Temperamental vulnerability in attempted suicide

Family history of suicide and neuroticism: a preliminary study

Whether a family history of suicide (FHS) might increase the risk for suicidal behavior through an effect on personality was examined. Patients with a first or second-degree relative who had committed suicide were compared with matched patients with a negative FHS for their scores on the Eysenck Personality Questionnaire (EPQ). The trend for a difference on EPQ neuroticism scores between the total groups became significant when subgroups of FHS positive and negative patients, who had no personal history of attempting suicide, were compared. Further studies of the relationship of a family history of suicide to personality are needed in other populations and incorporating biologic measures.

Drug use and suicide attempts: the role of personality factors

This study on suicide attempts is part of a large research project on dependent behavior in adolescents and young adults. 228 subjects aged 14-25 (107 "drug abusers," 121 controls) from the French speaking part of Switzerland were evaluated on the basis of a semi-structured interview (Mini International Neuropsychiatric Interview), enabling a DSM-IV diagnosis, and self-reports (SSS by Zuckermann, MMPI-2, IDI by Hirschfeld). 31.5% of "drug abuser" males and 41.2% of "drug abuser" females committed one or more suicide attempts. The results of a logistic regression show that the significant factor explaining suicide attempts in drug users is emotional reliance for males and experience-seeking for females.

Body attitudes and body experiences in suicidal adolescents

The relationships between cognitive and affective attitudes toward the body, body experiences (dissociation, insensitivity, and lack of control), and suicidal tendencies were examined as a derivative of the hypothesis that bodily attitudes and experiences may facilitate suicidal acting out. Three groups of adolescents (aged 14-18), including suicidal (made a suicide attempt) and nonsuicidal inpatients and controls, were compared with regard to suicidal tendencies, various body aspects, and depression and anxiety. A series of MANOVAs, discriminant analysis, Pearson correlations, and regressions were employed. The results show that the suicidal group differed from the two nonsuicidal groups in feelings toward the body, body protection, and body dissociation. Some aspects of bodily measures discriminated between suicidal and nonsuicidal subjects. In addition, various bodily measures were associated with and statistically predicted suicidal tendencies. The discussion focuses on the web of associations between body attitudes and experiences and their role in suicidal behavior.

Suicidal behavior: is there a genetic predisposition?

OBJECTIVES

To review the data that support the role of genetic factors in the predisposition to suicidal behavior and to examine whether or not these factors are part of the genetic liability to mood disorders. To review molecular genetic studies carried out in suicidal behavior.

METHODS

A review of the literature was carried out by means of systematic bibliographic database searches and complemented by searches in the references of relevant publications.

RESULTS

There is consistent evidence suggesting that genetic factors play an important role in the predisposition to suicide and suicidal behaviors. Although there is important overlap between suicide and mood disorders, a common genetic liability seems unlikely. It is possible that part of the predisposition to suicide may be transmitted via the presence of impulsive and impulsive-aggressive behaviors. An increasing number of molecular genetic studies have been carried out in subjects with suicidal behavior. There is some support for a role of some genes that code for components of the serotonergic pathway in the etiology of suicidal behavior, but these studies are still preliminary.

CONCLUSIONS

Further studies are needed at the epidemiological, clinical and molecular level to better characterize the genetics of suicide. These should control for the presence of behaviors that are considered as part of the phenotypic spectrum of suicide.

Emotion traits in older suicide attempters and non-attempters

BACKGROUND

Emotion is a flourishing area of cross-disciplinary research that can inform traditional approaches to psychopathology. The present study examines emotion traits associated with attempted suicide in a depressed older sample.

METHODS

Seven emotion traits were compared in depressed inpatients, age 50 years or older, who either had made a suicide attempt after age 50 (n=47) or had never made a suicide attempt (n=38) as assessed by self-report and a review of available medical records.

RESULTS

In univariate analyses controlled for age and sex, late-life suicide attempters were lower in Warmth and Positive Emotions than non-attempters. However, only lower Anxiety was associated with attempter status when all seven emotion traits were included as predictors. Of the attempters, those who had made a greater number of attempts reported lower Positive Emotions and higher Anger/Hostility and Guilt, though only lower Positive Emotions had a significant effect independent of the other emotions. In a subsample of 41 patients whose index admission was precipitated by an attempt, lower Anger/Hostility was associated with higher intent to die, and lower Anger/Hostility and lower Guilt was associated with higher lethality of method.

LIMITATIONS

The assessments of emotion traits may have been colored by transient moods, including, for the recent attempters, moods associated with the aftermath of their attempt. Participants who completed the key measures may not be representative of older attempters.

CONCLUSIONS

Emotion traits are associated with suicidal behavior in older depressed patients, and the specific type of emotion and the direction of its association depends on the specific suicide variable examined. Emotion traits may be helpful in assessing suicide risk.

Psychopathy, antisocial personality, and suicide risk

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist--Revised (PCL-R). Male prison inmates (N = 313) were assessed using the PCL-R and DSM-III-R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL-R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both.

Hostility as a feature of elderly suicidal ideators

Literature suggests that suicidal feelings are relatively rare in mentally healthy older adults. This research investigated the presence of death or suicidal ideation in a group of home-dwelling elderly people (N = 611, M age = 75.7 yr., SD = 7.2), taking into account their psychopathological profiles assessed by means of the Brief Symptom Inventory. Suicidality was investigated by the Italian translation of the 1974 questions from Paykel, Myers, Lindenthal, and Tanner. Elderly with death or suicidal ideation manifested depressive and anxious symptoms on the Brief Symptom Inventory. This psychopathological profile, which has been reported for these subjects in various contributions to the literature, was also characterized by the presence of hostility. The correlation with higher scores on the hostility scale is difficult to interpret, although these feelings are often accompanied by failure to control impulses, which is an essential characteristic in suicidal behaviour.

Cortisol in violent suicidal behaviour: association with personality and monoaminergic activity

BACKGROUND

According to recent theories, suicidal behaviour is associated with depressive disorders that are commonly induced by social stressors in persons with a trait-dependent vulnerability. Stressor-induced increased cortisol secretion may interfere with this vulnerability that can be defined in terms of (possibly inter-related) biological and psychological or personality-related characteristics. Delineation of such trait-like characteristics may increase the specificity in the prediction of suicidal behaviour and thus lead to new approaches to the treatment and prevention of suicidal behaviour.

METHODS

Psychiatric symptomatology, personality dimensions (Cloninger's Temperament and Character), peripheral markers of serotonergic (whole blood serotonin, platelet MAO activity) and noradrenergic (plasma MHPG) activity, and urinary cortisol were measured in a random sample of patients with a history of violent suicidal behaviour and compared to those of patients without such a history.

RESULTS

When compared to patients without a history of violent suicidal behaviour (n=23), patients with such a history (n=17) were characterised by higher urinary cortisol levels, a significantly lower mean score on Reward Dependence, a borderline significantly increased score on Novelty Seeking and a significantly lower mean plasma MHPG level. Urinary cortisol level correlated significantly with Reward Dependence and Novelty Seeking scores. There were no differences between patient groups regarding severity of anxiety or depressive symptomatology. No differences with regard to the biological parameters were found between patients who recently attempted suicide and those with a history of suicidal behaviour.

LIMITATIONS

Limitations of this study included a relatively small number of study subjects and the use of peripheral markers to assess central neurotransmission functions.

CONCLUSIONS

Violent suicidal behaviour is associated with increased cortisol secretion, a personality profile defined by low Reward Dependence (reflecting the degree of sensitivity to social stressors) and a tendency of increased Novelty Seeking (related to impulsivity and the regulation of anger), and reduced noradrenergic functioning (possibly reflecting an inability to adapt to stressors).

Two-year stability of Psychosis Proneness Scales and their relations to personality disorder traits

Two-year stability of Physical Anhedonia (PhA), Perceptual Aberration (PER), and Magical Ideation (MI) scale scores and their relation to personality disorder traits were examined. Additionally, the effects of a time-lagged (prospective) versus concurrent measurement of psychosis proneness and personality disorder traits were studied to examine the specificity of MI, PER, and PhA. With a non-college-student sample (n = 404), stability for PhA was sufficiently high, but for PER and MI, stability was moderate to low. The correlations between personality disorder traits and psychosis proneness scales demonstrate that simultaneous assessment leads to a more nonspecific pattern of associations for MI and PER, although the correlation to schizotypal personality disorder traits were the highest. However, prospectively only MI, but neither PER nor PhA, emerged as a significant predictor for schizotypal and paranoid personality disorder traits in multiple-regression analysis. This suggests that MI may allow for a more specific assessment of psychosis proneness than PER.

Suicidality and substance misuse in first-admitted subjects with psychotic disorder

OBJECTIVE

The aim of this study was to examine the links between suicidality and substance misuse (abuse or dependence) in subjects with early psychosis.

METHOD

Data were collected on a sample of first-admitted subjects with psychosis (n=64).

RESULTS

More than 1 in 4 patients had a history of parasuicide, and more than 1 in 10 patients were referred to the psychiatric hospital after such an act. Parasuicide was more frequent in subjects with a history of drug misuse (OR=4, 95% CI= 1.1-14.0, P=0.03), and especially of polysubstance use (OR=6.6, 95% CI=1.2-34.7, P=0.03).

CONCLUSION

The association between substance misuse and suicidality found in subjects with psychosis is similar to that which exists in the general population. Since early psychosis is a high-risk period for substance misuse, subjects with incipient psychosis may be especially vulnerable to the devastating consequences of drug use with regard to increased risk of suicide.

Temperament traits in male suicide attempters and violent offenders

With the purpose of comparing temperament traits in subjects who have been violent towards others and with subjects who have shown self-directed violence, 34 male suicide attempters and 34 male violent offenders were matched for age and psychiatric diagnosis. Violent offenders with a history of suicide attempts were excluded. Temperament traits were assessed by means of the Karolinska Scales of Personality. The temperament profiles of suicide attempters and violent offenders were very similar, with high trait anxiety and very low socialization. Violent offenders displayed significantly higher social desirability (P < 0.001). Suicide attempters tended to have higher indirect aggression and monotony avoidance. Impulsiveness, verbal aggression, and inhibition of aggression were within the normal range in both groups. There were substantial temperamental similarities between suicide attempters and violent offenders. In order to disentangle the differential mechanisms behind aggression towards self and others, we probably need to consider historical as well as current situation factors in a systematic way.

Temperament traits in seasonal affective disorder, suicide attempters with non-seasonal major depression and healthy controls

BACKGROUND

Very few studies have compared the temperament traits in matched suicidal and non-suicidal patients with major depression.

METHODS

We compared the temperament traits in two matched groups of patients with major depressive disorder (MDD), MDD with seasonal subtype (SAD) without any suicide attempt (n = 23) and MDD without seasonal variation who attempted suicide (non-SAD SA), and compared the patients to matched healthy controls by using the Karolinska Scales of Personality (KSP) and the Marke-Nyman Temperament (MNT) questionnaires.

RESULTS

Both the SAD and non-SAD SA groups showed significantly higher Somatic Anxiety, Muscular Tension, Psychasthenia, Irritability, Suspicion, and lower Socialization and Validity than the controls. The non-SAD SA group also showed significantly higher Psychic Anxiety, Detachment and Guilt as compared to controls. When the SAD and the non-SAD SA were compared, we found significantly higher Somatic Anxiety, Psychic Anxiety and Muscular Tension for the non-SAD SA group.

CONCLUSIONS

Both SAD and non-SAD SA patients display different temperament profiles compared to controls and in comparison with each other and the suicide attempters show especially high trait anxiety and hostility.

CLINICAL RELEVANCE

The results suggest that trait anxiety and hostility, but not impulsivity, are associated with suicidal behavior in major depression.

Temperament, character and suicide attempts in anorexia nervosa, bulimia nervosa and major depression

OBJECTIVE

We examined the relation between personality traits as measured by the Temperament and Character Inventory (TCI) and a reported history of suicide attempts in women with anorexia nervosa, bulimia nervosa and major depression.

METHOD

We compared the prevalence and severity of suicide attempts in women with anorexia nervosa (n = 68), bulimia nervosa (n = 152) and major depression with no history of an eating disorder (n = 59), and we examined the relation between the TCI scales and suicide attempts.

RESULTS

Comparable numbers of women across the three groups had attempted suicide. The temperament dimension of high persistence and the character dimensions of low self-directedness and high self-transcendence were associated with a reported history of suicide attempts.

CONCLUSION

Suicide attempts are equally common in women with eating disorders and women with depression. Whether the observed association between temperament and suicide attempts reflects correlates, causal factors or sequelae of suicide attempts is unknown.

Personality and the prediction of weight loss and relapse in the treatment of obesity

OBJECTIVE

This prospective study examined whether stable personality traits, as measured by the Karolinska Scales of Personality (KSP), predicted initial weight loss or long-term maintenance in obesity patients.

METHOD

The KSP was administered to 102 obese patients prior to entering an 8-week weight loss program. Patients were weighed again at the end of treatment and at 3- and 12-month follow-up.

RESULTS

The KSP did not predict initial weight loss after the 8-week program. Several of the KSP scales (Muscle Tension, Monotony Avoidance, Suspicion, and Guilt) had weak associations with 12-month relapse status. Weight gain at the 3-month follow-up was the strongest predictor of 12-month relapse status (O.R. = 0.46; 95% C.I. = 0.32, 0.66).

DISCUSSION

Personality traits, as measured by the KSP, do not appear to be important predictors of initial weight loss or 12-month relapse status. Personality assessment may not substantially contribute to predicting treatment outcome in obesity research.

Toward a clinical model of suicidal behavior in psychiatric patients

OBJECTIVE

Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study.

METHOD

Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed.

RESULTS

Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters.

CONCLUSIONS

The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.

D4 dopamine receptor gene exon III polymorphism and obesity risk

Many genes have been identified that may play a role in increasing individual susceptibility to obesity. Reduced dopamine function appears to play a role in dysfunctional eating patterns and may predispose some individuals to obesity. The long version of the D4 dopamine receptor gene (D4DR) has been shown to alter receptor function and reduce intracellular response to dopamine. It also has been associated with novelty-seeking-related personality traits that are found with greater frequency in obese individuals. We examined the association between the long alleles of the D4DR and obesity in a sample of 115 obese patients participating in a weight management program. No direct relationship was found between the D4DR and body mass or novelty-seeking-related personality traits. We constructed four models of increased obesity risk that included combinations of traditional risk factors (i.e., long-term history of obesity, parental obesity, a body mass index > 40) and elevations on the novelty-seeking-related scales of the Karolinska Scales of Personality. There was a significant increase in the frequency of the D4DR long alleles in individuals defined as high risk using the combination of novelty-seeking-related personality traits, severe obesity (i.e., BMI > 40), and any other traditional risk factor, but not with the traditional risk factors alone. These preliminary data suggest a potential role for the D4DR gene in increasing obesity susceptibility.

Correlations between plasma-neuropeptides and temperament dimensions differ between suicidal patients and healthy controls

BACKGROUND

Decreased plasma levels of plasma-neuropeptide Y (NPY) and plasma-corticotropin releasing hormone (CRH), and increased levels of plasma delta-sleep inducing peptide (DSIP) in suicide attempters with mood disorders have previously been observed. This study was performed in order to further understand the clinical relevance of these findings.

METHODS

Examination of correlates between temperament dimensions (Karolinska Scales of Personality (KSP), the Eysenck Personality Questionnaire together with the IVE- impulsiveness scale (EPQI), and the Marke-Nyman Temperament (MNT)) and NPY, CRH and DSIP and serum-cortisol in the dexamethasone suppression test (DST) in 38 suicidal patients and matched controls.

RESULTS

NPY correlated significantly and positively with psychasthenia, irritability, and stability and significantly and negatively with validity in patients, but significantly and negatively with muscular tension, psychasthenia, verbal aggression and irritability in controls. DSIP correlated significantly and positively with impulsiveness (EPQI) in controls. CRH correlated negatively with lie in controls. Cortisol correlated significantly and positively with validity, extraversion and verbal aggression and significantly and negatively with inhibition of aggression in controls.

CONCLUSION

NPY may be related to stress tolerance. DSIP seems to be associated with impulsivity/antisocial traits.

LIMITATIONS

Non-suicidal patients were not included in the examination.

CLINICAL RELEVANCE

The state of depression or stress seems to influence the correlations studied.

Clinical characteristics and biological parameters in temperamental clusters of suicide attempters

A sample of 215 suicide attempters was categorized in a cluster analysis into four groups according to temperamental trails. Monoamine metabolites in the cerebrospinal fluid were analysed (n = 106). Dexamethasone suppression tests (DST) were performed (n = 154) and the activity of the enzyme monoamine oxidase in platelets (pl-MAO) was assessed (n = 103). Patients belonging to the two clusters with the most deviant temperament profiles (nos 2 and 3) were young and scored high on the Beck Hopelessness Scale and the Suicide Assessment Scale. "Cluster 3" ("neurotic, impulsive, aggressive") patients often had dysthymia and axis II, cluster B diagnoses (e.g. borderline or histrionic personality). "Cluster 2" ("neurotic and introverted") patients often had major depression. The "Cluster 1", with on the whole a normal temperament profile, had significantly higher levels of post-DST cortisol than the other clusters. The "Cluster 4" had a normal temperament profile. Adjustment disorders were most common in "Cluster 1" and "Cluster 4". The monoamine metabolite levels did not differ between the clusters, and the differences in pl-MAO activity disappeared after adjusting for age and gender. The results suggest that temperament profiles in suicide attempters are related to psychiatric diagnoses, suicidality, hopelessness, and post-DST cortisol, but are not predictive of completed suicide.