Impulsivity and Suicidal Behavior: How You Define It Matters

摘要

Impulsivity is inconsistently defined in the literature. While there are some clear operationalizations of the trait of impulsivity, there is no consensus about the impulsivity of a specific suicidal behavior. Using a sample of 131 suicide attempters identified in a county emergency room, we used interviewer ratings from the Suicide Attempt Self-Injury Interview (SASII) and the Borderline Personality Disorder (BPD) trait impulsivity criterion from the Structured Clinical Interview for the DSM-IV Axis-II (SCID-II) to examine seven core constructs most commonly used in the literature on impulsivity of suicidal behavior. These constructs are resisting the urge/delaying, planning, trait impulsivity, communication to others, leaving a suicide note, the ability to be rescued, and intoxication. Comparison of these constructs shows relatively small relationships between them, and they clearly do not represent the same underlying concept. The ability of these constructs to predict intent and lethality of the index attempt and a future attempt in the following 6 months varied as well. Planning predicted greater suicidal intent of the index attempt. Chance of rescue predicted lower lethality and less suicidal intent of the index attempt. The presence of a suicide note at the index attempt decreased the odds of a re-attempt in the next 6 months. This study demonstrates that the conceptualization of impulsivity of suicide attempts needs further consideration, and perhaps underlying constructs such as delay, planning, ability to be rescued, and the presence of a suicide note should be studied separately.