Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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[ 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 ] Innovations in CLINICAL NEUROSCIENCE 51 (stable) hopelessness and new-onset hopelessness. A few limitations to our question wording warrant consideration. One m ight question the utility of the distinction between patient-reported "trait" vs. "recent" hopelessness and impulsivity, as numerous reports indicate that the recall of constructs is driven strongly by the congruence of what is being recalled with the mood of the patient at the time that he or she is asked. 5 6 While this point of view is reasonable, questions such as those examined in this study represent typical time frames often discussed by patients and clinicians in critical emergency department encounters. Consequently, although retrospective estimates of both "recent" and "typical" feelings are certainly colored by in-the-moment mood, it is important to examine the relationship of the responses to these types of questions to parameters that we know to be important in the clinician's judgment of risk for future suicidal behavior (e.g., previous suicide attempts) to see if, in fact, the questions yield information that behaves identically or, in fact, diverges in ways that may be clinically important. Another aspect of these findings that merits further exploration is that the impulsivity items behaved as hypothesized, despite their disparate nature. Specifically, the "recent" items could be construed as asking more about attacks of impulsive suicidality, whereas the "trait" item was open enough to include the more act-without-thought type of impulsive personality trait. We look forward to a replication elaborating upon this work in which a two-by-two matrix can tease apart the extent to which time scale may play a relevant role in altering the relationship between suicidal behavior and different types of impulsive behavior described. Limitations. A limitation of our study is the higher prevalence of SIB in our sample. We deliberately recruited our sample from clinical settings to represent a range of severity of suicidal ideation; consequently, the rate of suicidal ideation was quite high relative to the general population. However, our rate of reported suicidal behavior, (specifically suicide attempts) was quite high, particularly among those with current suicidal ideation (74%), The large proportion of individuals with prior attempts among those with current suicidal ideation may reflect the acuity of presentation and baseline risk for patients presenting to the emergency department with suicidal ideation overall. Similar findings of high rates of historical suicide attempts in those with current suicidal ideation have been reported in other high risk populations. 36,57–59 Clearly more work remains to be done. Although the range of patients from across a broad, prospectively defined range of severity of suicidal ideation is a strength of the study, the absolute number of patients available to us that had recently attempted suicide was quite small: it will be important to replicate these findings in a larger sample of such patients. Likewise, this study was only able to examine a portion of the hypothesized model. Future efforts will be needed to assess the extent to which depression modifies the role that hopelessness plays in fostering suicidal ideation and the manner in which a lack of coping skills may interact with impulsivity in spurring suicidal behavior. REFERENCES 1. United States Centers for Disease Control and Prevention. Twenty Leading Causes of Death Among Persons Ages 10 Years and Older, FIGURE 2. Clinician-rated trait impulsivity according to history of suicide attempts FIGURE 3. Clinician-rated recent impulsivity according to recent suicide attempt Clinician-rated Trait Impulsivity Clinician-rated Recent Impulsivity

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