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Impulsivity and Suicidality in Adolescent Inpatients

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Abstract

Suicide is the second leading cause of death among adolescents, and impulsivity has emerged as a promising marker of risk. The present study tested whether distinct domains of impulsivity are differentially associated with suicide ideation, plans, and attempts. Adolescents (n = 381; boys = 106, girls = 275) aged 13–19 years (M = 15.62, SD = 1.41) were recruited from an acute, residential treatment program. Within 48 h of admission to the hospital, participants were administered structured clinical interviews assessing mental health disorders and suicidality. Following these interviews, participants completed self-report questionnaires assessing symptom severity and impulsivity. Consistent with past research, an exploratory factor analysis of our 90-item impulsivity instrument resulted in a three-factor solution: Pervasive Influence of Feelings, Feelings Trigger Action, and Lack of Follow-Through. Concurrent analysis of these factors confirmed hypotheses of unique associations with suicide ideation and attempts in the past month. Specifically, whereas Pervasive Influence of Feelings (i.e., tendency for emotions to shape thoughts about the self and the future) is uniquely associated with greater suicidal ideation, Feelings Trigger Action (i.e., impulsive behavioral reactivity to emotions) is uniquely associated with the occurrence of suicide attempts, even after controlling for current psychiatric diagnoses and symptoms. Exploratory gender analyses revealed that these effects were significant in female but not male adolescents. These findings provide new insight about how specific domains of impulsivity differentially increase risk for suicide ideation and attempts. Implications for early identification and prevention of youth suicide are discussed.

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Notes

  1. The impulsivity measure includes both a negative and a positive urgency subscale (i.e., tendency to act recklessly or inappropriately during positive mood states). The 7-item positive urgency subscale was inadvertently omitted from the assessment. Nonetheless, the factor structure and interrelationships among the factors remained consistent with past research (see Carver et al. 2011; Johnson et al. 2013).

  2. When reporting the method of suicide attempts, some participants reported using multiple methods in their most recent attempt.

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Acknowledgments

Randy P. Auerbach was partially supported through funding from: National Institute of Mental Health K23MH097786, the Klingenstein Third Generation Foundation Adolescent Depression Fellowship, the Tommy Fuss Fund, and the Simches Fund. Jeremy G. Stewart was supportedthrough the Skip Pope Award for Young Investigators awarded by McLean Hospital.

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Authors and Affiliations

  1. Department of Psychiatry, Harvard Medical School;Center for Depression, Anxiety and Stress Research, McLean Hospital, 115 Mill Street, deMarneffe, Room 240, Belmont, MA, 02478, USA

    Randy P. Auerbach & Jeremy G. Stewart

  2. Department of Psychology, University of California, Berkeley, CA, USA

    Sheri L. Johnson

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  1. Randy P. Auerbach
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All procedures performed in this study with human subjects was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments.

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Auerbach, R.P., Stewart, J.G. & Johnson, S.L. Impulsivity and Suicidality in Adolescent Inpatients. J Abnorm Child Psychol 45, 91–103 (2017). https://doi.org/10.1007/s10802-016-0146-8

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