The Relations of Temperament and Emotion Self-regulation with Suicidal Behaviors in a Clinical Sample of Depressed Children in Hungary

Abstract

Although major depressive disorder (MDD) is associated with suicidal behaviors, some depressed individuals are not suicidal and others evidence various forms of suicidality. We thus investigated whether aspects of temperament and self-regulation of dysphoria represent risk factors for DSM-IV suicidality (recurrent thoughts of death, recurrent suicidal ideation, suicidal plan, and suicide attempt) in depressed youths. Using a sample of children with MDD (N = 407; ages 7-14 years), recruited from clinical sites across Hungary, we tested the hypotheses that: (a) suicidality is related to higher levels of trait negative emotionality as well as more maladaptive and fewer adaptive regulatory responses to dysphoria and (b) as the severity of suicidal behavior increases, levels of trait negative emotionality and dysfunctional emotion regulation also increase. We also explored if other aspects of temperament relate to suicidality. Children's DSM-IV diagnoses were based on semi-structured interviews and best-estimate psychiatric consensus. Parents independently provided ratings of their children's temperament, and children separately completed an inventory of emotion regulation (ER). Using multivariate models, we failed to confirm the hypothesized relations of negative trait emotionality and suicidality, but confirmed that high maladaptive and low adaptive ER response tendencies increase the odds of suicidal behaviors, above and beyond the risk posed by depressive illness severity. Unplanned interaction terms between temperament dimensions (other than negative emotionality) and ER suggested that at some high-extremes of temperament, ER has no impact on suicidality but in their absence, adaptive ER lowers the risk of suicidality. The practical implications of the findings are discussed.

The role of emotion dysregulation in suicide as considered through the ideation to action framework

“…In depressed children, maladaptive regulatory responses to dysphoria have been associated with suicidal ideation, planning, and attempts [22]. Lack of awareness of one's emotional coping strategies has been positively associated with suicidal ideation, with the effects largely explained by hopelessness and rumination [23].…”

Cytokine Genes <i>TNF</i>, <i>IL1A</i>, <i>IL1B</i>, <i>IL6</i>, <i>IL1RN</i> and <i>IL10</i>, and Childhood-Onset Mood Disorders

“…As described in detail elsewhere [66][67][68] , families were recruited into this study from 23 mental health facilities (inpatient and outpatient units for child psychiatry and psychology) across Hungary, each family having been ascertained through a child diagnosed as having depression. Each of the probands met the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) criteria for a mood disorder (depressive disorder or bipolar disorder), with onset of the first depressive episode occurring before the age of 15 years.…”

“…As reported previously, the actual severity scores have been found to range from 10 to 29 (mean score = 20) [67] . Additional characteristics of the subjects in this study sample have been described in detail in several recent publications [64][65][66][67][68] and are summarized briefly in table 1 . In accordance with Institutional Review Board requirements in Hungary and at the University of Pittsburgh, written informed consent from parents and assent from children were obtained prior to participation in the study.…”

Changes in acceptance and suppression of negative and positive emotions in patients with depressive disorders: a longitudinal study

“…This appears to be significant as emotion regulation and psychopathology symptoms seem to mutually influence each other. Additionally, there are reports that show the influence of psychopathology on emotion regulation [27], and several studies have shown evidence of the impact of emotion regulation strategies on the level of depressive and anxiety symptoms [28][29][30]. The intensity of the observed changes in the depressive-anxiety symptoms is different among patients: sometimes they are so small they are difficult to notice, other times they are transient.…”