Research report
Impulsivity: a relevant dimension in depression regarding suicide attempts?

https://doi.org/10.1016/S0165-0327(98)00130-XGet rights and content

Abstract

Background. This study focuses on clinical impulsivity in depressed patients, regarding suicide attempts.

Methods. Fifty depressed in-patients were assessed for impulsivity with the Impulsivity Rating Scale and the Baratt Impulsivity Scale, at admission (W0) and after 4 weeks of treatment (W4), with special attention to suicide attempts.

Results. In the whole sample, impulsivity scores decreased significantly between W0 and W4. The scale and the questionnaire correlated slightly with each other, suggesting some differences in impulsivity assessment between patients and clinicians. The two subgroups of patients, suicide attempters (SA) (n=16) and non-suicide attempters (NSA) (n=34), were different neither in terms of sample characteristics and antidepressant treatments nor in terms of depression and general psychopathology assessments. However, SA patients scored higher on the impulsivity scale and questionnaire than NSA patients, both at W0 and W4. These results suggest first that impulsivity may be both a trait and a state in depressed suicide attempters and second that it may be relevant in terms of suicide attempts in depression.

Introduction

Suicide is a major risk of depression, which remains difficult to predict (Barraclough et al., 1974, Robins, 1981, Fawcett et al., 1987, Isometsa et al., 1994, Nordström et al., 1995, Malone et al., 1995, Van Gastel et al., 1997). Nevertheless, suicide attempts may predict completed suicide, since 9–43% of depressed patients who commit suicide had previously attempted suicide (Avery and Winokur, 1978).

Many studies have been performed in the field of impulsive behavior, showing its association with low CSF 5-HIAA. In particular, low CSF 5-HIAA was evidenced in suicide attempters as compared to non-suicide attempters in unipolar depression, schizophrenia and personality disorders (Asberg et al., 1976, Roy et al., 1989).

Since suicide attempts may be biologically relevant in terms of impulsivity, we studied clinical impulsivity in depressed patients with or without suicide attempts.

Section snippets

Study design

In a 4-week study, 50 depressed in-patients were assessed for depressive symptomatology and impulsivity at admission (`W0') and after 4 weeks of treatment (`W4'). Two independent raters assessed depression and impulsivity, the impulsivity rater being blind to suicide attempts. Two subgroups of patients, suicide attempters (SA) (n=16) and non-suicide attempters (NSA) (n=34), were compared.

Study population

Fifty consecutive newly admitted in-patients with DSM-III-R major depression and a MADRS score >20,

Sample characteristics

Table 1 summarizes the sample characteristics of the whole sample, SA and NSA patients: none of these variables is significantly different between the two subgroups.

Depressive symptomatology

Mean scores (SD) are summarized in Table 2 for the whole sample, SA and NSA patients, at W0 and W4. Scores decrease between W0 and W4 in the whole sample and both subgroups. No significant differences are evidenced between the two subgroups for MADRS total score and SCL-90-R depression subscore, either at W0 or at W4.

Total scores

Mean scores

Discussion

Results for the whole sample show that both impulsivity and depression scores decreased significantly between W0 and W4. Impulsivity scale and questionnaire correlated slightly with each other, suggesting differences in impulsivity assessment between patients and clinicians.

The SA and NSA subgroups were not different in terms of sample characteristics, antidepressant treatments, depression and general psychopathology assessments. However, both at W0 and W4, SA depressed patients scored

References (17)

  • Y Lecrubier et al.

    The Impulsivity Rating Scale (IRS): preliminary results

    Eur. Psychiatry

    (1995)
  • K.M Malone et al.

    Major depression and the risk of attempted suicide

    J. Affect. Disord.

    (1995)
  • M Asberg et al.

    5-HIAA in the cerebrospinal fluid: a biochemical suicide predictor?

    Arch. Gen. Psychiatry

    (1976)
  • D Avery et al.

    Suicide, attempted suicide, and relapse rates in depression

    Arch. Gen. Psychiatry

    (1978)
  • E Baratt

    Factor analysis of some psychometric measures of impulsiveness and anxiety

    Psychol. Rep.

    (1965)
  • B Barraclough et al.

    A hundred cases of suicide: clinical aspects

    Br. J. Psychiatry

    (1974)
  • Bech, P., Mak, M., 1995. Measurements of impulsivity and aggression. In: Hollander, E., Stein, D.J. (Eds), Impulsivity...
  • Derogatis, L.R., 1977. SCL-90-R Version Manual I. Clinical Psychometrics Research Unit, John Hopkins University School...
There are more references available in the full text version of this article.

Cited by (149)

  • The relationship between impulsivity and shame and guilt proneness on the prediction of internalizing and externalizing behaviors

    2019, Heliyon
    Citation Excerpt :

    Previous studies have shown that low-impulsivity children are more prone to internalization and sadness than their high-impulsivity peers (Eisenberg et al., 2001; Eisenberg et al., 2009). However, studies of adults demonstrate links between depression and high impulsivity (Corruble et al., 1999; Grano et al., 2007). Additionally, high attentional, motor, and non-planning impulsivity on the Barratt Impulsiveness Scale (BIS-11; Patton et al., 1995) has been noted in depressed subjects (Corruble et al., 2003).

View all citing articles on Scopus
View full text