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Suicidal behaviors and irritability in children and adolescents: a systematic review of the nature and mechanisms of the association

  • Xavier Benarous
  • Angèle Consoli
  • David Cohen
  • Johanne Renaud
  • Hélène Lahaye
  • Jean-Marc Guilé
Original Contribution
  • 79 Downloads

Abstract

While many psychiatric disorders are associated with an increased risk for suicidal behaviors (SB) in children and adolescents, a few studies have explored the role of clinical symptoms based on a dimensional approach. Irritability is seen as a marker, a general psychopathology, and a symptom of both externalizing and internalizing disorders. In this review, we are interested in determining whether and how irritability can predict SB in youth. First, we reviewed consistencies and variation in the literature linking irritability to suicidal ideation (SI) and suicide attempt (SA). Second, based on the available models, we proposed specific mechanistic pathways, whereby irritability may modulate the risk for SB. Irritability has been found associated with SB both in cross-sectional and in longitudinal studies. The relation is consistent in different settings (i.e., general population and clinical settings) and across psychiatric disorders. The association is reduced but persists after adjusting for psychiatric disorder, including depression. On one hand, irritability constitutes a risk factor for SI via the onset of internalized disorder. On the other hand, irritable youth may be more prone to attempt suicide when experiencing SI. The measures for irritability were heterogeneous. A limited number of studies were designed to explore the role of mediators and/or moderators. Recognizing irritability in children and adolescents is a key issue with regards to suicide prevention.

Keywords

Irritability Trait anger Rage Disruptive mood dysregulation disorder Emotional dysregulation Suicidal behavior Suicidal ideation Suicide attempt 

Notes

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Xavier Benarous
    • 1
    • 2
  • Angèle Consoli
    • 1
    • 3
  • David Cohen
    • 1
    • 4
  • Johanne Renaud
    • 5
    • 6
  • Hélène Lahaye
    • 7
  • Jean-Marc Guilé
    • 2
    • 6
    • 7
  1. 1.Department of Child and Adolescent PsychiatryPitié-Salpêtrière HospitalParisFrance
  2. 2.INSERM Unit U1105 Research Group for Analysis of the Multimodal Cerebral FunctionUniversity of Picardy Jules Verne (UPJV)AmiensFrance
  3. 3.GRC-15, Dimensional approach of Child and Adolescent Psychotic EpisodesPierre and Marie Curie University (UPMC)ParisFrance
  4. 4.CNRS, UMR 7222, Institute for Intelligent Systems and RoboticsSorbonne Université, UPMCParisFrance
  5. 5.Manulife Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University InstituteMcGill UniversityMontrealCanada
  6. 6.Department of PsychiatryMcGill UniversityMontrealCanada
  7. 7.Child and Adolescent Psychopathology DepartmentAmiens University HospitalAmiensFrance

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