A Prospective Study of the Paradoxical Relationship Between Impulsivity and Lethality of Suicide Attempts
J Clin Psychiatry 2001;62(7):560-564
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: Biological studies suggest
that lower serotonergic activity is associated with both greater
suicide lethality and impulsive personality traits. These results
may lead to the conclusion that impulsivity in the attempt should
be associated with greater lethality. However, Klerman's review
of epidemiologic suicide studies suggests an inverse relationship
between impulsivity and lethality. This seemingly paradoxical
relationship between impulsivity and lethality has not been
explored in large representative clinical samples of suicide
Method: During 1996 to 1998, 478 individuals who
attempted suicide were studied in a general hospital in Madrid,
Spain. Impulsivity was measured as described in the literature by
combining 2 items of Beck's Suicidal Intent Scale (active
preparation for attempt and degree of premeditation). Lethality
of the attempt was assigned 1 of 4 levels according to the need
for medical and/or psychiatric treatment.
Results: More than half of the attempts were
impulsive (55%; 95% confidence interval [CI], 51% to 59%),
approximately one fourth of the attempts had an intermediate
level of impulsivity (28%; 95% CI, 24% to 32%), and approximately
one sixth of the attempts were not impulsive (17%, 95% CI, 13% to
21%). There was an inverse association between the impulsivity
and lethality of the suicide attempt (chi2 = 62.639,
df = 6, p < .0001). The most impulsive attempts tended to
result in less morbidity, while the less impulsive attempts
tended to be more lethal.
Conclusion: If the inverse relationship
between impulsivity and lethality is replicated in other large
and representative samples, new studies will be needed to clarify
the complex interactions between the clinical dimensions
(lethality, impulsivity as a state, and impulsivity as a
personality trait) and the biological correlates (particularly
serotonergic function) of suicidal behavior.