Brief report
Behind impulsive suicide attempts: Indications from a community study

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Abstract

Aim

A considerable proportion of suicide attempts are made on impulse. However, knowledge of characteristics of impulsive attempters is still limited. The present study investigated some of these characteristics and aimed to identify the pattern (if any) of suicidal ideation before an impulsive attempt.

Methods

Data from a randomized and stratified population of 5130 individuals from Brisbane, Australia, were analysed. Computer-assisted telephone interviews (CATI) were adopted to recruit subjects. Those reporting previous suicidal behaviour were sent a questionnaire by mail.

Results

One hundred and twelve subjects reported a suicide attempt. One quarter of these described a pattern consistent with an impulsive attempt. Most impulsive attempters experienced suicidal thoughts before their attempt. They were less likely to believe that their attempt would cause death, and less likely to experience depression. Impulsive attempters did not differ significantly from non-impulsive attempters in regards to age, gender, and motivations for the attempt. Surprisingly, no differences in mean scores of trait impulsivity between impulsive and non-impulsive attempters were found. In addition, the majority of suicide attempters (whether impulsive or not) experienced the suicidal process as fluctuating and not as developing along a continuum.

Limitations

The number of attempters who validly entered the study limited our ability to identify potential confounders. Due to the retrospective nature of the survey, the reliability of the information collected may have been affected by recall biases. In addition, as the surveys were administered by mail, it is possible that some questions may have been misinterpreted.

Conclusions

The presence of suicidal feelings prior to an attempt constitutes an opportunity for intervention also in impulsive attempters. However, the identification of impulsiveness requires more research efforts.

Introduction

Studies have consistently reported that a considerable proportion of suicide attempts are impulsive and unplanned (Baca-Garcia et al., 2005, Bertolote et al., 2005, Bryant et al., 1995, Crosby et al., 1999, De Leo et al., 2005, Kessler et al., 1999, Kuo et al., 2001, Perez, 2005, Simon et al., 2001, Williams et al., 1980, Wyder, 2004). Moreover, the progression from suicidal thoughts, to plans, to an attempt is not necessarily experienced as a continuous progression but is more likely to be perceived as a fluctuating phenomenon (De Leo et al., 2005, Portzky et al., 2005). The impulsiveness of many attempts and the fluctuating nature of suicidal thinking are of concern, as many prevention strategies rely on the early identification of either suicidal thoughts and/or plans (Conner, 2004, Portzky et al., 2005, Van Heeringen, 2001).

There are currently many definitions for impulsive attempters. These are either based on the absence of overt signs of planning (Baca-Garcia et al., 2005, Conner et al., 2006, Conner et al., 2004), absence of plans (Kessler et al., 1999, Kuo et al., 2001) or timing of suicidal thinking (Simon et al., 2001). These differences in definition make comparison between studies difficult.

Nonetheless, impulsive attempters were more likely to be characterized by the absence of depression, to be motivated by the desire to reduce tension, to attempt in the presence of somebody, and to commonly assume that they will survive their attempt (Williams et al., 1980). They did not differ significantly from non-impulsive attempters on the basis of gender, race, age, years of formal education and marital status (Conner, 2004, Hjemeland et al., 2000, Simon et al., 2001). It is also unclear if impulsive attempters experience suicidal thinking in the period leading up to their attempt (Andrews and Lewinson, 1992, Kessler et al., 1999, Simon et al., 2001).

While impulsive personality traits have consistently been associated with suicidal behaviours (Baca-Garcia et al., 2005, Corruble et al., 1999, Mann and Malone, 1997, Simon et al., 2001), studies investigating the association between these and impulsive attempts have only yielded conflicting results (Baca-Garcia et al., 2005, Simon et al., 2001).

Additional information on the experience of suicidal ideation and characteristics of impulsive suicide attempts may prove helpful in the development of screening procedures and prevention strategies. Consequently, we examined a community sample of suicide attempters to determine if suicidal thinking, motives for the attempt, intention to die, presence of mental illness and impulsive personality traits characterized impulsive attempters.

Section snippets

Materials and methods

Between 2001 and 2002, as part of the WHO SUPRE/MISS study, a large community survey into suicidal behaviours was undertaken in Queensland, Australia (De Leo et al., 2005). Gender-stratified telephone numbers were randomly selected from an electronic version of the directory for the Brisbane district. A total of 5130 participants were screened in order to identify those who, at some stage in their life, had either made plans/arrangements or an attempt to end their own life (n = 282, 5.4%). This

Results

A total of 112 suicide attempters entered the study. Most experienced suicidal ideation before their attempt (Table 1), with 41% having made plans/arrangements to take their own life (Table 1). Thirty-four percent experienced all five levels of suicidal ideation (Fig. 1).

With regard to the visual depictions of types of suicidal process, only a minority of attempters (n = 22, 21%) identified themselves with a linear progression increasing in severity. Most (n = 62, 59%) described their suicidal

Discussion

The suicidal process was experienced as fluctuating by both the majority of the total sample and the non-impulsive attempters. About two thirds of the total sample did not experience all levels of suicide ideation before the attempt. Moreover, the escalation of severity in suicidal ideation (as described in the continuum model) was only detected in eight cases. These findings may indicate that suicide risk is likely to vary from day to day and maybe from hour to hour, and call into question the

Acknowledgements

This research has been supported by grants from the National Health-Medical Research Council, Queensland Health, and the Commonwealth Department of Health and Ageing.

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