and antisocial symptoms characteristics of personality disorders, but other symptoms characteristics of personality disorders were relevant to adolescent depression and suicidal ideation. Understanding the emergence of symptoms characteristics of personality disorders and suicidal behaviors in a developmental context can ultimately inform not only the neurobiological origin of suicidal behaviors, but also provide new avenues for early detection and intervention.

Severity features of suicide attempters with epilepsy

BACKGROUND

After the Food and Drug Administration alert about antiepileptic medication and suicide, incident epilepsy has been associated with first or recurrent suicide attempts independently of psychiatric comorbidities and antiepileptic treatment. Following this thread, the aim of this study was to analyze if epilepsy was associated with a higher severity of lifetime suicide attempts (SAs).

METHODS

Analyses were carried out on 1677 adults hospitalized between 1999 and 2012 after a SA in a specialized ward for affective episodes. Five severity features were studied: frequent SAs (&gt;2), early onset of first SA (≤26 years), history of violent SA, high suicide intent and high lethality of the SA. Adjusted logistic regression models were used to estimate the association between the lifetime diagnosis of epilepsy and the severity features.

RESULTS

Among suicide attempters, ninety-three patients reported a lifetime diagnosis of epilepsy (5.5%). Epileptic patients diagnosed after the first SA were more likely to be frequent suicide attempters than non-epileptic ones. They showed also higher SA planification scores.

LIMITATIONS

Diagnosis accuracy is limited by the use of self-reports for epilepsy. The lack of precise information about the disease course and treatment have not allowed for further statistical analysis. With regard to psychiatric comorbidities, personality disorders could not be taken into account.

CONCLUSIONS

Suicide attempters with epilepsy present an increased severity in some aspects of their suicidal behavior regardless of demographic and clinical variables. Our results give support to the existence of a bidirectional association between epilepsy and suicidal behavior.

Impulsivity as a mediator between childhood maltreatment and suicidal behavior: A systematic review and meta-analysis

Childhood maltreatment is a known risk factor for the development of suicidal behavior. Possible mediators of the association between childhood maltreatment and suicide have been analyzed. Some studies have considered impulsivity as one of these mediators, but there are no previous reviews on this topic. We, therefore, present a systematic review and mediation meta-analysis of the literature summarizing the evidence on impulsivity as a mediator of the relationship between childhood maltreatment and lifetime suicidal behavior. This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The review was registered in the PROSPERO database. We searched PubMed, PsycINFO, WebOfScience, and EMBASE databases up to February 2021 to identify studies exploring the association between childhood maltreatment and suicide through impulsivity. Fourteen articles met the selection criteria and were included in the review. Seven articles could be included in the mediation meta-analysis. Impulsivity was a significant mediator of the relationship between childhood maltreatment and suicidal behavior in ten of the fourteen included studies. This result was confirmed using mediation meta-analysis (β = .06, 95% CI 0.03-0.10). Studies suggest that exposure to traumatic situations in childhood affects the proper neurobiological, cognitive, and affective development of individuals. This may increase impulsivity, which in turn would be related to an increased risk of suicide. The effects of childhood maltreatment and impulsivity may be both therapeutic targets of interest to reduce suicide rates.

The association of childhood trauma with sleep disturbances and risk of suicide in US veterans

BACKGROUND

Sleep dysregulation is prevalent among veterans and is associated with increased risk of suicidal ideation and behaviors. A confluence of risk factors have been identified to date that contribute to increase risk for suicidal behavior. How these risk factors including childhood trauma, comorbid psychopathology, impulsivity, and hostility together with sleep disturbance contribute to suicide risk remains an open question. These factors have never been examined simultaneously in a unified mediation model, as investigated in the present study, to determine their relative contribution to suicide risk.

METHODS

Veterans (N = 105) were recruited across 3-groups, including Major Depressive Disorder (MDD) with/without a history of a suicide attempt (n = 35 and n = 37, respectively), and non-psychiatric controls, who had no history of mental illness or suicidal behavior (n = 33). The participants were assessed using validated self-report assessments with in-depth phenotyping for relevant risk factors associated with suicidal behavior including childhood adversity, depression severity, impulsivity, hostility, and sleep quality. These factors were included in mediation models using path analysis.

RESULTS

Across all subjects including those with MDD and non-psychiatric controls, mediation analysis showed that higher levels of childhood trauma had an indirect effect on poor sleep quality (p = 0.001). This effect was orthogonal, being independently mediated by both MDD psychopathology (p = 0.003), and higher traits of impulsivity (p = 0.001) and hostility (p = 0.015). Amongst MDD veterans, childhood trauma was directly associated with increased suicide risk (p = 0.034), irrespective of their severity of depression, or their degree of hostility and impulsivity.

LIMITATIONS

include use of self-report data, and the inability to establish causal inferences with cross-sectional design.

CONCLUSION

Childhood adversity as a significant pre-deployment risk factor for disturbed sleep and elevated suicide risk, potentially important for incorporation in clinical practice for suicide.

Altered cortical morphology in major depression disorder patients with suicidality

Background

Major depressive disorder (MDD) is associated with high risk of suicide, but the biological underpinnings of suicidality in MDD patients are far from conclusive. Previous neuroimaging studies using voxel-based morphometry (VBM) demonstrated that depressed individuals with suicidal thoughts or behaviors exhibit specific cortical structure alterations. To complement VBM findings, surface-based morphometry (SBM) can provide more details into gray matter structure, including the cortical complexity, cortical thickness and sulcal depth for brain images.

Objective

This study aims to use SBM to investigate cortical morphology alterations to obtain evidence for neuroanatomical alterations in depressed patients with suicidality.

Methods

Here, 3D T1-weighted MR images of brain from 39 healthy controls, 40 depressed patients without suicidality (patient controls), and 39 with suicidality (suicidal groups) were analyzed based on SBM to estimate the fractal dimension, gyrification index, sulcal depth, and cortical thickness using the Computational Anatomy Toolbox. Correlation analyses were performed between clinical data and cortical surface measurements from patients.

Results

Surface-based morphometry showed decreased sulcal depth in the parietal, frontal, limbic, occipital and temporal regions and decreased fractal dimension in the frontal regions in depressed patients with suicidality compared to both healthy and patient controls. Additionally, in patients with depression, the sulcal depth of the left caudal anterior cingulate cortex was negatively correlated with Hamilton Depression Rating Scale scores.

Conclusions

Depressed patients with suicidality had abnormal cortical morphology in some brain regions within the default mode network, frontolimbic circuitry and temporal regions. These structural deficits may be associated with the dysfunction of emotional processing and impulsivity control. This study provides insights into the underlying neurobiology of the suicidal brain.

Sleep Disturbances and Suicidal Behavior

Sleep disturbances, particularly insomnia, nightmares, and excessive daytime sleepiness (EDS), are significant, proximal, and modifiable risk factors for suicidal ideation and behaviors (SIB) and could be targeted for preventative interventions. In this chapter, we review the evidence supporting the association of insomnia, nightmares, and EDS with SIB. We also describe these sleep disturbances in the general population, as well as their association with psychiatric disorders. A PubMed search was conducted to identify the relevant literature. Insomnia is very frequent across mental disorders, but SIB patients are particularly exposed. Specific interventions focused on insomnia are useful in contending suicidal ideation. Nightmares seem to constitute an independent risk factor for SIB, beyond insomnia, particularly in young people and when experienced frequently. The evidence regarding the association of EDS and SIB is less clear and probably explained by the reduction of health-related quality of life and comorbid depression. The mechanisms underlying the relationship between sleep disturbances and SIB as well as the role of potential confounders and future perspectives in this field are also discussed.

Exploring the boundaries between borderline personality disorder and suicidal behavior disorder

OBJECTIVE

To compare clinical traits of suicidal vulnerability among in-patients with suicidal behavior disorder (SBD) with and without borderline personality disorder (BPD).

METHOD

we recruited adult patients with SBD, consecutively and voluntarily hospitalized in a specialized unit for affective disorders and suicidal behavior between July and October 2016. Ninety-two inpatients having attempted suicide within the past 2 years were divided into two subgroups according to the presence or absence of BPD. Clinical vulnerability traits for suicidal behavior were assessed.

RESULTS

Half of the patients with SBD also had BPD. Patients with BPD were nine times more likely to be major suicide repeaters compared to those without. They were also more likely to display clinical and psychological vulnerability traits for suicidal behavior, even after considering potential confounders. Emotional dysregulation, shame-proneness, impulsiveness, preoccupied attachment pattern, and childhood trauma were high in both groups, but significantly increased in those with (vs. without) BPD status. Psychological traits remained stable in SBD-BPD patients, regardless of the time since the last suicide attempt (i.e. SBD in recent vs. early remission).

CONCLUSIONS

Clinical and psychological traits associated with suicidal vulnerability are present in all SBD patients compared to non-suicidal populations, but comorbidity with BPD is associated with particularly high scores. BPD could be considered as a specifier for SBD diagnoses.

Exposure to Early Life Adversity and Interpersonal Functioning in Attempted Suicide

BACKGROUND

Early life adversity (ELA) may lead to an increased risk for mental health problems including suicidal behavior. ELA alters biological stress systems that affect behavior and control within the individual that in turn will affect interpersonal behavior. Strained relations and interpersonal conflicts leading to rejection and isolation have been shown to be factors for suicidal behavior. Difficulties in interpersonal relationships are a common reason for seeking help in psychiatric care. In the present study, we examined relationship between different types of interpersonal problems and adverse childhood experiences in patients with a recent suicide attempt.

METHOD

The study included 181 recent suicide attempters. We assessed early life adversity and specific interpersonal problems by using the Karolinska Interpersonal Violence Scale and the Inventory of Interpersonal problems respectively.

RESULTS

Suicide attempters with high levels of early life adversity expressed a more socially avoidant, non-assertive, and exploitable personal style even after adjustment for comorbidities with personality disorder and substance use disorder.

CONCLUSIONS

Patients with a recent suicide attempt with high levels of early life adversity tend to isolate themselves, of being introvert, and having difficulties to open up and confide in others. They report low self-confidence and self-esteem and problems with feeling and expressing anger. These behaviors complicate interaction with others and make establishment of solid relationships more difficult. In regards to detection of suicidal communication and treatment of suicidal patients, this may lead to misinterpretations and difficulties to fully benefit from treatment given or for professionals to provide the appropriate treatment. Clinicians should closely investigate the presence of early life adversity in suicidal patients and pay attention to their personal style and their difficulties in interpersonal exchange.

Childhood Maltreatment and Impulsivity: A Meta-Analysis and Recommendations for Future Study

Both childhood maltreatment and impulsivity have been implicated in a broad array of negative public health outcomes and have been much studied in relation to each other. Characterizing this relationship, and the processes underlying it, are important for informing intervention efforts targeting this association and its psychopathological sequelae. The current review presented a systematic meta-analysis of the empirical literature on childhood maltreatment and impulsivity. In all, 55 eligible studies were identified and included in this review. General support was found for a positive association between childhood maltreatment, including its specific subtypes, and general trait impulsivity, with pooled effect sizes ranging from small in the case of childhood sexual abuse (OR = 1.59 [95% CI = 1.38-1.84]) to medium-to-large in the case of childhood emotional abuse (OR = 3.10 [95% CI = 2.27-4.23]). Support for a relationship between childhood maltreatment and laboratory-based measures of impulsive behavior was generally lacking. The current findings must be interpreted with a degree of caution, given several methodological limitations characterizing much of the empirical literature. Recommendations for addressing these limitations and directions for future research are provided.

Self-harm behaviour and externally-directed aggression In psychiatric outpatients: a multicentre, prospective study (viormed-2 study)

The aim of the project was to investigate differences between outpatients with Severe Mental Disorders (SMDs) with and without a history of Self-Harm behaviour (SHb) and/or Violent behaviour against other people (Vb) in relation to: (a) socio-demographic and clinical characteristics, (b) violent behaviour during a 1-year FU, (c) predictors of SHb and Vb during the FU. Outpatients with SMDs, with and without a history of Vb were enrolled. They were divided in four groups: patients with lifetime Vb (V), patients with both Vb and SHb (V-SH), patients with only SHb (SH) and patients with no history of SHb and Vb (control group, CONT). The frequency and severity of SHb and Vb during the FU were assessed every two weeks by the MOAS. Overall 246 patients were enrolled. BPRS-E Depression item, the SLOF Social acceptability, the BDHI Indirect Aggression, the BIS Motor Impulsiveness and the STAXI-2 Control-Out showed significant correlations with all the four groups (p < 0.030). V and V-SH patient groups reached higher scores in all MOAS sub-scales. Age among the SH group and BPRS-E affect-anxiety subscale among the V group significantly predicted aggression against people. In people with SMDs a history of SHb or Vb is associated with different medium-term outcomes.

Single nucleotide polymorphisms, variable number tandem repeats and allele influence on serotonergic enzyme modulators for aggressive and suicidal behaviors: A review

The serotonergic system plays key regulatory roles in cognition and emotion. Several lines of evidence suggest that genetic variation is associated with aggressive and suicidal behaviors. Genetic studies have largely focused on three types of variations: single nucleotide polymorphisms (SNPs), variable number tandem repeats (VNTRs), and alleles. 95 published papers (49 papers for aggression and 46 for suicide) were reviewed to summarize the impact of SNPs, VNTRs, and alleles of tryptophan hydroxylase (TPH, the rate-limiting enzyme in serotonin [5-HT] synthesis), 5-HT transporter (5-HTT), serotonergic receptors, monoamine oxidase (an enzyme that catalyzes 5-HT degradation) on aggression and suicidal behaviors. These study samples include healthy controls, psychiatric disease patients, and animal models. This article mainly reviews studies on the relationship between 5-HT transmissions and genetic variations involved in aggression (particularly impulsive aggression) or suicide in people with different ethnicities and psychiatric disorders. We found that most SNPs, VNTRs, and alleles exerted influences on aggression or suicide. Only A128C in TPH1, A138G in 5-HT2A, and L type in the VNTR of monoamine oxidase A (MAOA) affected both aggression and suicide. The associations between some genetic variations and aggression/suicide may be influenced by gender, age, ethnicity, psychiatric disease, and even parenting or prenatal stress. These findings may help clarify how genetic and environmental factors influence the development of aggressive and suicidal behaviors.

Implications of Increased Trait Impulsivity on Psychopathology and Experienced Stress in the Victims of Early Trauma With Suicidality

There is a paucity of research characterizing suicide-related factors in victims of early trauma (ET). This cross-sectional study investigated an increase in trait impulsivity of ET victims with suicidal ideation or behavior and its role in severity of psychopathologies and experienced stress. Using data of 401 Korean suicidal ideators and attempters, trait impulsivity, severity of psychopathologies, and stress levels in addition to sociodemographic and clinical characteristics were compared between the ET group and the no ET group. Three first-order factors of trait impulsivity measured in Barratt Impulsive Scale-11 (cognitive instability, motor, and [lack of] perseverance) as well as depression, anxiety, overall stress level, and stress from social relationships were significantly elevated in the ET group. Owing to the long-lasting neurobiological influences of ET, it is recommended clinically that victims be carefully monitored for the development of mental distress, such as depression and anxiety, even in adulthood.

Recent advances in genetics of aggressive behavior

One of the most important problems of modern neurobiology and medicine is an understanding of the mechanisms of normal and pathological behavior of a person. Aggressive behavior is an integral part of the human psyche. However, environmental risk factors, mental illness and somatic diseases can lead to increased aggression to be the biological basis of antisocial behavior in a human society. An important role in development of aggressive behavior belongs to the hereditary factors that may be linked to abnormal functioning of neurotransmitter systems in the brain yet the underlying genetic mechanisms remain unclear, which is due to a large number of single nucleotide polymorphisms, insertions and deletions in the structure of genes that encode the components of the neurotransmitter systems. The most studied candidate genes for aggressive behavior are serotonergic (TPH1, TPH2, HTR2A, SLC6A4) and dopaminergic (DRD4, SLC6A3) system genes, as well as the serotonin or catecholamine metabolizing enzyme genes (COMT, MAOA). In addition, there is evidence that the hypothalamic-pituitary system genes (OXT, OXTR, AVPR1A, AVPR1B), the sex hormone receptors genes (ER1, AR), neurotrophin (BDNF) and neuronal apoptosis genes (CASP3, BAX) may also be involved in development of aggressive behavior. The results of Genome-Wide Association Studies (GWAS) have demonstrated that FYN, LRRTM4, NTM, CDH13, DYRK1A and other genes are involved in regulation of aggressive behavior. These and other evidence suggest that genetic predisposition to aggressive behavior may be a very complex process.

Serotonergic gene polymorphisms (5-HTTLPR, 5HTR1A, 5HTR2A), and population differences in aggression: traditional (Hadza and Datoga) and industrial (Russians) populations compared

Background

Current knowledge on genetic basis of aggressive behavior is still contradictory. This may be due to the fact that the majority of studies targeting associations between candidate genes and aggression are conducted on industrial societies and mainly dealing with various types of psychopathology and disorders. Because of that, our study was carried on healthy adult individuals of both sex (n = 853).

Methods

Three populations were examined: two traditional (Hadza and Datoga) and one industrial (Russians), and the association of aggression with the following polymorphisms 5-HTTLPR, rs6295 (5HTR1A gene), and rs6311 (5HTR2A gene) were tested. Aggression was measured as total self-ratings on Buss-Perry Aggression Questionnaire.

Results

Distributions of allelic frequencies of 5-HTTLPR and 5HTR1A polymorphisms were significantly different among the three populations. Consequently, the association analyses for these two candidate genes were carried out separately for each population, while for the 5HTR2A polymorphism, it was conducted on the pooled data that made possible to introduce ethnic factor in the ANOVA model. The traditional biometrical approach revealed no sex differences in total aggression in all three samples. The three-way ANOVA (μ + 5-HTTLPR + 5HTR1A + 5HTR2A +ε) with measures of self-reported total aggression as dependent variable revealed significant effect of the second serotonin receptor gene polymorphism for the Hadza sample. For the Datoga, the interaction effect between 5-HTTLPR and 5HTR1A was significant. No significant effects of the used polymorphisms were obtained for Russians. The results of two-way ANOVA with ethnicity and the 5HTR2A polymorphism as main effects and their interactions revealed the highly significant effect of ethnicity, 5HTR2A polymorphism, and their interaction on total aggression.

Conclusions

Our data provided obvious confirmation for the necessity to consider the population origin, as well as cultural background of tested individuals, while searching for associations between genes and behavior, and demonstrated the role of cultural attitudes towards the use of in-group aggression. Our data partly explained the reasons for disagreement in results of different teams, searching for candidate-gene associations with behavior without considerations of culturally desirable norms. Previous studies suggested that the 5HTR2A gene polymorphism associates with aggression and criminality. Our data extended these findings, demonstrating the role of rs6311 (5HTR2A gene) in aggression in adult healthy men and women from our samples. We found that G-allele carriers were rated higher on total aggression.

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.

Neuropathology of suicide: recent findings and future directions

Suicide is a major public health concern and a leading cause of death in most societies. Suicidal behaviour is complex and heterogeneous, likely resulting from several causes. It associates with multiple factors, including psychopathology, personality traits, early-life adversity and stressful life events, among others. Over the past decades, studies in fields ranging from neuroanatomy, genetics and molecular psychiatry have led to a model whereby behavioural dysregulation, including suicidal behaviour (SB), develops as a function of biological adaptations in key brain systems. More recently, the unravelling of the unique epigenetic processes that occur in the brain has opened promising avenues in suicide research. The present review explores the various facets of the current knowledge on suicidality and discusses how the rapidly evolving field of neurobehavioural epigenetics may fuel our ability to understand, and potentially prevent, SB.

Functional and dysfunctional impulsivity and attempted suicide in rural China: A paired case-control study

This study aimed to clarify the relationship between functional and dysfunctional impulsivity and attempted suicide in rural China. Data of this study came from the investigation of 407 suicide attempters and their paired non-suicide attempters matched with the same gender, age (±3 years) and residence area in six counties in rural Shandong, China. Suicide attempters accounted for a lower proportion on high functional impulsivity, but a higher proportion on high dysfunctional impulsivity than non-suicide attempters. Dysfunctional impulsivity in the male denoted a significant risk factor for attempted suicide, even after adjustment for psychiatric disorder and demographic factors. Suicide attempters with high dysfunctional impulsivity had a higher percent of family suicide history than those with low dysfunctional impulsivity. High functional impulsivity was a significant protective factor for attempted suicide in the group aged 35-59 years, but a significant risk factor in the group aged 15-34 years. Suicide attempters with low functional impulsivity had poorer economic status and older age than those with high functional impulsivity. Our findings support the key roles of functional and dysfunctional impulsivity in attempted suicide among rural residents of China.

Positive and negative life events and reasons for living modulate suicidal ideation in a sample of patients with history of suicide attempts

BACKGROUND

The influence of life events on suicidal behavior remains inconclusive, while reasons for living (RFL) may be protective.

OBJECTIVES

To analyze the association between positive and negative life events and suicidal ideation (SI) and the interaction between life events and RFL on SI.

METHOD

Patients with history of suicide attempts (n = 338) underwent a comprehensive clinical evaluation, including SI (Beck's Suicidal Ideation scale), RFL (Reasons for Living Inventory, RFLI) and life events (family, school, student or professional, social, health and religion-related and other life events) during the last twelve months.

RESULTS

The only negative life events associated with SI were health-related events (OR = 2.01 95%CI[1.04;3.92]). Family-related positive life events and RFL were negatively associated with SI (OR = 0.73 95%CI[0.58;0.91] and OR = 0.98 95%CI[0.97;0.98], respectively). No significant interaction between the number of positive life events and RFLI total score with current SI (p = 0.57) was detected. Family-related positive life events and RFL did not have any additive effect on SI. Positive life events did not moderate the association between health-related negative life events and SI.

LIMITATIONS

This was a retrospective study, the presence of axis II disorders was not investigated and results cannot be generalized due to the sample choice (only suicide attempters).

CONCLUSIONS

Patients with history of suicide attempts could be less sensitive to negative life events, except for those related to health. Clinicians should pay more attention to somatic problems in patients at risk of suicide. Family support, positive psychology and therapies that strengthen RFL should be developed to prevent suicide.

First onset of suicidal thoughts and behaviours in college

BACKGROUND

College students are a worldwide increasing group of young people at risk for suicidal thoughts and behaviours (STB). However, no previous studies have prospectively investigated the first onset of STB during the college period.

METHODS

Using longitudinal data from the Leuven College Surveys, 2337 (response rate [RR]=66.6%) incoming freshmen provided baseline data on STB, parental psychopathology, childhood-adolescent traumatic experiences, 12-month risk for mental disorders, and 12-month stressful experiences. A total of 1253 baseline respondents provided data on 12-month STB in a two-year annual follow-up survey (conditional RR=53.6%; college dropout adjusted conditional RR=70.2%).

RESULTS

One-year incidence of first-onset STB was 4.8-6.4%. Effect sizes of the included risk factors varied considerably whether viewed from individual-level (ORs=1.91-17.58) or population-level perspective (PARPs=3.4-34.3%). Dating violence prior to the age of 17, physical abuse prior to the age of 17, and 12-month betrayal by someone else than the partner were most strong predictors for first-onset suicidal ideation (ORs=4.23-12.25; PARPs=8.7-27.1%) and plans (ORs=6.57-17.58; PARPs=15.2-34.3%). Multivariate prediction (AUC=0.84-0.91) revealed that 50.7-65.7% of first-onset STB cases were concentrated in the 10% at highest predicted risk.

LIMITATIONS

As this is a first investigation of STB onset in college, future studies should use validation samples to test the accuracy of our multivariate prediction model.

CONCLUSIONS

The first onset of STB in college appears to be higher than in the general population. Screening at college entrance is a promising strategy to identify those students at highest prospective risk, enabling the cost-efficient clinical assessment of young adults in college.

Family history of suicide and interpersonal functioning in suicide attempters

Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters' interpersonal problems is of importance to lower their distress.

Effect of early trauma on the sleep quality of euthymic bipolar patients

OBJECTIVE

Poor quality of sleep is frequent in euthymic bipolar patients and conveys worse clinical outcomes. We investigated the features of euthymic bipolar patients associated with poor sleep quality, with a focus on the effect of childhood trauma.

METHOD

493 euthymic patients with DSM-IV-defined bipolar disorders were recruited in FondaMental Advanced Centers of Expertize for Bipolar Disorders (FACE-BD) between 2009 and 2014. Clinical variables were recorded. Subjective sleep quality and history of childhood trauma were respectively measured by the Pittsburgh Sleep Quality Index (PSQI) and the Childhood Trauma Questionnaire (CTQ).

RESULTS

Poor sleepers were older, less professionally active, had significantly higher anxiety levels, took more anxiolytic drugs and did endorse more suicide attempts and suicidal ideas than good sleepers after adjusting for anxiety levels and age. Emotional abuse was associated with poor sleep quality after adjustment for BMI, age, professional activity, and bipolar disorders (BD) type (OR=1.83; 95% CI [1.30; 3.10]; p=0.02). However, this association was lost after adjustment for anxiety levels, anxiolytic treatment and suicide ideation/attempts.

LIMITATIONS

The main limitation was the type of sleep assessment, which only measured the subjective part of sleep complaints.

CONCLUSION

A history of emotional abuse might underlie sleep problems in many bipolar patients but anxiety seems to act as a confounding factor in this relationship. New studies are needed to elucidate the role of childhood maltreatment on poor sleep among bipolar patients.

Associations between adverse childhood experiences and clinical characteristics of eating disorders

Patients with eating disorders (EDs) frequently report a history of childhood trauma (CT). We investigated whether certain subtypes of CT are associated with more severe features of EDs, independently of psychiatric comorbidity, and whether they act additively. One hundred and ninety-two patients with DSM-V-defined EDs were consecutively recruited. Five clinical characteristics were assessed: restraint, eating, shape and weight concerns on the EDE-Q, and daily functioning. CT was assessed by the childhood traumatism questionnaire. The clinical features were associated with at least one CT subtype (emotional, sexual or physical abuse, emotional neglect). Multivariate analyses adjusted for lifetime comorbid psychiatric disorders revealed that emotional abuse independently predicted higher eating, shape and weight concerns and lower daily functioning, whereas sexual and physical abuse independently predicted higher eating concern. A dose-effect relationship characterised the number of CT subtypes and the severity of the clinical features, suggesting a consistent and partly independent association between CT and more severe clinical and functional characteristics in EDs. Emotional abuse seems to have the most specific impact on ED symptoms. Last, not all CT subtypes have the same impact but they do act additively.

Aggressive behavior in humans: Genes and pathways identified through association studies

Aggressive behavior has both genetic and environmental components. Many association studies have been performed to identify genetic factors underlying aggressive behaviors in humans. In this review we summarize the previous work performed in this field, considering both candidate gene (CGAS) and genome-wide association studies (GWAS), excluding those performed in samples where the primary diagnosis is a psychiatric or neurological disorder other than an aggression-related phenotype. Subsequently, we have studied the enrichment of pathways and functions in GWAS data. The results of our searches show that most CGAS have identified associations with genes involved in dopaminergic and serotonergic neurotransmission and in hormone regulation. On the other hand, GWAS have not yet identified genome-wide significant associations, but top nominal findings are related to several signaling pathways, such as axon guidance or estrogen receptor signaling, and also to neurodevelopmental processes and synaptic plasticity. Future studies should use larger samples, homogeneous phenotypes and standardized measurements to identify genes that underlie aggressive behaviors in humans. © 2016 Wiley Periodicals, Inc.

Genetics of aggressive behavior: An overview

The Research Domain Criteria (RDoC) address three types of aggression: frustrative non-reward, defensive aggression and offensive/proactive aggression. This review sought to present the evidence for genetic underpinnings of aggression and to determine to what degree prior studies have examined phenotypes that fit into the RDoC framework. Although the constructs of defensive and offensive aggression have been widely used in the animal genetics literature, the human literature is mostly agnostic with regard to all the RDoC constructs. We know from twin studies that about half the variance in behavior may be explained by genetic risk factors. This is true for both dimensional, trait-like, measures of aggression and categorical definitions of psychopathology. The non-shared environment seems to have a moderate influence with the effects of shared environment being unclear. Human molecular genetic studies of aggression are in an early stage. The most promising candidates are in the dopaminergic and serotonergic systems along with hormonal regulators. Genome-wide association studies have not yet achieved genome-wide significance, but current samples are too small to detect variants having the small effects one would expect for a complex disorder. The strongest molecular evidence for a genetic basis for aggression comes from animal models comparing aggressive and non-aggressive strains or documenting the effects of gene knockouts. Although we have learned much from these prior studies, future studies should improve the measurement of aggression by using a systematic method of measurement such as that proposed by the RDoC initiative.

[Childhood maltreatment and its impact on the mental health]

This review covers the literature of the last 25 years on the impact of childhood maltreatment on the mental health throughout the individual's life. Child abuse increases the risk of many mental disorders including depression, suicidal ideation and suicidal behavior, anxiety-related disorders, psychoses as well as alcohol and other drug abuse. The impact of child trauma on the mental health is largely due to structural and functional changes in the hippocampus, amygdala and prefrontal cortex. Early preventive interventions play a great role in the prevention of mental disorders associated with childhood adversities.

Amelioration of nicotinamide adenine dinucleotide phosphate-oxidase mediated stress reduces cell death after blast-induced traumatic brain injury

A total of 1.7 million traumatic brain injuries (TBIs) occur each year in the United States, but available pharmacologic options for the treatment of acute neurotrauma are limited. Oxidative stress is an important secondary mechanism of injury that can lead to neuronal apoptosis and subsequent behavioral changes. Using a clinically relevant and validated rodent blast model, we investigated how nicotinamide adenine dinucleotide phosphate oxidase (Nox) expression and associated oxidative stress contribute to cellular apoptosis after single and repeat blast injuries. Nox4 forms a complex with p22phox after injury, forming free radicals at neuronal membranes. Using immunohistochemical-staining methods, we found a visible increase in Nox4 after single blast injury in Sprague Dawley rats. Interestingly, Nox4 was also increased in postmortem human samples obtained from athletes diagnosed with chronic traumatic encephalopathy. Nox4 activity correlated with an increase in superoxide formation. Alpha-lipoic acid, an oxidative stress inhibitor, prevented the development of superoxide acutely and increased antiapoptotic markers B-cell lymphoma 2 (t = 3.079, P < 0.05) and heme oxygenase 1 (t = 8.169, P < 0.001) after single blast. Subacutely, alpha-lipoic acid treatment reduced proapoptotic markers Bax (t = 4.483, P < 0.05), caspase 12 (t = 6.157, P < 0.001), and caspase 3 (t = 4.573, P < 0.01) after repetitive blast, and reduced tau hyperphosphorylation indicated by decreased CP-13 and paired helical filament staining. Alpha-lipoic acid ameliorated impulsive-like behavior 7 days after repetitive blast injury (t = 3.573, P < 0.05) compared with blast exposed animals without treatment. TBI can cause debilitating symptoms and psychiatric disorders. Oxidative stress is an ideal target for neuropharmacologic intervention, and alpha-lipoic acid warrants further investigation as a therapeutic for prevention of chronic neurodegeneration.

The additive effect on suicidality of family history of suicidal behavior and early traumatic experiences

Family history of suicidal behavior and personal history of childhood abuse are reported risk factors for suicide attempts and suicide completion. We aim to quantify the additive effect of family history of suicidal behavior and different subtypes of childhood abuse on suicidal behavior. We examined a sample of 496 suicide attempters, comparing individuals with family history of suicidal behavior and personal history of childhood (physical or sexual) abuse, individuals with family history of suicidal behavior only, individuals with history of early traumatic experiences only, and individuals with none of these two risk factors with regards to suicidal features. An additive effect was found for the age at the first attempt in suicide attempters with both family history of suicidal behavior and either physical or sexual abuse. No significant interactions were found between family history of suicidal behavior and childhood trauma in relation to any characteristics of suicidal behavior. Subjects presenting family history of suicidal behavior and childhood abuse attempt suicide earlier in life than subjects with just one or none of them, particularly if they were sexually abused. Other suicidality indexes were only partially or not associated with this combination of risk factors. A careful assessment of patients with both family history of suicidal behavior and childhood abuse could help to prevent future suicide attempts, particularly in young people.