Progress in Neuro-Psychopharmacology and Biological Psychiatry
Understanding impulsivity in severe depression? A psychometrical contribution
Introduction
Depression, especially severe depression, is the main cause of suicide attempts and completed suicides Fawcett et al., 1987, Malone et al., 1995, Statham et al., 1998, Kessler et al., 1999, Mann et al., 1999. Impulsivity is a main dimension of suicidality (Mann et al., 1999). Biological and genetic markers of impulsivity, especially the serotonergic (5-HT) system, have been largely studied Asberg et al., 1976, Shalling et al., 1984, Roy et al., 1989, Coccaro et al., 1989, Mann and Arango, 1992, Evans et al., 2000. However, numerous studies (e.g., Suominen et al., 1997, Oquendo et al., 2000, Placidi et al., 2000) failed to evidence positive results in the field of suicidality and impulsivity. One of the hypotheses that may explain these negative results is related to the clinical measurement of impulsivity, especially in depressed patients Bech and Mak, 1995, Parker and Bagby, 1997, Corruble et al., 1999, Baca-Garcia et al., 2001.
Consequently, the main objective of this study was to assess the structure of impulsivity in severe depression and its relationships to suicide attempts.
Section snippets
Patient population
Two subgroups of 50 and 77 consecutively newly admitted in-patients with DSM-IV major depression (American Psychiatric Association, 1994) were included in the study. No standardized instrument was used to assess the DSM-IV diagnosis of major depression. Patients with bipolar disorders, schizophrenic disorders, current alcohol or drug abuses, neurological disorders or unstable medical disorders were excluded. All patients were fully informed and provided informed consent for their participation
Results
Results of PCA of the IRS, the ICS and the BIS are shown in Table 1. Three main dimensions of impulsivity are shown, depending on the scale considered.
Means (S.D.) and comparison of admission and follow-up impulsivity scores and subscores are shown in Table 2. Even if all subscores are not significantly different, higher scores of impulsivity are shown at admission and lower scores are shown at follow-up.
Impulsivity scores and subscores in recent suicide attempters and nonrecent suicide
Discussion
This study evidenced three dimensions of impulsivity in severe depression: behavioral loss of control, nonplanning and cognitive impulsivity. In severe depressed patients, the IRS and the ICS may assess primarily loss of control and nonplanning impulsivity, whereas the BIS may be primarily oriented toward assessment of cognitive impulsivity. All items of the IRS are relevant for assessing impulsivity in depression. Two items of the ICS (sexual and eating behaviors) do not belong to any factor,
Conclusion
This study evidences three dimensions of impulsivity in severe depression, i.e., behavioral loss of control, nonplanning and cognitive. These three dimensions seem to be state dependent. Suicide attempts in severe depression may be related to loss of control and cognitive impulsivity but not to nonplanning. IRS and ICS may assess primarily behavioral impulsivity, i.e., loss of control and nonplanning, whereas BIS may assess primarily cognitive impulsivity. In the future, these three dimensions
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2021, Journal of Psychiatric ResearchCitation Excerpt :Among these, those most robustly associated with suicidal behaviour are impulsive-aggressive traits (Fergusson et al., 2000b; Mann et al., 2009; Turecki et al., 2019). Behavioural disinhibition and impulsiveness have been extensively reported to encourage suicidal behaviours (Carpiniello et al., 2011; Corruble et al., 2003; Ponsoni et al., 2018). Furthermore, individuals who have experienced CT have a greater risk of developing pathological traits and emotional dysregulation thereby increasing the vulnerability to suicide (Turecki et al., 2019).