A Pilot Study on Differences in Aggression in New York City and Madrid, Spain, and Their Possible Impact on Suicidal Behavior.
J Clin Psychiatry 2006;67:375-380
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Published results from a U.S.
study of depressed suicide attempters and a
Madrid, Spain, study including all consecutively
admitted suicide attempters suggested that
aggression scores were higher in U.S. attempters. This
observation led us to compare depressed attempters and controls from both suicide research
centers and explore whether New York City (NYC) patients carry out suicidal acts of greater
lethality than patients in Madrid. The study goals were
(1) to compare aggression scores in attempters and healthy volunteers between the 2 cities and (2)
to determine whether higher aggression scores are associated with greater medical lethality of
Method: The respective samples from
NYC and Madrid included attempters with a DSM-IV diagnosis of major depressive disorder
(N = 117 and N = 133) and healthy controls (N = 90 and N = 317). Aggression scores, measured by
the Brown-Goodwin Scale, in attempters and healthy volunteers from both sites were compared
using an analysis of variance model. The
relationship between lethality of suicidal acts and
aggression scores in attempters was assessed using
logistic regression analyses. NYC subjects were
recruited from 1998 to 2001, and Madrid subjects
were selected from consecutive admissions in 1999.
Results: Depressed suicide attempters
from NYC made attempts of greater lethality and reported more lifetime aggressive behavior
than depressed attempters in Madrid. NYC healthy volunteers also reported more aggression
than their Madrid counterparts.
Conclusions: This pilot study suggests
that the greater lethality of suicidal behavior in
NYC compared to Madrid is related to higher aggression levels, although the data have
limitations. Cross-cultural studies are needed to
verify whether aggression and higher lethality
suicide attempts share a common diathesis explaining
the higher suicide rates in NYC.