Impulsivity and Suicidality in Adolescent Inpatients

Abstract

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13-19 years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed. KeywordsAdolescents; Suicide attempts; Suicide ideation; Suicide plans; Impulsivity Suicide rates have increased dramatically over recent decades, and presently, suicide is among the leading causes of death worldwide (Nock et al. 2008). Mental disorders are one of the strongest risk factors for attempted and completed suicide (Nock et al. 2010), andCorrespondence to: Randy P. Auerbach. Conflict of InterestThe authors declare that they have no conflict of interest. Compliance with Ethical StandardsEthical Approval All procedures performed in this study with human subjects was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.Informed Consent Informed consent was obtained from all individual participants included in the study. HHS Public AccessAuthor manuscript J Abnorm Child Psychol. Author manuscript; available in PMC 2018 January 01. Author Manuscript Author ManuscriptAuthor ManuscriptAuthor Manuscript approximately 90 % of individuals who die by suicide have a diagnosable psychiatric disorder (Harris and Barraclough 1997;Pokorny 1983). Nonetheless, the majority of psychiatric patients do not suicide, and thus, there are likely other proximal factors th...

A path model of different forms of impulsivity with externalizing and internalizing psychopathology: Towards greater specificity

“…Scales loading primarily on this factor were Reflexive Reaction to Feelings (Carver et al ., ), an abbreviated version of the Positive Urgency Measure (Cyders et al ., ), and an abbreviated version of the Negative Urgency scale (Whiteside & Lynam, ). Previous work has replicated the factor structure of scales (Auerbach et al ., ).…”

“…Despite overlap in the validity of the emotion‐related impulsivity factors, early studies suggest that it may be important to distinguish between these two factors in understanding psychopathology; that is, there is some evidence that Pervasive Influence of Feelings is more relevant for internalizing conditions such as depressive symptoms, whereas Feelings Trigger Action is more robustly related to externalizing conditions and hypomanic symptoms (Johnson et al ., ). In another study, Pervasive Influence of Feelings was tied to suicidal ideation, whereas Feelings Trigger Action was tied to suicidal actions (Auerbach et al ., ). These findings validate the idea that the two forms of impulsivity differentially guide difficulties with thoughts versus actions in the face of emotion.…”

“…Both of these factors have also been found to be correlated more robustly with key outcomes than non‐emotion‐related forms of impulsivity were, including aggression, borderline personality traits, depression, suicidality, and manic symptoms (Auerbach, Stewart, & Johnson, ; Carver et al ., ; Johnson et al ., ). Despite overlap in the validity of the emotion‐related impulsivity factors, early studies suggest that it may be important to distinguish between these two factors in understanding psychopathology; that is, there is some evidence that Pervasive Influence of Feelings is more relevant for internalizing conditions such as depressive symptoms, whereas Feelings Trigger Action is more robustly related to externalizing conditions and hypomanic symptoms (Johnson et al ., ).…”

Turning the UPPS down: Urgency predicts treatment outcome in a partial hospitalization program

“…As compared to other dimensions of impulsivity assessed via the UPPS, a recent meta-analysis reported that urgency (particularly negative urgency) showed the strongest correlations with a range of psychiatric symptoms including depression, substance use, anxiety, self-harm/suicidality, and disordered eating [6]. Other studies have documented an even broader profile of symptoms and outcomes that correlate with urgency, including obsessional symptoms of OCD [7, 8], symptoms of Generalized Anxiety Disorder [9], aggression [6, 10], and suicide attempts [11]. Case-control studies also reveal elevations in urgency in a diverse range of diagnostic groups, including individuals diagnosed with bipolar I disorder [12], eating disorders [13], major depressive disorder [14], and schizophrenia [15].…”

Neurocognitive mechanisms of emotion‐related impulsivity: The role of arousal

“…In a meta‐analysis of over 40,000 individuals, emotion‐related impulsivity was compared with other aspects of impulsivity and emerged as the best predictor of every clinical diagnosis and symptom group, including depression, anxiety, eating disorders, borderline personality traits, suicidality, and nonsuicidal self‐injury (Berg et al, ). In clinical populations, emotion‐related impulsivity predicts lower quality of life, higher rates of comorbidity, self‐injury, suicidal action, aggression, and poor social well‐being (Auerbach, Stewart, & Johnson, ; Muhtadie et al, ; Victor, Johnson, & Gotlib, ). Emotion‐related impulsivity appears to be a transdiagnostic vulnerability factor for both internalizing and externalizing disorders (Carver, Johnson, & Timpano, ; Johnson, Carver, & Joormann, ).…”