Is impulsivity a link between childhood abuse and suicide?

Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study

Introduction: The present study explores the association of adverse childhood experiences with impulsivity and functional identity among Pakistani adults. Methods: In this cross-sectional study, 260 Pakistani medical students aged 18 and above were approached. A consent form, a questionnaire on sociodemographic characteristics, and an English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt's Impulsiveness Scale (BIS-11) was employed in this study. All data were analyzed in SPSS v. 20. Results: A total of 122 (52.6%) of respondents had experienced at least one adverse childhood experience. Verbal, physical, sexual adverse events and poor support and affection from family were the most reported adverse events. ACE scores yielded a significantly positive association with cognitive stability, perseverance and motor impulsivity on the Barrat's impulsivity scale. Whereas, it yielded negative association with structure and harmony subscales of the functional identity as well as cognitive complexity subscale of the impulsivity scale. Conclusions: A high proportion of Pakistani medical students reported adverse childhood experiences, which lead to impulsive behaviors and poor functional identities.

Association of adverse childhood experiences with functional identity and impulsivity among adults: a cross-sectional study

Introduction: The present study explores the association of adverse childhood experiences with impulsivity and functional identity among Pakistani adults. Methods: In this cross-sectional study, 260 Pakistani medical students aged 18 and above were approached. A consent form, a questionnaire on sociodemographic characteristics, and an English versions of the Adverse Childhood Experiences (ACE) scale, Functions of Identity scale (FIS) and Barratt's Impulsiveness Scale (BIS-11) was employed in this study. All data were analyzed in SPSS v. 20. Results: A total of 122 (52.6%) of respondents had experienced at least one adverse childhood experience. According to linear regression analysis, ACE scores were significantly associated with increasing age, increasing order in birth, lower scores on functional identity structure and non-planning impulsivity, and higher scores on future (functional identity) and motor impulsivity. Conclusions: A high proportion of Pakistani medical students reported adverse childhood experiences, which lead to impulsive behaviors and poor functional identities.

Comparison of Baseline Characteristics between Community-based and Hospital-based Suicidal Ideators and Its Implications for Tailoring Strategies for Suicide Prevention: Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior

In this cross-sectional study, we aimed to identify distinguishing factors between populations with suicidal ideation recruited from hospitals and communities to make an efficient allocation of limited anti-suicidal resources according to group differences. We analyzed the baseline data from 120 individuals in a community-based cohort (CC) and 137 individuals in a hospital-based cohort (HC) with suicidal ideation obtained from the Korean Cohort for the Model Predicting a Suicide and Suicide-related Behavior (K-COMPASS) study. First, their sociodemographic factors, histories of medical and psychiatric illnesses, and suicidal behaviors were compared. Second, diagnosis by the Korean version of the Mini International Neuropsychiatric Interview, scores of psychometric scales were used to assess differences in clinical severity between the groups. The results revealed that the HC had more severe clinical features: more psychiatric diagnosis including current and recurrent major depressive episodes (odds ratio [OR], 4.054; P < 0.001 and OR, 11.432; P < 0.001, respectively), current suicide risk (OR, 4.817; P < 0.001), past manic episodes (OR, 9.500; P < 0.001), past hypomanic episodes (OR, 4.108; P = 0.008), current alcohol abuse (OR, 3.566; P = 0.020), and current mood disorder with psychotic features (OR, 20.342; P < 0.001) besides significantly higher scores in depression, anxiety, alcohol problems, impulsivity, and stress. By comparison, old age, single households, and low socioeconomic status were significantly associated with the CC. These findings indicate the necessity of more clinically oriented support for hospital visitors and more socioeconomic aid for community-dwellers with suicidality.

The impact of child maltreatment on the risk of deliberate self-harm among adolescents: A population-wide cohort study using linked administrative records

Adolescents exposed to maltreatment have an elevated risk of deliberate self-harm (DSH). The aim of this study was to investigate longitudinally the effects of the number, timing, and type of maltreatment allegations on adolescent risk of having a DSH-related hospital admission, using linked data in Western Australia. A total of 351,372 children born between 1986 and 2000 were followed from birth up to the year 2010. Cox regression models were utilized, while controlling for a range of psychosocial covariates. Compared to children without allegations of maltreatment, children with unsubstantiated allegations only (aHR=1.04, 95%CI: 1.00-1.08, p<.01) and children with a substantiated allegation (aHR=1.10, 95%CI: 1.06-1.15, p<.001) all had significantly increased risk of DSH in adolescence. Among children with a substantiated allegation of maltreatment, the greater the number of allegations, the longer the exposure to maltreatment, and the more types of maltreatment experienced by a child, the higher the child's risk of DSH. However, this dose-response pattern was not found among children with unsubstantiated allegations only. This study calls for the early identification of children who are vulnerable to maltreatment, the better identification of the duration and severity of maltreatment experiences, and the provision of continued care and support, to reduce the child's DSH risk in adolescence.

Gene-Gene-Environment Interactions of Serotonin Transporter, Monoamine Oxidase A and Childhood Maltreatment Predict Aggressive Behavior in Chinese Adolescents

Gene-environment interactions that moderate aggressive behavior have been identified independently in the serotonin transporter (5-HTT) gene and monoamine oxidase A gene (MAOA). The aim of the present study was to investigate epistasis interactions between MAOA-variable number tandem repeat (VNTR), 5-HTTlinked polymorphism (LPR) and child abuse and the effects of these on aggressive tendencies in a group of otherwise healthy adolescents. A group of 546 Chinese male adolescents completed the Child Trauma Questionnaire and Youth self-report of the Child Behavior Checklist. Buccal cells were collected for DNA analysis. The effects of childhood abuse, MAOA-VNTR, 5-HTTLPR genotypes and their interactive gene-gene-environmental effects on aggressive behavior were analyzed using a linear regression model. The effect of child maltreatment was significant, and a three-way interaction among MAOA-VNTR, 5-HTTLPR and sexual abuse (SA) relating to aggressive behaviors was identified. Chinese male adolescents with high expression of the MAOA-VNTR allele and 5-HTTLPR “SS” genotype exhibited the highest aggression tendencies with an increase in SA during childhood. The findings reported support aggression being a complex behavior involving the synergistic effects of gene-gene-environment interactions.

The Relationship between Childhood Maltreatment and Non-Suicidal Self-Injury: A Systematic Review

INTRODUCTION

Childhood maltreatment (CM) has been associated with an increased risk of non-suicidal self-injury (NSSI) and suicidal behaviors. However, the exact nature of the association between CM and NSSI is currently unclear. The present review aimed to systematically investigate the association between CM and NSSI in adolescence and early adulthood.

METHODS

A systematic search of four major electronic databases covering both medical and social science research (PubMed, Scopus, Science Direct, and PsycINFO) was conducted.

RESULTS

Overall, 20 cross-sectional studies including a total of 22,517 individuals, 3 longitudinal follow-up studies including 1,728 individuals, and 3 retrospective studies including 62,089 individuals were selected. It appears that CM is a significant risk factor for both NSSI and suicide attempts. The increased vulnerability to NSSI seems to be related to experiences of CM, particularly sexual abuse. Gender differences were also found. Generally, when compared to males, females who experienced CM seem to be more vulnerable to presenting with NSSI and suicidal behaviors.

CONCLUSION

There is a positive association between CM and NSSI. The importance of early detection and risk reduction of self-injurious behavior for adolescents is discussed.

Medically Serious Suicide Attempters With or Without Plan in Rural China

Although previous studies have discussed the risk factors of unplanned suicide behavior in several countries, the unplanned suicide attempt in China was not explored in a large sample. We aim to look into the characteristics of unplanned suicide attempters in China and compare them with those suicide attempters with plans. Subjects were 791 medically serious suicide attempters aged 15-54 years in rural China. The sixth item of Beck's Suicide Intent Scale was used to estimate the planned and unplanned suicide attempt. Logistic regression analysis was performed to examine the factors related to planned or unplanned suicide attempt. The results showed that the planned suicide attempts were associated with higher education, hopelessness, and previous suicide act. The unplanned suicide attempt tends to be suicide by pesticide and store pesticide at home. A ban of lethal pesticides may be a method for suicide prevention in rural China.

Early Childhood Environment and Genetic Interactions: the Diathesis for Suicidal Behavior

Adverse childhood experiences are associated with higher risk for suicide and suicidal behavior later in life. There are known associations between childhood trauma, particularly sexual abuse, and higher rates of suicide, non-lethal suicide attempts, and non-suicidal self-injurious behaviors in adolescence and adulthood. Emotional abuse/neglect, disrupted parental attachment, and cumulative effect of multiple forms of maltreatment, also increase risk. Yet, the causal relationship remains unclear. The diathesis-stress model provides a framework for understanding how early life adverse experiences contribute to suicide vulnerability. Current findings from the fields of biology, neurology, and genetics shed new light on mediating variables and possible causal links between early childhood trauma and suicide. In this paper, we review recent advances, particularly regarding the interaction of early life environmental adverse events with genetics factors, that increase the diathesis for psychological traits are associated with subsequent deliberate self-harm behaviors.

Type of childhood maltreatment and the risk of criminal recidivism in adult probationers: a cross-sectional study

BACKGROUND

Childhood maltreatment is strongly associated with delinquency and the repeated crime. Specific types of childhood maltreatment have been found to have differential effects on recidivism in juvenile offenders, but studies of adult probationers have not been performed. This study investigated the relationship between having a history of childhood maltreatment and mental-health problems and the independent contribution of specific types of maltreatment and mental-health problems to the criminal recidivism of adult probationers.

METHOD

This study included 183 adult probationers (107 males and 76 females) with a mean age of 40.1 (SD = 11.8) years. Type of childhood maltreatment was assessed using the Childhood Trauma Questionnaire, which consists of five subscales (emotional neglect and abuse, physical neglect and abuse, and sexual abuse). Additionally, we used the Mini International Neuropsychiatric Interview to assess participants for the presence of psychiatric disorders and assessed levels of emotional dysregulation and resilience. Hierarchical logistic regression analysis was performed to determine whether the types of childhood maltreatment were independently associated with repeated crime, after adjusting for demographic factors and mental-health problems.

RESULTS

The overall prevalence of mental illness in the childhood maltreatment group was significantly higher than in the no childhood maltreatment group (56.1 % vs. 38.2 %, p = 0.017). The maltreated group had a higher rate of major depressive disorder, a higher level of emotional dysregulation, and a lower level of resilience than the group that was not maltreated. Recidivism was uniquely associated with physical neglect (Adjusted Odds Ratio [AOR], 2.862; 95 % Confidence Interval [95 % CI], 1.213-6.752) and the presence of at least one psychiatric disorder (AOR, 3.791; 95 % CI, 1.703-8.443).

CONCLUSIONS

Childhood maltreatment deserves further attention in adult probationers because it is potentially associated with higher rates of psychiatric morbidity and recidivism. In particular, physical neglect during childhood plays a critical role in repeated crime, independent of mental-health problems for high-risk adults involved with the criminal justice system. Rigorous evaluations of the relevance of childhood maltreatment in the assessment and treatment of criminal offenders are needed.

Impulsive behavior and its correlates among patients with schizophrenia in a tertiary care psychiatry setting in Mansoura

BACKGROUND AND OBJECTIVES

Impulsive behavior has been repeatedly identified as a major problem in schizophrenia. Our objective was to examine the possible demographical and clinical correlates for impulsive behavior in patients with schizophrenia.

METHODS

Fifty-eight patients with schizophrenia and Seventy-seven healthy controls were recruited. Sociodemographic data were collected and they were subjected to the Barratt Impulsiveness Scale (BIS), Positive and Negative Syndrome scale (PANSS), and Trauma Assessment for Adults-Brief Revised Version (TAA).

RESULTS

Correlations between impulsive behavior and psychosocial variables were examined. A significant association between level of impulsive behavior and severity of psychopathological symptoms was observed (P=0.0001). Young age (P=0.001), male patients (P=0.0001) and those with history of childhood sexual or physical abuse (P=0.0001), were more impulsive. Linear regression (step wise) analysis model showed that male sex (P=0.001), positive symptoms (P=0.006), and childhood physical abuse (P=0.001) were significant associations.

CONCLUSION

Male gender, positive symptoms as well as history of physical and sexual abuse before 18 years of age are important predictors for high levels of impulsive behavior in schizophrenia patients.

The independent effects of child sexual abuse and impulsivity on lifetime suicide attempts among female patients

Child sexual abuse (CSA) is a causal agent in many negative adulthood outcomes, including the risk for life-threatening behaviors such as suicide ideation and suicide attempts. Traumatic events such as CSA may pose risk in the healthy development of cognitive and emotional functioning during childhood. In fact, high impulsivity, a risk factor for suicidal behavior, is characteristic of CSA victims. The current study aims to understand the relations among CSA, impulsivity, and frequency of lifetime suicide attempts among a female patient sample admitted for suicidal behavior. Participants included 177 female patients between the ages of 18 and 63 years admitted at two hospitals in Buenos Aires, Argentina. Number of previous suicide attempts and CSA were assessed via structured interviews, while impulsivity was assessed with the Barratt Impulsiveness Scale (BIS-11). A model of structural equations was employed to evaluate the role of impulsivity in the relation between CSA and suicide attempts. CSA (β=.18, p<.05) and impulsivity (β=.24, p<.05) were associated with the number of previous suicide attempts. However, impulsivity was not significantly associated with CSA (β=.09, p>.05). CSA and impulsivity are independently associated with lifetime suicide attempts among female patients with recent suicidal behavior.

In my end is my beginning: developmental trajectories of adverse childhood experiences to late-life suicide

OBJECTIVES

Converging evidence suggests that the sequelae of adverse childhood experiences (ACEs) including childhood abuse (e.g., sexual, physical, emotional/verbal abuse, neglect) and other ACE (e.g., family dysfunction, parental loss, parental psychopathology, substance abuse, incarceration, and domestic violence) have pronounced effects on suicidal behaviors (suicidal ideation, attempts, and death by suicide) in older age. There are fundamental changes in the developmental trajectory of biological, psychological and behavioral processes that result from ACE and that exert influence throughout the life span. Different moderators and mediators may affect the extent and nature of the relationship. However, the literature on the specific mechanisms whereby ACE affects suicidality in later life has not been well identified.

METHOD

We review and draw from extant multidisciplinary evidence to develop a heuristic framework through which to understand how ACE may lead to suicide in later life.

RESULTS

Proposed mechanisms span biological factors (neurological, gene-environment), psychiatric and health functioning, and psychosocial development (cognitive biases, coping resources, interpersonal deficits). Evidence suggests that ACEs affect each of these constructs, and it is likely in the interaction of these constructs with late-life stressors that suicidality in older adulthood emerges.

CONCLUSION

ACEs have persistent and multifaceted effects on suicidality in late life. This association is due to multi-varied pathways. It is believed that the explanatory framework developed herein--in which biological, psychological and behavioral factors are organized, and the role of late-life stressors is highlighted--will spark further scientific inquiry into this important area.

Impulsivity is relevant for trauma exposure and PTSD symptoms in a non-clinical population

Impulsivity is a relevant construct for explaining both normal individual differences in personality and more extreme personality disorder, and is often investigated within clinical populations. This study aims to explore the college students' impulsivity patterns and to investigate the association across levels of impulsivity with trauma exposure and PTSD development in a non-clinical population. A one-phase census survey of seven college institutions assessed 2213 students in three metropolitan regions of Northeastern Brazil. All subjects anonymously completed a self-applied protocol consisting of: a socio-demographic questionnaire, Trauma History Questionnaire (THQ), PTSD Checklist (PCL-C), and Barratt Impulsiveness Scale (BIS-11). The median for frequency of trauma exposure was 4 events for people with low and normal impulsivity, and 6 for highly impulsive ones. Individuals with higher impulsivity presented earlier exposition than non-impulsive ones, and worst outcome: 12.4% with PTSD, against 8.4% and 2.3% (normal and low impulsivity). Of the three factors of impulsivity, the Attentional factor conferred the strongest association with PTSD development. Results suggest that impulsivity is also a relevant trait in a non-clinical population and is associated with trauma exposure and PTSD. Strategies to promote mental health in adolescents may be pertinent, especially with the aim of managing impulsivity.

Neutrophil-to-lymphocyte ratio predicting suicide risk in euthymic patients with bipolar disorder: Moderatory effect of family history

BACKGROUND

Neutrophil-to-lymphocyte ratio (NLR) has been independently related to bipolar disorder (BD) and factors associated with suicidal risk. The aim of our study was to explore the relationship between NLR and suicide risk in euthymic BD patients. We also sought to propose a model of interaction between NLR and stress-diathesis factors, leading to suicidal risk in BD.

METHODS

The study group consisted of 83 patients diagnosed with BD (36 suicide attempters; 47 suicide non-attempters), compared to the healthy control group (n=73) and matched according to age, gender, and body mass index (BMI). NLR was measured according to the complete blood count. Mood symptoms have been assessed by Young Mania Rating Scale and Montgomery-Asberg Depression Rating Scale. Early trauma and acute stress were evaluated by Early Trauma Inventory Self Report-Short Form and List of Threatening Experiences Questionnaire, respectively. Suicide risk has been assessed by Suicide Behaviors Questionnaire-Revised (SBQ-R).

RESULTS

Significant correlation was found between NLR and SBQ-R score. The main effects of suicide attempts on NLR, after covarying for confounders, were observed, indicating increased NLR in BD suicide attempters compared to healthy controls. We found significant moderatory effects of family history on NLR relationship to suicidal risk, with NLR being significant positive predictor of suicidal risk only in the patients with positive family history of suicide attempts.

CONCLUSIONS

The results suggest an enhancing effect of positive family history of suicide attempts on predictive effect of NLR on suicide risk. Our data support the idea that immune markers can predict suicide attempt risk in BD, but only in the subpopulation of BD patients with family history of suicide attempts. This could lead to prevention in suicide behavior in the patient population at particular risk of suicide.

Appetitive Aggression and Adverse Childhood Experiences Shape Violent Behavior in Females Formerly Associated with Combat

This study investigated the impact of violent experiences during childhood, posttraumatic stress disorder (PTSD) and appetitive aggression on everyday violent behavior in Burundian females with varying participation in war. Moreover, group differences in trauma-related and aggression variables were expected. Appetitive aggression describes the perception of violence perpetration as fascinating and appealing and is a common phenomenon in former combatants. Semi-structured interviews were conducted with 158 females, either former combatants, supporters of armed forces or civilians during the civil war in Burundi. The PTSD Symptom Scale Interview was used to assess PTSD symptom severity, the Appetitive Aggression Scale to measure appetitive aggression and the Domestic and Community Violence Checklist to assess both childhood maltreatment and recent aggressive behavior. Former combatants had experienced more traumatic events, perpetrated more violence and reported higher levels of appetitive aggression than supporters and civilians. They also suffered more severely from PTSD symptoms than civilians but not than supporters. The groups did not differ regarding childhood maltreatment. Both appetitive aggression and childhood violence predicted ongoing aggressive behavior, whereas the latter outperformed PTSD symptom severity. These findings support current research showing that adverse childhood experiences and a positive attitude toward aggression serve as the basis for aggressive behavior and promote an ongoing cycle of violence in post-conflict regions. Female members of armed groups are in need of demobilization procedures including trauma-related care and interventions addressing appetitive aggression.

Predicting suicide attempts in depressed adolescents: Clarifying the role of disinhibition and childhood sexual abuse

BACKGROUND

Suicide is the second leading cause of death among adolescents, and depressed youth are six times more likely to make suicide attempts as compared to non-depressed adolescents. The present study examined the unique and interactive effects of two well-established correlates of suicidality - childhood sexual abuse (CSA) and disinhibition - in predicting suicide attempts among depressed adolescents.

METHOD

Participants were 163 adolescents (125 females) aged 13-18 (M=15.60, SD=1.27) diagnosed with Major Depressive Disorder (n=95, 58.3%) and/or Dysthymia (n=69, 42.3%) recruited from an acute residential treatment service. Participants completed interviews assessing psychopathology and suicidality, self-report measures of depressive symptoms and CSA, and a computerized disinhibition task.

RESULTS

Consistent with hypotheses, CSA moderated the association between disinhibition and adolescents' report of their past year and lifetime suicide attempts. Specifically, higher disinhibition was associated with a greater likelihood of having made a suicide attempt among adolescents with a history of CSA, but not among those without. The same pattern of results held in analyses of suicide attempt frequency.

LIMITATIONS

Primary findings were based on observational, cross-sectional data, and therefore, causal relationships cannot be inferred. The gender imbalance in the sample precluded stratifying our analyses by gender. CSA was ascertained by self-report; replication of the results with more objective measures is warranted.

CONCLUSIONS

Our findings indicate that CSA and disinhibition may work together to predict elevated suicide risk, and these results have implications for early identification efforts in youth at high risk for suicide.

Psychological strains and suicide intent: Results from a psychological autopsy study with Chinese rural young suicides

BACKGROUND

Previous studies have examined the prevalence of psychological strains among various suicide populations. However, it is still unexamined whether psychological strains can predict suicide intent directly.

AIMS

We planned to explore the prevalence of psychological strains and analyze the relationship between psychological strains and suicide intent among Chinese rural young suicides.

METHODS

Psychological autopsy method was used to investigate the environmental and other factors of rural young suicides. Psychological strains were identified from in-depth interviews by the proxy informants of each suicide. The first 8 items of Beck's Suicidal Intention Scale (SIS) were used to estimate the suicide intent.

RESULTS

Results showed that 96.6% of the suicides had at least one type of strain, and those suicides who had more strains tended to score higher on the suicide intent scale.

CONCLUSION

The study further supports that suicide intent can be predicted by psychological strains in Chinese rural young suicides. The scanning of psychological strains can be used for suicide prevention in Chinese rural young suicides.

Alexithymia as a Mediator Between Childhood Maltreatment and Impulsivity

Impulsivity, specifically negative urgency, is associated with diverse health risk behaviours, yet relatively little research has examined factors contributing to negative urgency. The purpose of this study was to examine the relationship between childhood maltreatment, alexithymia and negative urgency. The sample was comprised of 410 undergraduate students who completed measures online. A series of regression analyses tested whether alexithymia mediated the association between childhood maltreatment and negative urgency. Results supported the hypothesized mediation model. Subsequent analyses examined effects of specific subtypes of maltreatment and alexithymia subscales. These analyses indicated that growing up in a punishing environment (e.g. being hit or beat; expected to follow a strict code of behaviour) was indirectly associated with negative urgency via difficulty identifying feelings, suggesting that excessive use of punishment during childhood may reduce the development of the ability to identify and label feeling states. This difficulty in emotional processing may in turn lead to acting rashly when emotionally aroused.

Neighborhood Disadvantage and Adolescent Substance Use Disorder: The Moderating Role of Maltreatment

The ecological-transactional model proposes that nested contexts interact to influence development. From this perspective, child maltreatment represents an individual-level risk factor posited to interact with numerous other nested contextual levels, such as the neighborhood environment, to affect development. The aim of this study was to investigate whether adolescents with maltreatment histories represent a vulnerable group for whom disadvantaged neighborhoods confer risk for substance use disorders. Participants were 411 adolescents (age 15-18; mean age = 16.24) from an investigation of the developmental sequelae of childhood maltreatment. Multiple-group structural equation models, controlling for family-level socioeconomic status, indicated that neighborhood disadvantage was associated with more marijuana-dependence symptoms among maltreated but not among non-maltreated adolescents. Moreover, among maltreated adolescents, those who experienced multiple subtypes of maltreatment were at greatest risk for problematic marijuana use in the context of neighborhood disadvantage. Interestingly, the direct effect of neighborhood disadvantage, but not the interaction with maltreatment, was related to adolescent alcohol-dependence symptoms. Results highlight the importance of considering multiple levels of influence when examining risk associated with child maltreatment.

Impulsivity and the association between the feedback-related negativity and performance on an inhibitory control task in young at-risk children

Identifying neurocognitive processes associated with effective inhibitory control is particularly relevant for individuals at high risk for disruptive behaviors, such as maltreated children. Performance feedback processing during a flanker task was investigated in maltreated preschool-aged children (N = 67) via an event-related potential component, the feedback-related negativity (FRN). The functionality of the FRN in children with high impulsivity was of interest, as impulsivity was associated with an exaggerated FRN in previous research. Results showed that high impulsivity was associated with an exaggerated FRN and greater post-error slowing. For children with high impulsivity, there was a correlation between the FRN and accuracy, which was not found in children with low impulsivity. This suggests that an exaggerated FRN is particularly important for children with high impulsivity to maintain effective inhibitory control.

Characteristics of Chinese rural young suicides: who did not have a strong intent to die

BACKGROUND

In exploration of the risk factors of the Chinese rural young suicide, previous researchers found low prevalence of mental problems, high degree of impulsivity, and great proportion of lethal pesticide consumption. It noticed that some of the young suicides in rural China did not intend to die from the suicidal behavior which was only instrumentally used for certain gains.

AIMS

This study aims to look into the characteristics of those young suicides who did not really intend to die and compare them with those young suicides who had a strong intent to die.

METHODS

Subjects were 386 suicides aged 15-34years in the rural areas of three provinces in China. The data were obtained by psychological autopsy method. The degree of suicidal intent of the subjects was evaluated by the first 8 items of Beck's Suicide Intent Scale (SIS).

RESULTS

It was found that those suicides that had a strong intent of death were more likely to have higher age, more years of education, live alone, and suffer mental disease. On the other hand, the low intent suicides were more likely to have pesticides at home and to be impulsive. In other words, pesticides and impulsivity killed some Chinese rural young men and women who did not really want to die by suicide.

CONCLUSION

Findings of the study may be translated into practical measures in suicide prevention in China as well as elsewhere in the world.

The Relationship between Mood Instability and Suicidal Thoughts

The objective of this study was to determine whether affective instability predicts suicidal thoughts. Data from a Dutch panel study (N = 1686) was used. Affective instability was assessed with 7 items representing suddenly shifting moods. Suicidal thoughts were assessed by the occurrence of suicidal thoughts in the past week. Negative affect was indexed by anxious, depressed and angry moods extracted by factor analysis. Odds ratios using logistic regression modeling were calculated, adjusting for clinical and demographic variables. The study found that both males (OR: 1.14; 95% CI: 1.02-1.28) and females (OR: 1.11; 95% CI: 1.00-1.23) were more likely to experience suicidal thinking with higher affective instability. Affective instability and negative affect independently predict suicidal thoughts. Affective instability requires more attention in the assessment of suicide risk.

Time Left for Intervention in the Suicidal Process in Borderline Personality Disorder

The objective of this study was to measure the duration of the suicidal process among patients diagnosed with Borderline Personality Disorder (BPD). The sample included 110 female patients who met DSM-IV-TR criteria for BPD and were consecutively admitted after suicide-related behavior. A total of 63 patients (58%) reported that their suicidal process lasted 10 minutes or less. After being adjusted, the β coefficient of impulsivity scales in women with a suicidal process ≤10 minutes was lower compared to those observed in women with >10 min (β = -0.03, 95% CI = -0.06 = -0.01, p < 0.01). Suicidal patients with BPD can be divided into two groups; patients who report a suicidal process less than 10 minutes show a higher degree of impulsivity.

The additive effect on suicidality of family history of suicidal behavior and early traumatic experiences

Family history of suicidal behavior and personal history of childhood abuse are reported risk factors for suicide attempts and suicide completion. We aim to quantify the additive effect of family history of suicidal behavior and different subtypes of childhood abuse on suicidal behavior. We examined a sample of 496 suicide attempters, comparing individuals with family history of suicidal behavior and personal history of childhood (physical or sexual) abuse, individuals with family history of suicidal behavior only, individuals with history of early traumatic experiences only, and individuals with none of these two risk factors with regards to suicidal features. An additive effect was found for the age at the first attempt in suicide attempters with both family history of suicidal behavior and either physical or sexual abuse. No significant interactions were found between family history of suicidal behavior and childhood trauma in relation to any characteristics of suicidal behavior. Subjects presenting family history of suicidal behavior and childhood abuse attempt suicide earlier in life than subjects with just one or none of them, particularly if they were sexually abused. Other suicidality indexes were only partially or not associated with this combination of risk factors. A careful assessment of patients with both family history of suicidal behavior and childhood abuse could help to prevent future suicide attempts, particularly in young people.

Antecedents and sex/gender differences in youth suicidal behavior

Suicide is the second leading cause of death in youth globally; however, there is uncertainty about how best to intervene. Suicide rates are typically higher in males than females, while the converse is true for suicide attempts. We review this "gender paradox" in youth, and in particular, the age-dependency of these sex/gender differences and the developmental mechanisms that may explain them. Epidemiologic, genetic, neurodevelopmental and psychopathological research have identified suicidal behaviour risks arising from genetic vulnerabilities and sex/gender differences in early adverse environments, neurodevelopment, mental disorder and their complex interconnections. Further, evolving sex-/gender-defined social expectations and norms have been thought to influence suicide risk. In particular, how youth perceive and cope with threats and losses (including conforming to others' or one's own expectations of sex/gender identity) and adapt to pain (through substance use and help-seeking behaviours). Taken together, considering brain plasticity over the lifespan, these proposed antecedents to youth suicide highlight the importance of interventions that alter early environment(s) (e.g., childhood maltreatment) and/or one's ability to adapt to them. Further, such interventions may have more enduring protective effects, for the individual and for future generations, if implemented in youth.

Adolescent nonsuicidal self-injury: examining the role of child abuse, comorbidity, and disinhibition

The purpose of the study is to examine how several well-known correlates of nonsuicidal self-injury (NSSI) might work together to contribute to the occurrence of this behavior. Specifically, we examined models including child abuse, psychiatric comorbidity, and disinhibition, testing how these factors may work together to lead to NSSI in the past month. Participants (n=194; 144 female; age 13-18 years) were recruited from a short-term, acute adolescent residential unit. Within 48 hours of admission to the hospital participants completed structured clinical interviews assessing mental disorders and patterns of NSSI. Following the interviews, participants completed a self-report questionnaire assessing childhood abuse and a computerized continuous performance task. Consistent with study hypotheses, results revealed that the association between child abuse and NSSI is partially mediated by comorbidity. Although disinhibition is associated with comorbidity, contrary to our hypothesis, disinhibition does not mediate the relation between child abuse and NSSI. Collectively, these findings provide new information about how comorbidity may increase risk for NSSI, and critically, discuss the potential importance of creating targeted programs to reduce the prevalence of child abuse.

Increased severity of suicidal behavior in impulsive aggressive patients exposed to familial adversities

BACKGROUND

The mechanisms by which childhood abuse and family history of suicidal behavior (FHS) lead to an increased risk of suicidal behavior are still unknown. Impulsive aggression may play an intermediate role. We investigated whether greater scores for aggression and impulsivity might be associated with the effects of FHS and/or childhood abuse on the severity of suicidal behavior.

METHOD

We examined the scores of three scales measuring impulsive aggression in a sample of 696 suicide attempters. We compared the highest and lowest scores with regard to reports of childhood abuse and FHS using adjusted multinomial regression models. Genetic polymorphisms of the serotonergic system known to be associated with impulsive aggression were also analyzed.

RESULTS

Patients with high impulsive aggressive scores showed significant differences in sociodemographic, clinical and suicidal features compared with patients with low impulsive aggressive scores. Adjusted results showed that combinations of some types of childhood abuse and FHS, particularly emotional abuse and emotional neglect, are associated with high impulsivity and hostility scores. The SS genotype of the serotonin transporter gene (5-HTTLPR) was associated with high levels of impulsivity when the subjects reported emotional abuse [odds ratio (OR) 5.55, 95% confidence interval (CI) 1.75-17.5] or physical abuse (OR 5.03, 95% CI 1.50-16.9) in their childhood.

CONCLUSIONS

Our results support the role of impulsive aggression as one of the links that may connect childhood abuse and FHS with severity of suicidal behavior.

Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

OBJECTIVE

To assess the association between lifetime crack cocaine use and psychiatric (post-traumatic stress disorder, current depression, current dysthymia, generalized anxiety disorder, panic disorder with agoraphobia, social phobia, as well as SRQ scores and suicide risk) and substance-use disorders (tobacco, alcohol, cannabis, cocaine, amphetamine, inhalants, sedatives, hallucinogens and opioids) in youth in the general population of the city of Pelotas, RS.

METHOD

This was a cross-sectional population-based study, involving 1560 participants between 18 and 24 ears old. Lifetime substance use and abuse were investigated using the ASSIST inventory. Psychiatric comorbidities were assessed using the Mini-International Neuropsychiatric Interview and symptoms of common mental disorders were evaluated with the Self-Reported Questionnaire (SRQ).

RESULTS

The prevalence of lifetime crack cocaine use in the sample was 2.5%. Its use was associated with total SRW scores and the presence of post-traumatic stress disorder, antisocial personality disorder and suicide risk in the final regression model. Tobacco, alcohol, cannabis, cocaine, amphetamine and cocaine dependence were also associated with lifetime use of crack cocaine.

DISCUSSION

Youth with a history of crack cocaine use had a higher prevalence of psychiatric conditions such as post-traumatic stress disorder, as well as an increased risk of tobacco, alcohol, cannabis, cocaine, amphetamine and inhalant use and dependence.

Role of CNR1 polymorphisms in moderating the effects of psychosocial adversity on impulsivity in adolescents

Enhanced endocannabinoid signaling has been implicated in typically adolescent behavioral features such as increased risk-taking, impulsivity and novelty seeking. Research investigating the impact of genetic variants in the cannabinoid receptor 1 gene (CNR1) and of early rearing conditions has demonstrated that both factors contribute to the prediction of impulsivity-related phenotypes. The present study aimed to test the hypothesis of an interaction of the two most studied CNR1 polymorphisms rs806379 and rs1049353 with early psychosocial adversity in terms of affecting impulsivity in 15-year-olds from an epidemiological cohort sample followed since birth. In 323 adolescents (170 girls, 153 boys), problems of impulse control and novelty seeking were assessed using parent-report and self-report, respectively. Exposure to early psychosocial adversity was determined in a parent interview conducted at the age of 3 months. The results indicated that impulsivity increased following exposure to early psychosocial adversity, with this increase being dependent on CNR1 genotype. In contrast, while individuals exposed to early adversity scored higher on novelty seeking, no significant impact of genotype or the interaction thereof was detected. This is the first evidence to suggest that the interaction of CNR1 gene variants with the experience of early life adversity may play a role in determining adolescent impulsive behavior. However, given that the reported findings are obtained in a high-risk community sample, results are restricted in terms of interpretation and generalization. Future research is needed to replicate these findings and to identify the mediating mechanisms underlying this effect.

Childhood trauma and suicide risk in a sample of young individuals aged 14-35 years in southern Brazil

Suicide is among the main causes of death of people aged between 15 and 44 years old. Childhood trauma is an important risk factor for suicide. Hence, the objective of this study was to verify the relationship between childhood trauma and current suicide risk (suicidal behavior and ideation) in individuals aged 14-35 years, in the city of Pelotas, Brazil. This is a cross-sectional, population-based study. Sample selection was performed by clusters. Suicide risk was evaluated using the Mini International Neuropsychiatric Interview (MINI) and Childhood trauma was assessed with the Childhood Trauma Questionnaire (CTQ). Moreover, the participants responded to a questionnaire concerning socioeconomic status, work, and substance use. The sample was composed of 1,380 individuals. The prevalence of suicide risk was 11.5%. The prevalence figures of childhood trauma were 15.2% (emotional neglect), 13.5% (physical neglect), 7.6% (sexual abuse), 10.1% (physical abuse), and 13.8% (emotional abuse). Suicide risk was associated (p<.001) with gender, work, alcohol abuse, tobacco use, and all types of childhood trauma. The odds of suicide risk were higher in women (OR=1.8), people who were not currently working (OR=2.3), individuals who presented alcohol abuse (OR=2.6), and among tobacco smokers (OR=3.4). Moreover, suicide risk was increased in all types of trauma: emotional neglect (OR=3.7), physical neglect (OR=2.8), sexual abuse (OR=3.4), physical abuse (OR=3.1), and emotional abuse (OR=6.6). Thus, preventing early trauma may reduce suicide risk in young individuals.

Suicide and substance use among female veterans: a need for research

BACKGROUND

The number of female veterans is increasing. Veterans Administration (VA) enrollment increased over 40% from past eras. However, little research has focused on their mental health. We reviewed literature to examine associations of substance use with suicide in female veterans, identify research gaps, and inform future studies.

METHODS

Google Scholar, Pub Med, and PsychINFO were searched using: substance use, female veteran, and suicide. Exclusion criteria (e.g., not discussing U.S. veterans) left 17 articles.

RESULTS

Nine studies examined completed suicide among veterans. In most recent years, rates of deaths were greater for veterans than nonveterans, including females. Completed suicide was associated with past trauma, young age, and a mental disorder. Studies have often not addressed substance use. Three studies examined completed suicide among VA treated veterans without examining substance use as an associated factor. Rates of completed suicides were also higher among veterans than nonveterans, including females. A large proportion of females also had a mental diagnosis. Five studies examined substance use and attempted or completed suicide among VA treated veterans. Veterans in poor mental health had increased odds of suicide mortality; women with a substance use disorder (SUD) had a higher hazard ratio for completed suicide than men with a SUD. Engagement in substance abuse treatment decreased odds of suicide attempt among veterans.

CONCLUSION

Available data suggest that suicide rates are higher among female veterans than women in the general population. Substance use may increase the likelihood of suicidal behaviors among female veterans, particularly those with a mental diagnosis.

Trauma exposure interacts with impulsivity in predicting emotion regulation and depressive mood

BACKGROUND

Traumatic exposure may modulate the expression of impulsive behavioral dispositions and change the implementation of emotion regulation strategies associated with depressive mood. Past studies resulted in only limited comprehension of these relationships, especially because they failed to consider impulsivity as a multifactorial construct.

OBJECTIVE

Based on Whiteside and Lynam's multidimensional model that identifies four distinct dispositional facets of impulsive-like behaviors, namely urgency, (lack of) premeditation, (lack of) perseverance, and sensation seeking (UPPS), the current study used a sample of community volunteers to investigate whether an interaction exists between impulsivity facets and lifetime trauma exposure in predicting cognitive emotion regulation and depressive mood.

METHODS

Ninety-three adults completed questionnaires measuring lifetime trauma exposure, impulsivity, cognitive emotion regulation, and depressive mood.

RESULTS

Results showed that trauma-exposed participants with a strong disposition toward urgency (predisposition to act rashly in intense emotional contexts) tended to use fewer appropriate cognitive emotion regulation strategies than other individuals. Unexpectedly, participants lacking in perseverance (predisposition to have difficulties concentrating on demanding tasks) used more appropriate emotion regulation strategies if they had experienced traumatic events during their life than if they had not. Emotion regulation mediated the path between these two impulsivity facets and depressive mood.

CONCLUSIONS

Together, these findings suggest that impulsivity has a differential impact on emotion regulation and depressive mood depending on lifetime exposure to environmental factors, especially traumatic events.

Childhood physical abuse, non-suicidal self-harm and attempted suicide amongst regular injecting drug users

BACKGROUND

Childhood physical abuse (CPA), non-suicidal self-harm and attempted suicide are all highly prevalent amongst injecting drug users (IDU). This paper reported on the association of CPA with self-harm and attempted suicide.

METHODS

Cross-sectional study, with 300 IDU administered a structured interview examining the prevalence of CPA, non-suicidal self-harm and suicide attempts.

RESULTS

CPA was reported by 74.3%, and severe CPA by 40.3%. A history of non-suicidal self-harm was reported by 23.7%, and 25.7% had attempted suicide. Non-suicidal self-harm preceded the suicide attempt in 83.3% of cases where both had occurred. Independent correlates of non-suicidal self-harm were: female gender (OR 3.62), avoided home due to conflict (OR 2.28) and more extensive polydrug use (OR 1.32). Independent correlates of attempted suicide were: severe CPA (OR 3.18), frequent CPA (OR 2.54), avoided home due to conflict (OR 3.95), female gender (OR 2.99), a positive screen for Conduct Disorder (OR 3.53), and more extensive polydrug use (OR 1.52).

CONCLUSIONS

Those presenting to treatment agencies are highly likely to have a history of CPA, that may still influence their behaviours. Screening for histories of CPA and non-suicidal self-harm appears warranted when determining suicide risk for this population. At the population level, reductions in the rate of CPA, could possibly reduce the rate of subsequent suicidality.

Longitudinal associations between types of childhood trauma and suicidal behavior among substance users: a cohort study

OBJECTIVES

We examined the longitudinal associations between different types and severities of childhood trauma and suicide attempts among illicit drug users.

METHODS

Data came from 2 prospective cohort studies of illicit drug users in Vancouver, Canada, in 2005 to 2010. We used recurrent event proportional means models to estimate adjusted and weighted associations between types and severities of childhood maltreatment and suicide attempts.

RESULTS

Of 1634 participants, 411 (25.2%) reported a history of suicidal behavior at baseline. Over 5 years, 80 (4.9%) participants reported 97 suicide attempts, a rate of 2.6 per 100 person-years. Severe to extreme levels of sexual abuse (adjusted hazard ratio [AHR] = 2.5; 95% confidence interval [CI] = 1.4, 4.4), physical abuse (AHR = 2.0; 95% CI = 1.1, 3.8), and emotional abuse (AHR = 3.5; 95% CI = 1.4, 8.7) predicted suicide attempts. Severe forms of physical and emotional neglect were not significantly associated with an increased risk of suicidal behavior.

CONCLUSIONS

Severe sexual, physical, and emotional childhood abuse confer substantial risk of repeated suicidal behavior in adulthood. Illicit drug users require intensive secondary suicide prevention efforts, particularly among those with a history of childhood trauma.

Affective temperament, history of suicide attempt and family history of suicide in general practice patients

BACKGROUND

Untreated major affective disorders are strongly associated with suicidal behaviour; however, clinical, psychological and psycho-social risk factors also play a contributory role. Personal history and family history of suicide are also important predictors of suicidal behaviours, and are also a powerful marker of current major depressive episode in general practice patients. Affective temperaments, which can be considered the subaffective manifestations of major mood disorders also show a specific pattern of association with suicidal behaviour. In the present study our aim was to investigate the association between affective temperaments, personal history of suicide attempts and family history of completed suicide in primary practice patients.

METHODS

Five hundred and nine patients from 6 primary care practices completed the TEMPS-A, and were assessed concerning self-reported history of personal or family suicide.

RESULTS

We found that among those answering questions concerning suicide, 9.1% reported a family history of suicide in first and second degree relatives and 4.8% had at least one prior suicide attempt. Among those giving a positive answer to both questions, those who had a positive family history had significantly more frequent suicide attempts (15.4% vs. 4.0%). Patients with prior suicide attempts had a significantly higher score on the cyclothymic and depressive, and those with positive family history of suicide had on cyclothymic and anxious subscales.

LIMITATIONS

In the present study, personal and family history of suicide was assessed retrospectively and in a self-report way. The cross-sectional nature of this study and the facts that no current psychiatric morbidity has been investigated and only the documented history of depressive and anxiety disorders have been detected limit the generalisability of this study.

DISCUSSION

We found a significant relationship between depressive and cyclothymic affective temperament and personal history of suicide attempts, and between cyclothymic and anxious temperament and family history of completed suicide in first and second degree relatives. This is in line with previous findings showing a strong relationship between these affective temperaments and major mood episodes and that these temperaments are overrepresented among suicide attempters. Our findings also suggest that the presence of cyclothymic (and to lesser extent depressive) affective temperament in a patient with family history of completed suicide indicates a very high risk of suicidal behaviour.

Additive effects between prematurity and postnatal risk factors of suicidal behavior

BACKGROUND

Pre- and perinatal insults increase suicide risk. The main objective of the present study is to investigate if prematurity interacts in an additive fashion with postnatal risk factors of suicidal behavior.

METHOD

Sample and procedure: 857 adult suicide attempters consecutively hospitalized for a suicide attempt were included. Studied characteristics of suicide attempts included use of a violent mean, age at first suicide attempt, and number of suicide attempts. Risk factors of suicidal behavior included indexes of pre- and perinatal adversity, childhood maltreatment as measured with the Childhood Trauma Questionnaire, personality traits as measured with the Tridimensional Personality Questionnaire, and family history of suicidal behavior.

STATISTICAL ANALYSES

Comparisons between the different patterns of suicide attempts characteristics were made using logistic regression with crude and adjusted odds ratios and 95% confidence intervals.

RESULTS

The risk of violent suicide attempts increased significantly in patients born prematurely (OR [95%] = 2.38[1.12-5.08]). There were additive effects for very preterm birth and 1) emotional abuse (OR [95% CI] = 4.52 [1.75-11.60]), 2) novelty seeking (OR [95% CI] = 8.92[3.09-25.7]), and 3) harm avoidance (OR [95% CI] = 5.81 [2.43-13.90]) on the age at first suicide attempt, after adjustment for potential confounders.

CONCLUSIONS

Very preterm birth appears to be the first step in a cascade of stressors across lifetime, which affects the risk and the severity of suicidal behavior. Furthermore, very preterm birth, childhood maltreatment and personality traits have additive effects that influence the age at onset of suicide attempt. Our findings may have potential consequences for preventive policies.

Early childhood sexual abuse increases suicidal intent

Childhood sexual abuse has been consistently associated with suicidal behavior. We studied suicide attempt features in depressed individuals sexually abused as children. On average, sexual abuse started before age 9. It frequently coexisted with physical abuse. Suicide attempters more often had personality disorders and had endured abuse for longer, but did not differ in terms of other clinical characteristics from non-attempters. Earlier onset of sexual abuse and its duration were associated with more suicide attempts. However, when personality disorders were included in the regression model, only these disorders predicted number of attempts. The severity of sexual abuse and the coexistence of physical abuse were correlated with age at first suicide attempt. However, only severity of sexual abuse was marginally associated with age at first suicide attempt in the regression model. Finally, the earlier the age of onset of sexual abuse, the higher the intent, even after controlling for age, sex and personality disorders. This suggests that the characteristics of childhood sexual abuse, especially age of onset, should be considered when studying the risk for suicidal behavior in abused populations.

Temperament personality profiles in suicidal behaviour: an investigation of associated demographic, clinical and genetic factors

BACKGROUND

Personality traits have been suggested as possible risk factors for suicidal behaviours. Cloninger's model of personality (TCI), given its neurobiological background, might provide an ideal tool for the identification of dimensions associated with suicide attempt.

METHODS

A number of 1333 suicide attempters and 589 non-suicide attempters suffering from different DSM-IV Axis I disorders were assessed using either the temperament and character inventory (TCI) or the tridimensional personality questionnaire (TPQ), as well as other self-report questionnaires evaluating dimensions associated with suicidal behaviour, such as impulsivity and anger traits. The severity of suicide attempts and the methods used were also assessed. Subjects were genotyped for polymorphisms within the key genes involved in monoaminergic pathways and the HPA axis.

RESULTS

Compared with non-suicide attempters, suicide attempters scored higher for harm avoidance (HA) and novelty seeking (NS), and lower for self-directedness (SD). The difference was independent of Axis I disorders. Higher HA and NS scores were associated with a greater severity of suicidal behaviour. A multivariate model showed that HA was the single temperamental dimension independently related to suicide attempt history, beside impulsivity and anger-related traits. The genetic factors investigated did not play a significant role in modulating these temperamental dimensions.

LIMITATIONS

The TCI was available for only half of the sample.

CONCLUSIONS

Early detection of subjects displaying high HA and low SD, associated with high impulsivity and poor anger control, may help to prevent suicidal behaviours. Physicians should therefore be aware of these risk factors so that they can offer the best primary care intervention.

Possible risk factors for increased suicide following bariatric surgery

OBJECTIVE

There is a growing research literature suggesting that there may be elevated risk of suicide following bariatric surgery. Most of the data reported thus far has been cross-sectional and observational, and very little is known about the possible specific causal variables involved.

DESIGN AND METHODS

The purpose of this report is to review this literature and to review possible risk factors for increased suicidal risk following bariatric surgery, to delineate future research directions.

RESULTS

First a variety of medical, biological, and genetic factors, including the persistence or recurrence of medical comorbidities after bariatric surgery, the disinhibition and impulsivity secondary to changes in the absorption of alcohol, hypoglycemia, as well as pharmacokinetic changes that may affect the absorption of various medications including antidepressant medications are reviewed. Also reviewed are possible mediating factors involving changes in various peptidergic systems such as GLP-1 and Ghrelin. A number of psychosocial issues that might be involved are discussed, including lack of improvement in quality of life after surgery, continued or recurrent physical mobility restrictions, persistence or recurrence of sexual dysfunction and relationship problems, low self-esteem, and a history of child maltreatment. Inadequate weight loss or weight regain are also discussed.

CONCLUSIONS

A number of possible contributing factors have been identified. Possible theoretical models involved and directions for research are suggested.

Sex differences in disinhibition and its relationship to physical abuse in a sample of stimulant-dependent patients

BACKGROUND

Research suggests that impulsivity is a vulnerability factor for developing stimulant dependence, that women develop dependence more quickly than men, and that physical abuse can increase impulsivity and may have greater adverse health consequences in women. This study sought to tie these findings together by evaluating: (1) sex differences in disinhibition prior to lifetime initiation of stimulant abuse and (2) the relationship between physical abuse and disinhibition in stimulant-dependent patients.

METHOD

The Frontal Systems Behavior Scale (FrSBe) is a reliable and valid self-report assessment of three neurobehavioral domains associated with frontal systems functioning (Apathy, Disinhibition, and Executive Dysfunction, summed for a Total), that assesses pre-morbid functioning and has a specific cutoff for defining clinically significant abnormalities. Six sites evaluating 12-step facilitation for stimulant abusers obtained the FrSBe from 118 methamphetamine- and/or cocaine-dependent participants. Lifetime physical abuse was measured by the Addiction Severity Index (ASI).

RESULTS

The proportion reporting clinically significant disinhibition was significantly higher in women (64.9%) than in men (45.0%, p=0.04), with no significant difference on the other FrSBe scales. Physical abuse in women, but not men, was associated with worse functioning, with physically abused, relative to non-abused, women having a significantly greater proportion with clinically significant disinhibition (p<0.01) and total neurobehavioral abnormalities (p<0.01).

CONCLUSION

These findings suggest that women may have significantly greater disinhibition than men prior to lifetime initiation of stimulant abuse and that physical abuse in women is associated with greater disinhibition.

The mediator roles of trait anxiety, hostility, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients

The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.

Clinical features associated with trait-impulsiveness in euthymic bipolar disorder patients

BACKGROUND

A strong association has been reported between trait-impulsiveness and bipolar disorder (BD). Much attention has been focused on this association, but subgroup analysis has generated conflicting results, raising questions about the role of trait-impulsiveness in suicidal behavior and substance misuse in bipolar patients.

METHOD

We compared Barratt Impulsiveness Scale-10 scores between 385 euthymic bipolar patients and 185 healthy controls. We then investigated possible association between impulsiveness scores and the following clinical characteristics: suicide attempt (SA), lifetime alcohol/cannabis misuse, rapid cycling and mixed episodes.

RESULTS

Bipolar patients and healthy controls had significantly different BIS-10 total score and subscores (motor, attentional and nonplanning impulsiveness) (all p values <0.0001). No association was observed between BIS-10 total score, personal history of SA, number of SA, age at first SA and history of violent SA. Higher BIS-10 total scores were associated with alcohol misuse (p=0.005), cannabis misuse (p<0.0001), with an additive effect for these two substances (p=0.005). Higher BIS-10 total scores were also associated with rapid cycling (p=0.006) and history of mixed episodes (p=0.002), with an additive effect of these two variables (p=0.0006).

LIMITATIONS

We used only one clinical measurement of impulsiveness and did not carry out cognitive assessment.

CONCLUSION

This study demonstrates that trait-impulsiveness may be considered as a dimensional feature associated with BD and with a more severe clinical expression of the disease, characterized by a history of substance misuse, rapid cycling and mixed episodes. We found no association between impulsiveness and SA characteristics in bipolar patients, confirming some previous negative results.

Psychosocial predictors of impulsivity in alcohol-dependent patients

Impulsivity is an important risk factor of severe course of alcohol dependence. However, the significance of environmental determinants of impulsivity has been underestimated. The aim of this study was to identify psychosocial factors increasing the level of impulsivity in alcoholics. Levels of impulsivity were measured in 304 alcohol-dependent patients. The stop-signal task was used to assess behavioral impulsivity, and the Barratt Impulsiveness Scale, to measure global and cognitive impulsivity. Correlations between impulsivity and psychosocial variables were examined. A significant association between level of impulsivity and severity of psychopathological symptoms was observed. Patients who reported childhood sexual or physical abuse, lower social support, and more severe course of alcohol dependence were more impulsive, especially in the cognitive domain. When entered into a linear regression analysis model, severity of alcohol dependence, psychopathology, and childhood physical abuse remained significant. These results suggest that psychosocial variables are important factors associated with high levels of impulsivity in alcohol-dependent patients.

Prevalence and correlates of child sexual abuse: a national study

BACKGROUND

This study examines the prevalence, correlates, and psychiatric disorders of adults with history of child sexual abuse (CSA).

METHODS

Data were derived from a large national sample of the US population. More than 34000 adults 18 years and older residing in households were interviewed face-to-face in a survey conducted during the 2004-2005 period. Diagnoses were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between CSA and psychiatric disorders, adjusted for sociodemographic characteristics, risk factors, and other Axis I psychiatric disorders.

RESULTS

The prevalence of CSA was 10.14% (24.8% in men and 75.2% in women). Child physical abuse, maltreatment, and neglect were more prevalent among individuals with CSA than among those without it. Adults with CSA history had significantly higher rates of any Axis I disorder and suicide attempts. The frequency, type, and number of CSA were significantly correlated with psychopathology.

CONCLUSIONS

The high correlation rates of CSA with psychopathology and increased risk for suicide attempts in adulthood suggest the need for a systematic assessment of psychiatric disorders and suicide risk in these individuals. The risk factors for CSA emphasize the need for health care initiatives geared toward increasing recognition and development of treatment approaches for the emotional sequelae CSA as well as early preventive approaches.