Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] 50 Primary hypotheses. Hopelessness. Results of analyses of the relationships between hopelessness and suicidal ideation were consistent with hypotheses. Trait hopelessness correlated positively with the S-STS suicidal ideation score (p=0.607, p<0.0001). Similarly, hopelessness over the past seven days correlated positively with the S-STS suicidal ideation score (p=0.751, p<0.0001). Impulsivity. Results of analyses of the relationships between impulsivity and suicidal behavior were also consistent with hypotheses. As predicted, patients who reported any historical suicide attempt were rated as reporting higher trait impulsivity than those who did not, as depicted in Figure 2 (mean [M]=4.400, standard deviation [SD]=1.694 vs. M=3.267, SD=1.033, respectively; t(43)= -2.372, p<0.05). Similarly, those who were enrolled in the study secondary to a very recent suicide attempt (M=6.400, SD=2.191) were rated as reporting higher levels of recent impulsivity than those who had not recently attempted suicide, as depicted in Figure 3 (M=3.250, SD=2.933, t(43)= -2.312, p<0.05). DISCUSSION Our sample, chosen specifically to provide a range of suicidal ideation, allowed us to examine some of the relationships hypothesized in our model of SIB. Consistent with our model, we found that higher levels of b oth recent and trait hopelessness are linked to more severe suicidal ideation. Similarly, higher trait impulsivity is reported by those with any historical suicide attempt, whereas higher recent impulsivity is reported by those with a recent history of suicide attempt. It is striking that these effects were evident statistically even with our relatively limited numbers of subjects and items. These findings corroborate evidence establishing strong associations between hopelessness and suicidal ideation and between impulsivity and suicidal behavior. 21,25,44 Moreover, our study suggests that simple questions to establish stable and recent hopelessness and impulsivity can demonstrate strong associations with SIB and may prove very useful in clinical settings where time and patient tolerance for extended interviews are limited. This study suggests the importance of the delineation of recent feelings of hopelessness and impulsivity compared to chronic or state feelings of hopelessness and impulsivity in determining acute suicidal risk. Many studies of impulsivity have used the Barratt Impulsivity Scale, which is a measure of trait (stable) impulsivity. Few studies have measured recent impulsivity that may reflect attacks of impulsive suicidality in suicide attempts and death. However, increasing recent impulsivity factors have been considered as likely etiologies of the high correlation of alcohol substance use and suicide. One theory of the strong correlation of cocaine and alcohol use to suicide is via their ability to transiently increase impulsivity. 45–48 Others have examined the role of higher trait impulsivity in suicide, which may explain the link between Cluster B personality disorders and suicide as well as the strong hereditability of suicidal behavior. 19,21,28,49–55 However, no standard scales assess acute impulsivity and no scales delineate clearly between trait TABLE 1. Demographics of study subjects DEMOGRAPHICS MEAN STANDARD DEVIATION RANGE Age 39.9 15 19–73 Age at first psychiatric symptoms 16.6 10.4 5–42 Age at first psychiatric treatment 24.5 13.3 5–58 Age at first psychiatric hospitalization 30.8 14.7 10–68 Past suicide attempts 2.1 2.8 0–13 TABLE 2. Severity of suicidal ideation and behavior SEVERITY SUBJECTS, n (%) N = 45 Not suicidal, recent accident 5 (11.1) Not suicidal, but self-harm (borderline) 7 (15.6) Questionably suicidal 5 (11.1) Mildly suicidal 6 (13.3) Moderately suicidal 6 (13.3) Severely suicidal 5 (11.1) Extremely suicidal 6 (13.3) Recently attempted suicide 5 (11.1)

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