Characteristics of individuals who make impulsive suicide attempts

Research indicates that a significant proportion of suicides are made impulsively (e.g., Simon et al., 2001; Wojnar et al., 2009). The identification of factors that are associated with making an impulsive suicide attempt can shed light on prevention efforts, which may need to be modified for this subgroup of suicidal individuals (Simon et al., 2001). Recently, several research teams have attempted to identify characteristics of individuals who make impulsive suicide attempts, yet only a few variables have been identified consistently across studies. For example, several investigations have demonstrated that those who make impulsive attempts tend to report lower expectations of death as a result of their attempt as compared to individuals who make premeditated attempts (Baca-Garcia et al., 2001; Williams, Davidson, & Montgomery, 1980; Wyder & De Leo, 2007). In addition, studies have shown that those who make impulsive attempts tend to be less depressed than those who make premeditated attempts (Baca-Garcia et al., 2005; Simon et al., 2001; Williams et al., 1980; Wyder & De Leo, 2007). Furthermore, several single studies have identified characteristics such as reporting less suicide ideation (Wyder & De Leo, 2007) and less hopelessness (Simon et al., 2001), and being unemployed (Wojnar et al., 2009), with making an impulsive attempt. It is important to acknowledge that these same studies have failed to find differences between individuals who make impulsive and premeditated attempts on variables such as marital status, years of education, and history of past attempts (Simon et al., 2001; Wojnar et al., 2009). Preliminary evidence also suggests that ethnicity (Simon et al., 2001) and history of childhood abuse (Wojnar et al., 2009) do not distinguish individuals who make impulsive attempts from those who make planned attempts, but again, these findings have only been reported in a single study. Finally, there are several variables that have received mixed support regarding their association with impulsive attempts, such as gender (Baca-Garcia et al., 2001; Simon et al., 2001; Weyrauch, Roy-Byrne, Katon, & Wilson, 2001; Wojnar et al., 2009; Wyder & De Leo, 2007), lower lethality of the attempt (Baca-Garcia et al., 2001; Baca-Garcia et al., 2005; Simon et al., 2001; Wyder & De Leo, 2007), and use of alcohol prior to suicide attempt (Baca-Garcia et al., 2001; Simon et al., 2001; Williams et al., 1980; Wojnar et al., 2009). Overall, further investigation of the characteristics of individuals making impulsive suicide attempts is indicated in order to clarify the mixed results that characterize this literature to date. This study compared individuals who made an impulsive suicide attempt with those who made a premeditated attempt on many characteristics that have been examined in previous studies, including demographics (i.e., gender, ethnicity, employment status, marital status, education level), suicide attempt characteristics (i.e., attempt lethality, use of alcohol or drugs immediately prior to attempt), and clinical characteristics (i.e., history of multiple suicide attempts, child sexual abuse history, severity of suicide ideation, depressive symptoms, hopelessness). On the basis of previous research, it was expected that in comparison to those making a premeditated attempt, individuals making an impulsive attempt would be more likely to be unemployed, report lower expectations of death, as well as lower levels of suicide ideation, hopelessness, and depression. No differences in ethnicity, marital status, education level, history of past suicide attempts, and history of childhood sexual abuse were expected. On the basis of previous inconsistent findings, no hypotheses were made in regard to gender differences, differences in lethality of attempt, or differences in the use of drugs and alcohol prior to the attempt. An additional feature of the present study was that structured diagnostic assessments were conducted with each participant. It is possible that those who make impulsive suicide attempts may be more likely to meet criteria for a diagnosis of an alcohol or drug use disorder and/or borderline personality disorder (BPD) than those who make premeditated attempts, given the high prevalence of impulsivity and risk-taking behaviors in these populations (e.g., Casillas & Clark, 2002). Therefore, these diagnoses were examined as novel characteristics that have not been previously investigated in previous studies.