Childhood physical abuse, aggression, and suicide attempts among criminal offenders

Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning

Patients with schizophrenia spectrum disorders (SSD) have an elevated risk of suicidality. The same has been found for people within the penitentiary system, suggesting a cumulative effect for offender patients suffering from SSD. While there appear to be overlapping characteristics, there is little research on factors distinguishing between offenders and non-offenders with SSD regarding suicidality. Our study therefore aimed at evaluating distinguishing such factors through the application of supervised machine learning (ML) algorithms on a dataset of 232 offenders and 167 non-offender patients with SSD and history of suicidality. With an AUC of 0.81, Naïve Bayes outperformed all other ML algorithms. The following factors emerged as most powerful in their interplay in distinguishing between offender and non-offender patients with a history of suicidality: Prior outpatient psychiatric treatment, regular intake of antipsychotic medication, global cognitive deficit, a prescription of antidepressants during the referenced hospitalisation and higher levels of anxiety and a lack of spontaneity and flow of conversation measured by an adapted positive and negative syndrome scale (PANSS). Interestingly, neither aggression nor overall psychopathology emerged as distinguishers between the two groups. The present findings contribute to a better understanding of suicidality in offender and non-offender patients with SSD and their differing characteristics.

Does Gender Really Matter: Childhood Trauma, Trait Anger, and Suicide Risk in Early Adulthood

Background: Previous studies have reported mixed findings regarding gender differences in suicidal behavior. This discrepancy may be partly attributable to common predictors of suicide risk, such as childhood trauma and anger, and may also be independent of gender. Objectives: The present study investigated gender differences in the impact of childhood trauma and current trait anger on suicide risk, in a group of young Turkish adults. We hypothesized that trait anger would mediate the association between childhood trauma and suicide risk, independently of gender. Participants and Setting: Participants were 589 university students (84.3% women) aged 18-34 years (M = 21.43, SD = 1.82). Methods: Gender group differences in suicide risk, history of childhood trauma, and trait anger as well as possible covariates (i.e., self-rated socio-economic status and academic performance) were assessed. Possible predictors of suicide risk in gender groups were examined. The role of trait anger as a mediator of the relationship between childhood trauma and suicide risk was also examined. Results: Results showed that men reported a higher suicide risk, history of childhood trauma, and trait anger than women. Early childhood trauma and current trait anger scores were significant predictors of suicide risk in both gender groups. Trait anger significantly mediated the relationship between early trauma history and risk for suicide, independently of gender. Conclusions: Study findings support early reports of the effects of childhood trauma and trait anger on suicide risk. It was suggested that preventive interventions for suicidal behavior and monitoring risk groups with aggressive tendencies and childhood trauma history may be important.

Association between childhood physical abuse and suicidal behaviors among Chinese adolescents: The mediation of aggression

BACKGROUND

Although previous studies have examined many predictors of suicidal behaviors. However, little is known for childhood physical abuse (CPA) and aggression, which are prevalent among adolescents. This study aimed to explore association between CPA and suicidal behaviors, and the potential mediating role of aggression.

METHOD

A total of 16,111 students graded 7 to 12 were recruited using a stratified cluster sampling across five representative provinces in China. Conflict Tactics Scale-Parents to Child (CTS-PC) and Buss and Warren's Aggression Questionnaire (BWAQ) were used to measure CPA and aggression, respectively.

RESULTS

During the last year, 16.0 % of adolescents reported suicidal behaviors. Specifically, 7.9 % were suicide ideators, 4.6 % were planners, and 3.5 % were attempters. The prevalence of CPA in mild, moderate, and severe was 15.7 %, 26.9 %, and 4.4 %, respectively. Multinomial logistic regression indicated that moderate and severe CPA and overall aggression were associated with suicide ideators, planners, and attempters. In five sub-types of aggression, only hostility was significantly associated with all three suicidal behaviors. Structural equation modelling showed that aggression partially mediate the relationship between CPA and suicidal behaviors. The mediation proportion of overall aggression, physical aggression, verbal aggression, anger, hostility, and indirect aggression were 27.2 %, 22.4 %, 5.2 %, 14.2 %, 23.5 %, and 12.1 %, respectively.

LIMITATIONS

Cross-sectional design, self-reported questionnaire, and no other forms of childhood maltreatment.

CONCLUSIONS

CPA is a critical risk factor of suicidal behaviors among Chinese adolescents and aggression is a mediator between CPA and suicidal behaviors. Targeted suicide prevention should focus on those adolescents who report CPA and aggression, especially for hostility.

Is the end in the beginning? Child maltreatment increases the risk of non-suicidal self-injury and suicide attempts through impaired personality functioning

BACKGROUND

Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.

OBJECTIVE

To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.

PARTICIPANTS AND SETTING

Data were drawn from a representative German population sample (N = 2510).

METHODS

Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.

RESULTS

Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p < .001) and greater impairments in personality functioning (d = 1.64, p < .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.

CONCLUSIONS

The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

The Relation of childhood adversity and antisociality to suicide attempts in men admitted to forensic psychiatric hospital

Suicide is a leading cause of death in custody. Although previous studies with prison inmates suggest a strong relation between childhood adversity and suicidal behavior, as well as between childhood adversity and antisociality, this has not been explored in the forensic psychiatric system. We compared 211 men admitted to a forensic hospital having a lifetime history of suicide attempts with 275 men with no suicide history in the same institution. Data were retrospectively coded from information gathered during their assessment and medical records. We examined associations of adverse childhood events and antisociality with suicide attempt history in a series of regression analyses. Childhood adversity was present in majority of individuals and significantly more common for individuals with a history of suicide attempts (76.8%) than those with no suicide attempts (63.3%). The suicide attempt group also experienced a greater number of adverse childhood events. Physical abuse, parental separation, and parental psychiatric history during childhood were associated with suicide attempts. Men with a suicide attempt history had higher antisociality scores than the comparison group and adult antisocial behavior partially mediated the relationship between adverse childhood experiences and suicide attempts. Men in forensic hospital who have suffered multiple experiences of childhood adversity are at increased risk for exhibiting antisocial behavior and engaging in suicidal attempts. Early interventions targeted toward antisociality and trauma-informed care in the forensic hospital are needed to support the mental health of the forensic population.

Suicidal Histories in Adults Experiencing Psychological Trauma: Exploring Vulnerability and Protective Factors

OBJECTIVE

This study aimed to identify vulnerability and protective factors for suicidal histories among adults experiencing psychological trauma.

METHOD

Adults seeking treatment for psychological trauma (N = 113) completed self-report questionnaires measuring childhood trauma history, self-concept, relational functioning, emotion regulation, living arrangements, employment status, marital status, and suicidal history. Independent samples t-tests were used to determine variables on which those with and without suicidal histories differed significantly. These variables were then entered into a binary logistic regression model to identify factors which independently distinguished between those with and without a suicidal history.

RESULTS

Univariate differences were found for childhood emotional abuse (CEA), childhood emotional neglect (CEN), emotion deactivation, and employment status, with those in the suicidal history group scoring higher on all of these. CEA (OR = 1.13, 95% CI = 1.01-1.27) and employment status (OR = 4.12, 95% CI = 1.23-13.73) remained significant predictors of suicidal status in the multivariable logistic regression.

CONCLUSIONS

CEA was an independent vulnerability factor for suicidal risk, highlighting the need for clinicians to assess exposure to such trauma in those presenting with proximal traumatic experiences. Being in employment was an independent protective factor against suicidal risk, highlighting the importance of social buffers or networks when faced with traumatic situations.

Exploring the mediating role of methamphetamine use in the relationship between adverse childhood experiences and attempted suicide

OBJECTIVE

Methamphetamine (METH) use and adverse childhood experiences (ACEs) has been associated with an increased risk of suicidal behaviour. However, whether METH use underlies the risk of suicide attributable to ACEs is unknown and warrants investigation to inform preventive interventions. In this study, we examined the mediating role of METH use in the relationship between attempted suicide and ACEs.

METHOD

METH users recruited from a mandatory detoxification center (n = 346) and healthy controls (n = 342) both completed a survey related to 9 types of ACE, which was based the Family Health Questionnaire. A lifetime history of attempted suicide was obtained using the Chinese version of the Composite International Diagnostic Interview. We conducted a bootstrapped mediation analysis to examine the mediating effect of METH use on the association between ACEs and attempted suicide.

RESULTS

Female gender, METH use, and having multiple (≥3) ACEs were associated with an increased risk of attempted suicide. A dose-response relationship between the number of ACEs and suicide rate was observed among individuals with METH use. METH use significantly mediated the association between ACEs and attempted suicide in those with multiple (2 and 3 ACEs respectively with proportion mediated 0.16 and 0.42) and specific types of ACEs (physical abuse, witnessing maternal battering, household substance abuse, sexual abuse, and parental separation with proportion mediated 0.25, 0.35, 0.38, 0.48, 0.47 respectively).

CONCLUSION

Our study is the first to demonstrate that METH use partially mediates the association between ACEs and attempted suicide. Addressing METH use in people with ACEs could reduce their suicide risk.

Prevalences of and correlations between childhood trauma and depressive symptoms, anxiety symptoms, and suicidal behavior among institutionalized adolescents in Vietnam

OBJECTIVES

We investigated the prevalence rates of childhood trauma, depressive symptoms, anxiety symptoms and suicidal behaviors among Vietnamese adolescents and compared the differences between institutionalized adolescents (IAs) and noninstitutionalized adolescents (NIAs). In addition, we examined the multidimensional associations between childhood trauma and psychopathology among IAs.

METHODS

Five hundred forty-six participants were recruited into two groups (IAs and NIAs) matched by age, sex and grade. They completed a childhood trauma questionnaire, depression scale, anxiety scale, and 3 suicide-related questions. The chi-squared test and logistic regressions were performed.

RESULTS

The prevalences of anxiety symptoms and suicide attempts among IAs was higher than that among NIAs (25.6 % vs 14.7 %, p = 0.001 and 8.1 vs 3.7, p = 0.03, respectively), while the prevalences of other psychopathologies did not differ significantly. In the IA group, high prevalences of victimization through physical abuse (22.3 %), emotional neglect (57.9 %), and physical neglect (72.9 %) were found, and 58.6 % of the participants had experienced more than one type of trauma. These figures were significantly higher in IAs than in NIAs. Depression and suicidal ideation were more strongly correlated with emotional abuse and neglect than other types of maltreatment, while anxiety, suicide planning and suicide attempts were more strongly correlated with physical abuse. IAs who experienced more than two categories of trauma or greater intensity of trauma were more susceptible to developing depression, anxiety, and suicidal behaviors.

CONCLUSIONS

Childhood trauma was multidimensionally associated with adverse psychological outcomes. We suggest that various aspects of childhood trauma, as well as psychopathologies, must be routinely assessed.

Source-based morphometry reveals gray matter differences related to suicidal behavior in criminal offenders

Relative to the general population, criminal offenders have a higher risk of suicide. Neurobiological deficits related to suicidal behavior have been identified in the general population, but unexamined in offenders to date. We examined the association between brain morphology and suicidal behavior in adult male criminal offenders. Brain morphology was examined using voxel-based morphometry (VBM) and source-based morphometry (SBM), a multivariate alternative to VBM which analyzes brain volume in between-subject spatially independent networks. Results showed that offenders with past suicide attempts (n = 19), relative to offenders without past suicide attempts (n = 19) and non-offenders (n = 26), had reduced gray matter in an SBM component that comprised the posterior cingulate, dorsal prefrontal cortex, and amygdala. The SBM source weights were significantly associated with suicide attempts independent of other suicide risk variables (e.g., depression). VBM results were similar to the SBM results but less robust. The results reveal a potential neurobiological marker of vulnerability to suicidal behavior among criminal offenders and illustrate the utility of multivariate methods of gray matter analyses.

Longitudinal association between deviant peer affiliation and externalizing behavior problems by types of child maltreatment

BACKGROUND

Previous research has documented that deviant peer affiliation (DP) and externalizing behavior problems (EXT) are highly related and often co-occur. However, the directionality of the association between DP and EXT remains debatable. In addition, few studies have examined the longitudinal effects of child maltreatment types on co-development of DP and EXT overtime. Therefore, this study examined the role of child maltreatment in predicting the co-development of DP and EXT.

METHODS

DP and EXT were assessed at ages 12, 14, and 16. DP was measured using 13 items from the modified version of the Youth Risk Behavior and Monitoring the Future Survey. EXT was measured using the Child Behavior Checklist. Each type of child maltreatment (birth to age 12) was assessed using the CPS substantiated cases.

RESULTS

The results indicated that, on average, DP increased over time, whereas EXT decreased over time. In addition, the initial levels of EXT were associated with the slope of DP. Conditional parallel-process latent growth curve modeling identified that physically abused adolescents had higher initial levels of DP and showed a slower increase in DP, while those who had been emotionally abused were associated with a steeper decrease in EXT.

CONCLUSION

The findings offer several meaningful implications for practice. First, early assessment of and treatment for EXT may be helpful in preventing DP over time. In addition, practitioners could assess each type of maltreatment to tailor preventive interventions for early onset and ongoing development of DP and EXT.

Influence of childhood trauma and post-traumatic stress symptoms on impulsivity: focusing on differences according to the dimensions of impulsivity

BACKGROUND

Impulsivity, a trait and multidimensional construct, is associated with a wide range of impulsive behaviours. Although it is well documented that childhood trauma (CT) affects impulsivity, few studies examine whether its effects depend on particular dimensions of impulsivity and the role post-traumatic stress symptoms play in the relationship between childhood trauma and different dimensions of impulsivity.

OBJECTIVE

This research aims to explore the relationships between CT, PTSD, and impulsivity in a heterogeneous clinical sample. We also sought to examine whether the influence of CT on impulsivity differs across the dimensions of impulsivity.

METHOD

We investigated the relationships between CT, symptoms of post-traumatic stress disorder (PTSD), and five dimensions of impulsivity using a sample of 162 non-psychotic psychiatric patients without neurocognitive diagnoses. Participants completed the Childhood Trauma Questionnaire (CTQ), Impact of Event Scale - Revised (IES), and the UPPS-P Impulsive Behaviour Scale (UPPS-P).

RESULTS

The results of structural equation modelling showed that CT is associated with PTSD symptoms, in addition to four of the five dimensions of impulsivity in the UPPS-P:positive urgency, negative urgency, lack of premeditation, and lack of perseverance. The indirect effect of CT through PTSD symptoms was significant only for the two types of urgency.

CONCLUSIONS

The results of this study suggest that interventions that aim to alleviate impulsive behaviour derived from high urgency should pay particular attention to the presence of CT and PTSD symptoms.

The Intersection between Criminal Accusations, Victimization, and Mental Disorders: A Canadian Population-Based Study

OBJECTIVE

Understand the relationship between criminal accusations, victimization, and mental disorders at a population level using administrative data from Manitoba, Canada.

METHOD

Residents aged 18 to 64 between April 1, 2007, and March 31, 2012 (N = 793,024) with hospital- and physician-diagnosed mental disorders were compared to those without. Overall and per-person rates of criminal accusations and reported victimization in the 2011/2012 fiscal year were examined. Relative risks were calculated, adjusting for age, sex, income, and presence of a substance use disorder. The overlap between diagnosed mental disorders, accusations, and victimization with a χ² test of independence was studied.

RESULTS

Twenty-four percent (n = 188,693) of the population had a mental disorder over the 5-year time frame. Four to fifteen percent of those with a mental disorder had a criminal accusation, compared to 2.4% of the referent group. Individuals with mental disorders, especially psychotic or personality disorders, were often living in low-income, urban neighborhoods. The adjusted relative risk of accusations and victimization remained 2 to 5 times higher in those with mental disorders compared to the referent group. Criminal accusations and victimization were most prevalent among individuals with a history of attempted suicide (15.2% had an accusation and 8.1% were victims). The risk of victimization in the same year as a criminal accusation was significantly increased among those with mental disorders compared to those without (χ² = 211.8, P < 0.001).

CONCLUSIONS

Individuals with mental disorders are at elevated risk of both criminal involvement and victimization. The identification of these multiply-stigmatized individuals may lead to better intervention and support.

Anger mediates the relationship between posttraumatic stress disorder and suicidal ideation in veterans

BACKGROUND

Theoretical models and cross-sectional empirical studies of suicide indicate that anger is a factor that may help explain the association between posttraumatic stress disorder (PTSD) and suicide, but to date no longitudinal studies have examined this relationship. The current study used longitudinal data to examine whether changes in anger mediated the association between changes in PTSD symptomatology and suicidal ideation (SI).

METHODS

Post 9/11-era veterans (N = 298) were assessed at baseline, 6-months, and 12-month time points on PTSD symptoms, anger, and SI. Analyses covaried for age, sex, and depressive symptoms. Multilevel structural equation modeling was used to examine the three waves of data.

RESULTS

The effect of change in PTSD symptoms on SI was reduced from B = 0.02 (p = .008) to B = -0.01 (p = .67) when change in anger was added to the model. Moreover, the indirect effect of changes in PTSD symptoms on suicidal ideation via changes in anger was significant, B = 0.02, p = .034. The model explained 31.1% of the within-person variance in SI.

LIMITATIONS

Focus on predicting SI rather than suicidal behavior. Sample was primarily male.

CONCLUSIONS

Findings suggest that the association between PTSD and SI is accounted for, in part, by anger. This study further highlights the importance of anger as a risk factor for veteran suicide. Additional research on clinical interventions to reduce anger among veterans with PTSD may be useful in reducing suicide risk.

Childhood maltreatment and suicide attempts in prisoners: a systematic meta-analytic review

In the past decade, the links between core types of childhood maltreatment and suicidal acts have become an increasingly important area of investigation. However, no meta-analytic review has examined this relationship in prisoners. We undertook the first systematic meta-analytic review examining the link between childhood maltreatment and suicide attempts in prisoners to redress this important gap. We searched Medline, PsychINFO, Embase, Web of Science and CINAHL from inception until August 2019. Meta-analyses using random effect models were applied, and heterogeneity was quantified using the I2 statistic. Publication bias and risk of bias across studies were assessed. We identified 24 studies comprising 16 586 prisoners. The rates of different types of childhood maltreatment ranged between 29% and 68% [95% confidence interval (CI) 18-81%]. The rate of suicide attempts in prisoners was 23% (95% CI 18-27%). Main results demonstrated that sexual abuse [odds ratio (OR) 2.68, 95% CI 1.86-3.86], physical abuse (OR 2.16, 95% CI 1.60-2.91), emotional abuse (OR 2.70, 95% CI 1.92-3.79), emotional neglect (OR 2.29, 95% CI 1.69-3.10), physical neglect (OR 1.57, 95% CI 1.27-1.94) and combined abuse (OR 3.09, 95% CI 2.14-4.45) were strongly associated with suicide attempts in prisoners. There was an indication of publication bias. Duval and Tweedie's trim-and-fill method was applied, which increased the odds for suicide attempts. Given the high rates of prison suicide deaths and suicide attempts, our findings suggest an urgent need for targeted suicide prevention priorities for prisoners, with a particular focus on ameliorating the effects of childhood traumatic experiences on suicidal prisoners.

Childhood Sexual Abuse and Lifetime Aggression

This study of college undergraduates (N = 873) examined three hypotheses regarding associations between childhood sexual abuse and lifetime aggression: 1) childhood sexual abuse was expected to account for unshared variance in the lifetime aggression indicators after controlling for the potential effects of parental physical abuse, sibling physical abuse, exposure to intimate partner violence, peer bullying, and respondent age; 2) childhood sexual abuse associations were expected to be relatively stronger among the women than the men; 3) childhood sexual abuse links to lifetime aggression were expected to vary as a function of age of victimization (adolescent < childhood < dual-age victims). Aggression histories varied widely with over 20% reporting prior injuries inflicted on others (3.2% > five injuries). Sexual abuse links to aggression tended to be stronger (p < .001) for the women than the men, and rates of aggression were higher when sexual abuse recurred across both childhood and adolescence. Partial support was found for all three hypotheses.

Childhood Trauma as a risk factor for suicidal behaviour in prisons

Suicide is a public health problem worldwide. Although it affects people of any age, race, gender, nationality or culture, the studies reveal that one of the groups that present high risk are the inmates of a penitentiary institution, with suicide figures higher than those of the general population. In recent years, penitentiary institutions around the world are trying to reduce cases of suicide deaths through prevention and early detection programs. However, in countries such as the United Kingdom, Wales or Spain, the figures are still very high. Researchers and professionals from different disciplines have tried to establish the causes and risk factors that can lead to committing suicide. Among them, suffering traumatic events in childhood (childhood trauma) has been established as one of these factors. Recent studies have shown that childhood trauma has a significant incidence in the prison population, thus assuming an important specific risk factor in this population. The objective of this article is to review the risk factors associated with suicide in the penitentiary institution in order to understand the role of childhood trauma, its emotional impact and its relation to suicidal behavior in the prison environment, thereby contributing to the understanding and management of the cases having repercussions in an improvement in the programs for the prevention of suicide in prisons.

Association of aggression and suicide behaviors: A school-based sample of rural Chinese adolescents

BACKGROUND

To determine the prevalence of suicide behaviors and the associations between aggression and suicide behaviors among a nationwide school-based sample of adolescents in rural China.

METHODS

A total of 16,271 students from 24 junior and 23 senior high schools in five provinces of China participated in a self-administered anonymous survey to report suicide ideation, plans, attempts, aggression and other related information. Multivariable logistic regression models were used to investigate the associations between aggression and the risks of suicide behaviors while controlling for potential confounders.

RESULTS

The prevalence of suicide ideation, plans, and attempts during the past one year was 15.1%, 7.2%, and 3.5% respectively. In the fully adjusted model, participants with high level of total aggression had 4.31 times (95% CI, 3.69-5.05), 4.10 times (95% CI, 3.26-5.11), and 3.29 times (95% CI, 2.62-4.93), higher risk of suicide ideation, plans, and attempts, respectively, compared with subjects who had low level of total aggression. Moreover, high levels of all the five dimensions of total aggression also had positive associations with suicide behaviors.

LIMITATIONS

This study was cross-sectional. Hence, the causal link between aggression and suicide behaviors should be verified in the future studies.

CONCLUSIONS

This study suggests that aggression may be a risk factor for suicide behaviors among rural Chinese adolescents. Our findings highlight the importance of aggression treatment in suicide prevention programs. Further longitudinal studies are needed to confirm these associations.

Suicidality in patients with somatoform disorder - the speechless expression of anger?

OBJECTIVE

To identify emotion-associated risk factors for suicidality in patients with somatoform disorders.

METHODS

A sample of 155 consecutive patients diagnosed with somatoform disorders at the Psychosomatic Ambulance of Bonn University Hospital filled in several questionnaires including the Symptom Checklist 90-Revised Version (SCL-90-R), the Toronto Alexithymia Scale (TAS-20), and the State Trait Anger Expression Inventory (STAXI). Our aim was to compare patients with suicide attempts to patients without suicide attempts via a MANCOVA (IV: Group; DV: SCL-90-R, TAS-20, STAXI; covariates: sex, age, depression, borderline personality disorder).

RESULTS

Lifetime suicide attempts were documented in 20 patients (12.9%), current active suicidal ideation in 33.6%, and thoughts of death or dying in 55.9%. Patients with lifetime suicide attempts showed significantly more psychological distress, a significantly higher alexithymia sum score, a significantly higher score on trait anger, state anger, and a stronger tendency to express anger.

CONCLUSION

Somatoform disorder patients with lifetime suicide attempts might have greater difficulties in identifying and describing emotions, and a tendency to intensely experience and express anger. Future longitudinal studies should further investigate possible links between difficulties in coping with anger and suicidality to improve prophylaxis and treatment of suicidal behaviour in somatoform disorder patients.

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.

Life experiences and the acquired capability for suicide in incarcerated men

Suicide is a leading cause of death in U.S. prisons. Prisoners may be at risk for suicide due to their greater likelihood of experiencing events that promote the acquired capability for suicide. The current study examined the associations of 10 domains of life experiences with the acquired capability for suicide in 399 male prisoners. All life experience domains were associated with acquired capability with certain domains evidencing relatively stronger relations. Results support that aggression, thrill seeking, suicidal thoughts and behaviors, and accidental injury may be particularly important to the development of the acquired capability for suicide in prisoners.

The association of adverse childhood experiences and appetitive aggression with suicide attempts and violent crimes in male forensic psychiatry inpatients

Although previous studies in inmates, forensic and psychiatric samples suggest the relation between childhood trauma and suicide behavior as well as between childhood trauma and violent delinquency, the understanding of possible underlying mechanisms is still fragmentary. In a naturalistic study design, we tested if suicidal attempts and violent crimes are differently associated with adverse childhood experiences and levels of appetitive aggression in male forensic psychiatry inpatients. Adverse childhood experiences and appetitive aggression styles were collected by means of self-report measures, suicide attempts were taken from the medical history and violent crimes were appraised by official court records. The data were analyzed by the means of generalized linear models. Results revealed that appetitive aggression and adverse childhood experiences were significant predictors of suicide attempts, whereas violent crimes were associated solely with appetitive aggression. Suicide attempts and violent delinquency in forensic patients seem to be both positively associated with high levels of appetitive aggression, whereas their etiological pathways might differ with regard to adverse childhood experiences. Considering these interrelations to a greater extent might improve both diagnostics and treatment of forensic patients.

Adverse Childhood Experiences and Suicide Attempts: The Mediating Influence of Personality Development and Problem Behaviors

Adverse childhood experiences, comprised of forms of maltreatment and certain dysfunctional household environments, can affect the development of a child in a variety of different ways. This multitude of developmental changes may subsequently produce compounding harmful effects on the child's life and increase acutely maladaptive outcomes, including adolescent suicidal behavior. This study uses data collected from 2007 to 2012 for 64,329 Florida Department of Juvenile Justice youth (21.67 % female, 42.88 % African American, and 15.37 % Hispanic) to examine the direct and indirect effects of adverse childhood experiences on suicide attempts. Using a generalized structural equation model, the effects of adverse childhood experience scores are estimated on suicidal behavior through pathways of certain aspects of a child's personality development (aggression and impulsivity), as well as adolescent problem behaviors (school difficulties and substance abuse). The results show that a large proportion of the relationship between childhood adversity and suicide is mediated by the aforementioned individual characteristics, specifically through the youth's maladaptive personality development. These results suggest that, if identified early enough, the developmental issues for these youth could potentially be addressed in order to thwart potential suicidal behavior.

Predictors for self-directed aggression in Italian prisoners include externalizing behaviors, childhood trauma and the serotonin transporter gene polymorphism 5-HTTLPR

Suicidal behavior and self-mutilation can be regarded as the expression of self-directed aggression and both are common in prison populations. We investigated the influence of externalizing behaviors, depressive symptoms, childhood trauma, 5-HTTLPR variants on self-directed aggression (N = 145) in a group of 702 male Italian prisoners. Participants were comprehensively evaluated, including for psychiatric disorders, impulsive traits, lifetime aggressive behavior [Brown-Goodwin Lifetime History of Aggression (BGHA)], hostility, violent behavior during incarceration, depressive symptomatology [Hamilton Depression Rating Scale (HDRS)], childhood trauma [Childhood Trauma Questionnaire (CTQ)]. Logistic regression analysis showed false discovery rate corrected independent main effects of externalizing behaviors: BGHA (P = 0.001), violent behavior in jail (P = 0.007), extraversion (P = 0.015); HDRS (P = 0.0004), Axis I disorders (P = 0.015), CTQ (P = 0.004) and 5-HTTLPR genotype (P = 0.02). Carriers of 5-HTTLPR high (LA LA ), intermediate (LA LG , SLA ) activity variants were more likely to have exhibited self-directed aggression relative to the low activity (LG LG , SLG , SS) variant: high/low: odds ratio (OR) = 2.3, 95% confidence interval (CI) 1.27-4.68, P = 0.007; intermediate/low: OR = 1.96, 95% CI 1.09-3.68, P = 0.025. The CTQ main effect was driven by physical abuse. There was no interactive effect of 5-HTTLPR and CTQ. Secondary logistic regression analyses in (1) all suicide attempters (N = 88) and (2) all self-mutilators (N = 104), compared with controls showed that in both groups, childhood trauma (P = 0.008-0.01), depression (P = 0.0004-0.001) were strong predictors. BGHA, violent behavior in jail predicted self-mutilation (P = 0.002) but not suicide attempts (P = 0.1). This study was able to distinguish differing influences on self-directed aggression between groups of closely related predictor variables within the externalizing behavioral domain. 5-HTTLPR had an independent, variant dosage effect.

Development pathways from abusive parenting to delinquency: the mediating role of depression and aggression

This study investigated the long-term relationship between abusive parenting and adolescent mental health, and the path to delinquent behavior. Longitudinal data from 5th through 7th graders from the Korean Children and Youth Panel Survey (KCYPS) were analyzed to examine if abusive parenting was a predictor of early adolescent delinquency behavior, via aggression and depression as mediating factors. The results were as follows. First, parental abuse (both emotional and physical) was found to have significant effects on children's psychosocial factors (aggression and depression), while parental neglect (both emotional and physical) had significant effects on depression alone and not on aggression. Second, aggression exerted significant effects on both violent and non-violent delinquent behaviors, while depression had a significant effect on only non-violent delinquent behaviors. Third, children's psychosocial factors (aggression and depression) played significant mediating roles between earlier abusive parenting and delinquent behaviors. Fourth, for children living in a family with their grandparents, paths from abusive parenting, psychosocial adaptation, and later delinquent behaviors were not significant, implying that living with grandparents played a protective factor in these relationships.

The co-occurrence of aggression and self-harm: systematic literature review

BACKGROUND

Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence.

METHOD

Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data.

RESULTS

123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated.

LIMITATIONS

Results were subject to descriptive synthesis only and thus, unable to report an overall effect size.

CONCLUSIONS

Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).

Interpersonal violence, alcohol use, and acquired capability for suicide

Acquired capability for suicide (ACS), defined as pain tolerance and fearlessness about death, is theorized as necessary to enact suicide. This study examined the associations of interpersonal violence and alcohol use with ACS in 502 college students. General fearlessness/pain tolerance was positively associated with male gender and alcohol use. Fearlessness about death was positively associated with male gender and general physical violence perpetration. However, these risk factors did not explain variance in ACS beyond male gender and history of suicide attempts/nonsuicidal self-injury. These findings add to the understanding of ACS correlates.

Does history of childhood maltreatment make a difference in prison? A hierarchical approach on early family events and personality traits

This study attempts to assess childhood maltreatment in prison through a hierarchical approach. The hierarchical approach principally aims to disentangle the independent effects of childhood maltreatment upon psychiatric morbidity/personality traits, if any, from the burden that the adverse family conditions have already imposed to the mental health of the maltreated individual-prisoner. To this direction, a conceptual framework with five hierarchical levels was constructed, namely: immutable demographic factors; family conditions; childhood maltreatment (physical abuse, neglect and sexual abuse); personality traits, habits and psychiatric morbidity; prison-related variables. A self-administered, anonymous set (battery) of questionnaires was administered to 173 male prisoners in the Chalkida prison, Greece; 26% of prisoners disclosed childhood maltreatment. Psychiatric condition in the family, parental alcoholism and parental divorce correlated with childhood maltreatment. After adjustment for immutable demographic factors and family conditions, childhood maltreatment was associated with aggression (both in terms of Lifetime History of Aggression and Buss–Perry Aggression Questionnaire scores), illicit substance use, personal history of psychiatric condition, current smoking, impulsivity and alcohol abuse. In conclusion, childhood maltreatment represents a pivotal, determining factor in the life course of male prisoners. Delinquents seem to suffer from long-term consequences of childhood maltreatment in terms of numerous mental health aspects.

Low plasma eicosapentaenoic acid levels are associated with elevated trait aggression and impulsivity in major depressive disorder with a history of comorbid substance use disorder

Major depressive disorder (MDD) is associated with low levels of omega-3 polyunsaturated fatty acids (PUFAs), holding promise for new perspectives on disease etiology and treatment targets. As aggressive and impulsive behaviors are associated with low omega-3 PUFA levels in some clinical contexts, we investigated plasma PUFA relationships with trait aggression and impulsivity in patients with MDD. Medication-free MDD patients (n = 48) and healthy volunteers (HV, n = 35) were assessed with the Brown-Goodwin Aggression Inventory. A subset (MDD, n = 39; HV, n = 33) completed the Barratt Impulsiveness Scale. Plasma PUFAs eicosapentaenoic acid (EPA, 20:5n-3), docosahexaenoic acid (DHA, 22:6n-3), and arachidonic acid (AA, 20:4n-6) were quantified and ln-transformed to mitigate distributional skew. Ln-transformed PUFA (lnPUFA) levels were predictors in regression models, with aggression or impulsivity scores as outcomes, and cofactors of sex and diagnostic status (MDD with or without a history of substance use disorder [SUD], or HV). Interactions were tested between relevant PUFAs and diagnostic status. Additional analyses explored possible confounds of depression severity, self-reported childhood abuse history, and, in MDD patients, suicide attempt history. Among PUFA, lnEPA but not lnDHA predicted aggression (F1,76 = 12.493, p = 0.001), and impulsivity (F1,65 = 5.598, p = 0.021), with interactions between lnEPA and history of SUD for both aggression (F1,76 = 7.941, p = 0.001) and impulsivity (F1,65 = 3.485, p = 0.037). Results remained significant when adjusted for childhood abuse, depression severity, or history of suicide attempt. In conclusion, low EPA levels were associated with aggression and impulsivity only in patients with MDD and comorbid SUD, even though in most cases SUD was in full sustained remission.

Persistence of aggression into adulthood in detained adolescent females

OBJECTIVE

Although detained adolescent females show high rates of severe aggression, we know little about the long-term impact of this risk-behavior. Furthermore, qualitative differences in aggression between males and females argue for gender specific research. In contrast to males, females display aggressive acts more often towards themselves (inward aggression; self harm behavior) than towards others (outward aggression). Therefore, this prospective study investigated the prevalence and predictive validity of different types of aggression in detained adolescent females.

METHOD

Participants were 139 adolescent females (mean age 20.1) assessed at start of detention and 5 years later. Both inward and outward aggression subtypes were assessed twice using standardized instruments. Mutual relations over time were analyzed by means of structural equation modeling.

RESULTS

High levels of all types of aggression were found repeatedly, suggesting substantial persistence over time. While inward aggression predicted both inward and outward aggression at follow-up, outward aggression was related to outward aggression only. Furthermore, the covert form of outward aggression only, and not the overt subtype, predicted outward aggression 5 years later.

CONCLUSIONS

This study suggests that aggression in detained adolescent females does not fade away, and should thus be given substantial clinical attention. In assessment, focus should also be on inward and covert subtypes. Further research should explore the necessity of developing gender-specific diagnostic instruments, treatment modules and risk assessment tools. When replicated, our findings may also bear implications for the classification of behavior disorders in adolescent females.

Self-reported physical and emotional abuse among youth offenders and their association with internalizing and externalizing psychopathology: a preliminary study

The aim of this exploratory study was twofold. First, the severity of physical and emotional abuse perpetrated by parents and its association with internalizing and externalizing problems were explored in a sample of 104 male and female youth offenders. Second, we tested the moderate effect of callous-unemotional traits on the relation between physical and emotional victimization and internalizing and externalizing problems in boys. The analyses revealed that a high percentage of youth offenders reported having been physically abused. More severe physical abuse was not related to higher levels of internalizing or externalizing problems. Young offenders' emotional abuse levels were low; however, this type of abuse was positively associated with externalizing problems among boys, regardless of the level of callous-unemotional traits. Thus, we suggest that youth offenders must be assessed using measures of physical and emotional abuse, and their case management should integrate specific programs to focus on the family environment to which the adolescents will most likely return after their sentence.

Nonfatal suicidal behavior among women prisoners: the predictive roles of childhood victimization, childhood neglect, and childhood positive support

Women entering prison report high rates of childhood victimization. Women in prison also report higher rates of nonfatal suicidal behavior (self-reported suicide attempts) than women in the general population and similar rates to their male counterparts despite having significantly lower suicide rates than males in the general population. Yet, there is a dearth of research that addresses the relationship between childhood victimization and suicidality for women prisoners in the United States. The purpose of this study is (a) to assess the relationship between childhood victimization and nonfatal suicidal behavior for a random sample of women prisoners; (b) to investigate predictive differences between childhood physical victimization, childhood sexual victimization, childhood neglect, and childhood support; and (c) to determine whether women prisoners with higher frequencies of childhood victimization and neglect are more likely to have attempted suicide than women prisoners with lower frequencies. Results indicate that childhood victimization, neglect, and lack of support are all significantly associated with nonfatal suicidal behavior among women prisoners. Frequency of childhood neglect had a larger effect size than frequency of childhood physical victimization, childhood sexual victimization, and lack of support. The results of this study add to the growing body of literature on childhood victimization and suicidality in general, and nonfatal suicidal behavior for prisoner populations in particular. The article ends with a discussion on clinical implications; particularly the finding that frequency of childhood victimization, childhood neglect, and lack of childhood support matters when determining the risk of suicidality.

The relationship of outwardly-directed aggression to suicidal ideation and suicide attempts across two high-risk samples

OBJECTIVE

While research has established some relationships between risk factors and specific suicide-related outcomes, in large part the extent to which suicidal ideation and attempts have different risk profiles is unclear. Using two theories of suicidal behavior to guide our hypotheses, we studied the relationship of outwardly-directed aggression to suicidal ideation and attempts in two high-risk samples.

METHOD

Participants in study one were 271 criminal offenders in a pretrial diversion program. Participants in study two were 892 psychiatric inpatients who participated in the MacArthur Violence Risk Assessment Study.

RESULTS

In both studies, after controlling for relevant covariates, outwardly-directed aggression was associated with suicide attempts, but not ideation. Among psychiatric patients, further analyses revealed that outwardly-directed aggression was associated with planned, but not unplanned, suicide attempts.

CONCLUSIONS

That aggression is related to suicide attempts and not ideation is consistent with hypotheses based on both Joiner's (2005) interpersonal theory of suicidal behavior and theories based on a diathesis toward behavioral dysregulation (e.g., Mann, 2009). That aggression was associated with planned suicide attempts is consistent with Joiner's theory. Competing explanations for the results include a potential role of proactive aggression in suicide attempts, particularly planned attempts.

Risk-related and protective correlates of nonsuicidal self-injury and co-occurring suicide attempts among incarcerated women

Individual and environmental correlates of nonsuicidal self-injury (NSSI) and co-occurring suicide attempts (SA) among incarcerated women (N = 104) were examined. Participants completed measures of putative risk and protective factors, including coping styles, childhood maltreatment, and hopelessness. Results indicated that active coping was uniquely, negatively associated with the presence and frequency of NSSI, whereas avoidant coping and childhood physical/emotional abuse were positively associated with NSSI frequency. Conversely, among women with a history of NSSI, hopelessness was uniquely, positively associated with the presence and frequency of SA. Further, childhood sexual abuse was associated with the presence of SA, while physical/emotional abuse was associated with SA frequency. Hopelessness was more strongly related to SA frequency than NSSI frequency. These findings help disentangle the unique risk and protective factors for NSSI and co-occurring SA in incarcerated samples.

Reactive and proactive aggression and suicide attempts among criminal offenders

Outwardly-directed aggression is associated with suicide attempts, but aggression is a heterogeneous construct. Increased specificity in our understanding of the link between aggression and suicide attempts can be attained by examining subtypes of aggression. We studied the relationships of reactive and proactive aggression to history of a suicide attempt among 96 criminal offenders in a pretrial supervision program. Consistent with prior findings in non-offender samples, reactive aggression was associated with a history of suicide attempt after controlling for gender and depression. Proactive aggression was unrelated to suicide attempts. Results indicate that suicide risk assessments in forensic settings may be informed by the measurement of reactive aggression.

Childhood trauma and adult interpersonal relationship problems in patients with depression and anxiety disorders

INTRODUCTION

Although a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood.

METHODS

A total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis.

RESULT

Different types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress.

CONCLUSION

Childhood emotional trauma has more influence on interpersonal problems in adult patients with depression and anxiety disorders than childhood physical trauma. A history of childhood physical abuse is related to dominant interpersonal patterns rather than submissive interpersonal patterns in adulthood. These findings provide preliminary evidence that childhood trauma might substantially contribute to interpersonal problems in adulthood.

Comparisons of prisoners who make or do not make suicide attempts and further who make one or multiple attempts

Suicidal behavior among prisoners is a major problem. The objective of this study was to compare prisoners who have made an attempt at suicide vs non-attempters and further to compare single vs multiple suicide attempts. Among 1,537 prisoners, 200 (13%) had a lifetime history of attempting suicide and 92 (6%) had made multiple attempts. Those who had made multiple or single attempts were compared on socio-demographic, developmental, personality, forensic, and psychiatric variables. In a re-analysis we also compared non-attempters with attempters in this larger sample. The comparison showed that prisoners who had made multiple attempts had experienced significantly more childhood trauma, were more introverted, less resilient, had a history of self-mutilation, and had more suicidal ideation. Anger and hostility scores and criminal and violence histories significantly differentiated prisoners who had attempted from those who had never attempted but they did not differentiate multiple from single attempters. Having a history of multiple attempts may be indicative of more severe psychopathology in prisoners, as found in other populations. These findings may be helpful in predicting which prisoner is at increased risk of exhibiting suicidal behavior while incarcerated and after release.

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.

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.

Forging an agenda for suicide prevention in the United States

Suicide prevention must be transformed by integrating injury prevention and mental health perspectives to develop a mosaic of common risk public health interventions that address the diversity of populations and individuals whose mortality and morbidity contribute to the burdens of suicide and attempted suicide. Emphasizing distal preventive interventions, strategies must focus on people and places--and on related interpersonal factors and social contexts--to alter the life trajectories of people before they become suicidal. Attention also must be paid to those in the middle years--the age with the greatest overall burden. We need scientific and social processes that define priorities and assess their potential for reducing what has been a steadily increasing rate of suicide during the past decade.

Preventive detention in Germany: an overview and empirical data from two federal states

Eighty years ago, preventive detention for dangerous offenders was implemented in the German Penal Code (Section 66). In 2011, about 500 individuals were incarcerated under a preventive detention order in Germany. Through semi-structured clinical interviews and/or collateral file review, the present investigators assessed the sociobiographic, criminological, and clinical characteristics of 58 men for whom preventive detention had been ordered in two German federal states. In addition, risk assessment instruments were administered. The majority of the inmates were sexual offenders. The main mental health problems were antisocial personality disorder (APD), substance abuse/disorder, and paraphilias. Most individuals had a history of poor socialization. Structured clinical judgment as well as actuarial risk assessment instruments identified all inmates as high-risk offenders. Future development of preventive detention in Germany must emphasize treatment interventions. Given the life histories and the mental health problems of the detainees assessed in the present study, the implementation of effective treatment will prove difficult.

Self-Reported Childhood Physical Abuse and Perpetration of Intimate Partner Violence: The Moderating Role of Psychopathic Traits

Whereas considerable evidence links childhood physical abuse with later perpetration of intimate partner violence (IPV), research to identify moderators of this relationship will increase our understanding of which victims of childhood abuse are at risk for later IPV. The present study examined dimensions of psychopathy as moderators of the relationship between physical abuse in childhood and perpetration of IPV in a sample of criminal offenders. Results indicated that, among individuals with higher levels of impulsive-irresponsible (i.e., Lifestyle) traits of psychopathy, childhood physical abuse was associated with later perpetration of IPV. Findings have implications for the propensity toward IPV perpetration among individuals who have experienced childhood physical abuse.

Hostility, physical aggression and trait anger as predictors for suicidal behavior in Chinese adolescents: a school-based study

Purpose

This study explored the extent to which trait aggression is associated with suicidal behavior in a nationwide school-based sample of adolescents.

Methods

A nationwide sample of 14,537 high school students in urban areas of China was recruited. Information concerning suicide ideation, plans, attempts, trait aggression and other risk factors was collected by a self-reported questionnaire. Multivariate regression analyses were employed to predict suicidal behavior.

Results

Approximately 18.5% of students reported suicide ideation, 8.7% reported suicide plans, and 4.1% reported attempts during the past one year. Hostility and trait anger had a significant positive association with suicidal ideation. Hostility and physical aggression were positively related to suicide plans. Hostility had a positive correlation with suicide attempts, while trait anger was inversely associated with suicide attempts.

Conclusions

This study suggests that hostility, physical aggression and trait anger may be able to be used to predict suicidal behavior among adolescents. Suicide prevention programs should target at attenuating the severity of hostility, anger and physical aggression. But teachers and parents should also give close attention to students with low trait anger.

History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression

The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss-Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State-Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n=66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance-dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features.