Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data

Cates, Angharad N de; Catone, Gennaro; Bebbington, P; Broome, Matthew R.

doi:10.1177/0020764019827986

Cited by 6 publications

(6 citation statements)

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“…This pattern was consistent across 2007 and 2014 datasets, but the effect was lower overall in 2014. The consistently lower impact of impulsivity as a mediator for both thoughts and attempts is interesting: it may indicate that mood instability itself includes important elements of impulsivity ( de Cates et al, 2019 ). As might be expected, we also confirmed that depression was an important mediator for suicide attempts and thoughts in persecutory ideation and auditory hallucinations.…”

Section: Discussionmentioning

confidence: 99%

“…Such self-harm has also been linked to impulsivity, which may also be a mediator of longer-term clinical outcome ( Nanda et al, 2016 ). Mood instability and impulsivity have a complex relationship, particularly as potential mediators of self-harm ( de Cates et al, 2019 ). Previous work using community data has identified that psychotic symptoms are associated with self-harm risk, and that this relationship is not necessarily explained by symptoms of borderline personality disorder (which include impulsivity and mood instability) ( Kelleher et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

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Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Cates

Catone

Marwaha

et al. 2021

Schizophrenia Research

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Background Schizophrenia is associated with premature mortality, partly through increased suicide rates. Aims To examine (1) if persecutory ideas, auditory hallucinations, and probable cases of psychosis are associated with suicidal thoughts or attempts cross-sectionally and prospectively, and (2) if such links are mediated by specific affective factors (depression, impulsivity, mood instability). Method We analysed the 2000, 2007, and 2014 British Adult Psychiatric Morbidity Surveys (APMS) separately. Measures of psychosis provided independent variables for multi-stage logistic regressions, with suicidal thoughts and attempts as dependent variables. We also conducted analyses to assess mediation by affective variables, and longitudinal analyses on a subset of the 2000 dataset. Results In every dataset, persecutory ideas, auditory hallucinations and probable psychosis were associated cross-sectionally with lifetime suicidal attempts and thoughts, even after controlling for confounders, with a single exception (persecutory ideation and suicide attempts were unconnected in APMS 2014). Cross-sectional associations between auditory hallucinations and suicidal phenomena were moderated by persecutory ideation. In the 2000 follow-up, initial persecutory ideas were associated with later suicidal thoughts (O.R. 1.77, p < 0.05); there were no other longitudinal associations. In the 2007 and 2014 datasets, mood instability mediated the effects of psychotic phenomena on suicidality more strongly than impulsivity; depression was also an important mediator. There were appreciable direct effects of positive symptoms on suicidal thoughts and behaviour. Conclusions Improving psychotic symptoms and ameliorating co-morbid distress may in itself be effective in reducing suicidal risk in schizophrenia. Given their potential mediating role, mood instability and depression may also be targets for intervention.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Cates

Catone

Marwaha

et al. 2021

Schizophrenia Research

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“…Self-harm is the result of complex interactions of personality factors, including impulsivity, social factors and mental state. 46 It is well established that impulsivity is an important risk factor for suicide attempts. 47 It has been shown that impulsivity increases with exposure to nicotine, returns to a normal levels with abstinence and increases with re-challenge after abstinence.…”

Section: Discussionmentioning

confidence: 99%

Examining the effect of smoking on suicidal ideation and attempts: triangulation of epidemiological approaches

et al. 2020

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BackgroundPrevious literature has demonstrated a strong association between cigarette smoking, suicidal ideation and suicide attempts. This association has not previously been examined in a causal inference framework and could have important implications for suicide prevention strategies. AimsWe aimed to examine the evidence for an association between smoking behaviours (initiation, smoking status, heaviness, lifetime smoking) and suicidal thoughts or attempts by triangulating across observational and Mendelian randomisation analyses. MethodFirst, in the UK Biobank, we calculated observed associations between smoking behaviours and suicidal thoughts or attempts. Second, we used Mendelian randomisation to explore the relationship between smoking and suicide attempts and ideation, using genetic variants as instruments to reduce bias from residual confounding and reverse causation. ResultsOur observational analysis showed a relationship between smoking behaviour, suicidal ideation and attempts, particularly between smoking initiation and suicide attempts (odds ratio, 2.07; 95% CI 1.91-2.26; P < 0.001). The Mendelian randomisation analysis and single-nucleotide polymorphism analysis, however, did not support this (odds ratio for lifetime smoking on suicidal ideation, 0.050; 95% CI −0.027 to 0.127; odds ratio on suicide attempts, 0.053; 95% CI, −0.003 to 0.110). Despite past literature showing a positive dose-response relationship, our results showed no clear evidence for a causal effect of smoking on suicidal ideation or attempts. ConclusionsThis was the first Mendelian randomisation study to explore the effect of smoking on suicidal ideation and attempts. Our results suggest that, despite observed associations, there is no clear evidence for a causal effect.

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“…Self-harm is the result of complex interactions of personality factors, including impulsivity, social factors and mental state 47 . It is well established that impulsivity is an important risk factor for suicidal attempts 48 .…”

Section: Discussionmentioning

confidence: 99%

Examining the effect of smoking on suicidal ideation and attempts: A triangulation of epidemiological approaches

Harrison

Munafò

Smith

et al. 2019

Preprint

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Background: Previous literature has demonstrated a strong association between cigarette smoking and suicide-related behaviours, characterised as ideation, plans, attempts and suicide related death. This association has not previously been examined in a causal inference framework and has important implications for suicide prevention strategies. Aims: We aimed to examine the evidence for an association between smoking behaviours (initiation, smoking status, heaviness, lifetime smoking) and suicidal thoughts or attempts by triangulating across observational and Mendelian randomisation (MR) analyses. Methods: First, in the UK Biobank, we calculate observed associations between smoking behaviours and suicidal thoughts or attempts. Second, we used Mendelian randomisation (MR) to explore the relationship between smoking and suicide using genetic variants as instruments to reduce bias from residual confounding and reverse causation. Results: Our observational analysis showed a relationship between smoking behaviour and suicidal behaviour, particularly between smoking initiation and suicidal attempts (OR = 2.07, 95% CI = 1.91 to 2.26, p<0.001). The MR analysis and single SNP analysis, however, did not support this. Despite past literature showing a positive dose-response relationship our results showed no clear evidence for a causal effect of smoking on suicidal behaviours. Conclusion: This was the first MR study to explore the effect of smoking on suicidal behaviours. Our results suggest that, despite observed associations, there is no strong evidence for a causal effect of smoking behaviour on suicidal behaviour. Our evidence suggests that further research is needed into alternative risk factors for suicide which might make better intervention targets.

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Attempting to disentangle the relationship between impulsivity and longitudinal self-harm: Epidemiological analysis of UK household survey data

Cited by 6 publications

References 55 publications

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Self-harm, suicidal ideation, and the positive symptoms of psychosis: Cross-sectional and prospective data from a national household survey

Examining the effect of smoking on suicidal ideation and attempts: triangulation of epidemiological approaches

Examining the effect of smoking on suicidal ideation and attempts: A triangulation of epidemiological approaches

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