Understanding impulsivity in severe depression? A psychometrical contribution

https://doi.org/10.1016/S0278-5846(03)00115-5Get rights and content

Abstract

Background: Depression, especially severe depression, is strongly associated with suicidality. Impulsivity is one of the main dimensions of suicidality. The objective of this study was to assess the structure of impulsivity in severe depression and its relationships to suicide attempts. Methods: 127 depressed in-patients were assessed at admission and after 4 weeks of treatment for depression and impulsivity with the Impulsivity Rating Scale (IRS) and the Impulse Control Scale (ICS) or the Baratt Impulsivity Scale (BIS). Results: Three dimensions of impulsivity were evidenced in these severely depressed patients, i.e., behavioral loss of control, nonplanning and cognitive. These three dimensions are state dependent. Recent suicide attempts in severe depression are related to loss of control and cognitive impulsivity but not to nonplanning. IRS ad ICS may assess primarily behavioral impulsivity, i.e., loss of control and nonplanning, whereas BIS may assess primarily cognitive impulsivity. Conclusions: In the future, these three dimensions should be correlated to biological and genetic markers of impulsivity [serotonergic (5-HT) system] and prospective studies should assess the predictive value of the three dimensions of impulsivity in the occurrence of suicide attempts in depressed patients.

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

References (25)

  • E. Corruble et al.

    Impulsivity: a relevant dimensions in depression regarding suicide attempts?

    J. Affect. Disord.

    (1999)
  • Y. Lecrubier et al.

    The Impulsivity Rating Scale (IRS): preliminary results

    Eur. Psychiatry

    (1995)
  • M.A. Oquendo et al.

    Suicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters

    J. Affect. Disord.

    (2000)
  • American Psychiatric Association

    Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)

    (1994)
  • M. Asberg et al.

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

    Arch. Gen. Psychiatry

    (1976)
  • E. Baca-Garcia et al.

    A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts

    J. Clin. Psychiatry

    (2001)
  • E.S. Baratt

    Factor analysis of some psychometric measures of impulsiveness and anxiety

    Psychol. Rep.

    (1965)
  • P. Bech et al.

    Measurements of impulsivity and aggression

  • E.F. Coccaro et al.

    Serotonergic studies in patients with affective and personality disorders. Correlates with suicidal and impulsive aggressive behaviour

    Arch. Gen. Psychiatry

    (1989)
  • J. Evans et al.

    Impulsiveness, serotonin genes and repetition of deliberate self-harm (DSH)

    Psychol. Med.

    (2000)
  • J. Fawcett et al.

    Clinical predictors of suicide in patients with major affective disorders: a controlled prospective study

    Am. J. Psychiatry

    (1987)
  • M. Hamilton

    A rating scale for depression

    J. Neurol. Neurosurg. Psychiatry

    (1960)
  • Cited by (103)

    • Childhood Trauma increases suicidal behaviour in a treatment-resistant depression population: a FACE-DR report

      2021, Journal of Psychiatric Research
      Citation 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).

    View all citing articles on Scopus
    View full text