Research report
Sensation seeking as risk factor for suicidal ideation and suicide attempts in adolescence

https://doi.org/10.1016/j.jad.2012.05.058Get rights and content

Abstract

Background

High sensation seeking in adolescence is associated with engagement in risk-taking behaviors, especially substance use. Although depressed adolescents are prone to increased risk-taking, and suicidal behavior can be considered within the spectrum of risk-taking behaviors, the relationships between sensation seeking, depression, and suicidal behavior have not been explored.

Methods

A self-report questionnaire assessing sensation seeking, depression, substance use problems, and suicidal ideation and suicide attempts was completed by 9th- through 12th-grade students (n=2189) in six New York State high-schools from 2002 through 2004. Logistic regression analyses were conducted to examine main and interaction effects between sensation seeking and the four clinical variables.

Results

High sensation seeking was positively associated with depressive symptoms and substance use problems. The main effects of sensation seeking on suicidal ideation and suicide attempts remained significant after controlling for depression and substance use. The association between sensation seeking and suicide attempts was moderated by substance use problems.

Limitations

The schools were suburban and predominantly white, limiting the generalizability of the results. Other mental disorders with potential implications for sensation seeking and for suicidal behavior, such as bipolar disorders, were not assessed.

Conclusions

The finding that sensation seeking makes an independent contribution to the risk of suicidal ideation and attempts is consistent with findings in literature on novelty seeking and impulsivity. The associations between sensation seeking, depressive symptoms and suicidal behavior may be compatible with the presence of an underlying temperamental dysregulation. Screening for sensation seeking may contribute to the reduction of adolescent suicide risk.

Introduction

Heightened levels of sensation seeking in adolescence have been consistently associated with increased participation in risk-taking behaviors ranging from reckless driving to unsafe sex (Arnett, 1990, Arnett, 1996, Roberti, 2004, Wagner, 2001). High levels of sensation seeking have been particularly implicated in earlier onset and greater severity of substance use problems (Bekman et al., 2010, Crawford et al., 2003, Macpherson et al., 2010). While for the most part these studies have not addressed suicidal behavior, some justification has been found for including suicidal behavior within the spectrum of risk-taking behaviors. In a community probability sample of 9–17 year olds, suicidal ideation and suicide attempts were associated with risk-taking behaviors such as substance use, early onset of sexual intercourse and physical fighting independent of psychiatric diagnosis (King et al., 2001); moreover, covariation was found between each of the types of risk-taking behaviors, including suicidal ideation and suicide attempts (Flisher et al., 2000). Despite these associations, only one study of which we are aware has explored the potential role of sensation seeking as a risk factor for suicide attempts in adolescence. Bolognini et al. (2002) examined personality differences among 107 drug abusers and 121 controls aged 14–25 years, and found that the Experience Seeking subscale of the Sensation Seeking Scale (SSS; Zuckerman et al., 1964) distinguished suicide attempters from non-attempters in both groups. Within the drug abusing group, sensation seeking was significantly associated with lifetime suicide attempts when controlling for other personality traits, conferring higher risk on girls than on boys.

The association between adolescent depression and suicidal ideation and suicide attempts is well-established (Brent et al., 1993, Shaffer et al., 1996). At the same time, depressive symptoms in this period have also been associated with increased engagement in risk-taking behaviors such as unsafe sex, drunk driving, driving without a seat-belt, and physical fights (Brooks et al., 2002, Spittle et al., 1976, Testa and Steinberg, 2010). Nevertheless, no studies to date have explored the relationship between sensation seeking and depression in adolescence, or examined the potential interactions between sensation seeking, depression, and suicidal behavior.

Sensation seeking is a personality trait defined by “the seeking of varied, novel, complex, and intense sensations and experiences and the willingness to take physical, social, legal and financial risks for the sake of such experiences” (Zuckerman, 1994). High sensation seekers show high reward-sensitivity, less reactive anxiety in physically threatening situations, and diminished perception of risk (Blankstein, 1975, Franken et al., 1992, Horvath and Zuckerman, 1993, Steinberg, 2010). As one facet of disinhibited personality, sensation seeking is related to but distinct from novelty seeking and impulsivity (Ferrett et al., 2011, Howard et al., 1996, McCourt et al., 1993), two additional disinhibited personality traits which are measured using different scales (Barratt, 1965, Cloninger, 1987, Zuckerman et al., 1964). Recent research suggests that sensation seeking and impulsivity may reflect distinct dimensions of behavioral disinhibition with different implications for externalizing behaviors (Handley et al., 2011, Harden and Tucker-Drob, 2011, Mackie et al., 2011, Malmberg et al., 2010, Steinberg et al., 2008). For example, Castellanos-Ryan and Conrad (2011) and Castellanos-Ryan et al. (2011) conceptualize dual cognitive/motivational pathways of disinhibition, in which sensation seeking is associated with “hot,” reward-motivated disinhibition, more predictive of binge drinking, while impulsivity is associated with “cool” deficits in response inhibition, more predictive of the development of conduct disorder. Romer (2010) and Romer et al. (2011) suggests that impulsivity and sensation seeking among adolescents may be attributable to deficits in prefrontal executive function and to rapid maturation of the subcortical motivation system, respectively.

Unlike sensation seeking, novelty seeking and impulsivity have each been more extensively studied in relation to adolescent suicidal behavior. Consistent findings show that novelty seeking (defined as the tendency to respond with intense excitement to novel stimuli or potential reward, and to actively avoid frustration) increases the risk of suicidal behavior in adolescence even after controlling for psychopathology, including depression (Fergusson et al., 2003, Fergusson et al., 2000). For example, Csorba et al. (2010) reported that novelty seeking was the only personality dimension of the Junior Temperament Character Inventory (JTCI; Cloninger) which significantly differentiated between 39 suicidal depressive and 51 non-suicidal depressive outpatient adolescents (aged 14–18 years). Studies of the relationship between impulsivity (defined as a tendency to act quickly without reflection or planning, while failing to inhibit behavior that is likely to result in negative consequences) and suicidal behavior in adolescence have produced mixed findings. Whereas a number of studies have demonstrated an association between impulsivity and suicidal behavior in adolescence, this association does not always remain significant after controlling for psychopathology (Horesh et al., 1999, Javdani et al., 2011, Kingsbury et al., 1999, Renaud et al., 2008). In a case-control study, for example, 81 adolescents in short term juvenile detention were matched with 81 adolescent psychiatric inpatients aged 13–16 years. After controlling for depression, impulsivity remained significantly associated with suicide risk in the juvenile detention group, but not in the inpatient group (Sanislow et al., 2003).

The relationship between depression and disinhibited personality traits in adolescence remains unexplored. Only one study to date has examined a measure of disinhibited personality in relation specifically to adolescent depression. In a study of 110 Swiss secondary school students, depression as measured by the Reynolds Adolescent Depression Scale (RADS; Reynolds, 1987) was associated with impulsivity as measured by the UPPS Impulsive Behavior Scale (Whiteside and Lynam, 2001). Specifically, depression was associated with the Urgency and Lack of Premeditation subscales. The association with the Sensation Seeking subscale of the UPPS (which includes a shortened adaptation of two of the four subscales of Zuckerman's SSS) was negligible (d'Acremont and Van der Linden, 2007). More broadly, novelty seeking has been consistently associated with the externalizing dimensions and not with the internalizing dimensions of Achenbach's Scales, including the anxious/depressed subscale (Asch et al., 2009, Copeland et al., 2004, Kim et al., 2006, Kuo et al., 2004). The replicated finding that high levels of novelty seeking in adolescence are associated with both externalizing disorders and suicide risk has led investigators to speculate that adolescents who attempt suicide “may have a mixed affective–behavioural psychopathology… [and] may occupy a midposition between depressive adolescents and those suffering from conduct disorder pathology with regard to character dimensions” (Csorba et al., 2010).

In sum, most extant research on the role of disinhibited personality traits in adolescent suicide risk has used measures of novelty seeking or impulsivity, while a significant body of research on the role of disinhibited personality traits in substance use problems and other risk-taking behaviors has used a sensation seeking measure. By examining sensation seeking, substance use and suicidal behavior in an adolescent sample, we hope to bring these bodies of knowledge into closer communication with each other. By also including a measure of depression in our analyses, we seek to clarify the relationship between adolescent depression and a disinhibited personality trait. The specific aims of this study are: (1) to investigate the role of sensation seeking in relation to suicidal ideation and suicide attempts, depressive symptoms, and substance use problems; (2) to explore the extent to which sensation seeking independently contributes to the risk of suicidal ideation and suicide attempts, beyond what is contributed by depression and substance use problems; and (3) to clarify whether sensation seeking interacts with depression and/or substance use problems to increase the risk for suicidal ideation and suicide attempts.

Section snippets

Participants

Study participants were recruited from five public high-schools and one private school in Nassau, Suffolk, and Westchester counties in New York State from 2002 to 2004. These schools were part of a study examining possible iatrogenic effects of asking about suicide in a school screening program (Gould et al., 2005). A total of 3635 students were eligible for participation; 2342 (64.4%) participated in the study. Reasons for nonparticipation included parental refusals (61.9%), student refusals

Sensation seeking and demographics

In the logistic regression analyses, a small effect was found for gender when controlling for schools, with boys scoring significantly higher in sensation seeking than girls (Table 1). Sensation seeking was not significantly associated with grade or age. Subsequently, the regression analyses were adjusted only for gender.

Association of sensation seeking with the clinical variables

A total of 11.9% of the sample met the clinical cutoff on the BDI-IA. There was a significant association between sensation seeking and depressive symptoms (Table 2).

Discussion

The aim of the present study was to clarify the relationship of sensation seeking to depression and suicidal behavior in adolescence, using data gathered from 2189 adolescents from 6 high schools in New York State who participated in a school-based suicide screening program. Three major findings emerged. First, a positive association between sensation seeking and depressive symptoms was found. Second, high levels of sensation seeking significantly increased the risk of current suicidal ideation

Role of funding source

The sponsors were not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or in the preparation, review, or approval of the manuscript.

Conflicts of Interest

None of the authors have conflict of interest/financial disclosures.

Acknowledgments

This study was supported by NIMH Grant, R01-MH64632. The first author is currently supported by a Grant from Alicia Koplowitz Foundation, Spain.

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