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Aggressiveness, not impulsiveness or hostility, distinguishes suicide attempters with major depression

Published online by Cambridge University Press:  07 September 2006

JOHN G. KEILP ,
MARIANNE GORLYN ,
MARIA A. OQUENDO ,
BETH BRODSKY ,
STEVEN P. ELLIS ,
BARBARA STANLEY  and
J. JOHN MANN
JOHN G. KEILP
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
MARIANNE GORLYN
Affiliation:
Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
MARIA A. OQUENDO
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
BETH BRODSKY
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
STEVEN P. ELLIS
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
BARBARA STANLEY
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
J. JOHN MANN
Affiliation:
Department of Neuroscience, New York State Psychiatric Institute, New York Department of Psychiatry, Columbia University College of Physicians and Surgeons, USA
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Abstract

Background. Impulsiveness, hostility and aggressiveness are traits associated with suicidal behavior, but also with borderline personality disorder (BPD). The presence of large numbers of BPD subjects in past attempter samples may distort the relative importance of each of these traits to predicting suicidal behavior, and lead to prospective, biological and genetic models that systematically misclassify certain subpopulations of suicidal individuals.

Method. Two hundred and seventy-five subjects with major depressive disorder (MDD), including 87 with co-morbid BPD (69 past suicide attempters, 18 non-attempters) and 188 without BPD (76 attempters, 112 non-attempters) completed standard impulsiveness, hostility and aggressiveness ratings. Differences between past suicide attempters and non-attempters were examined with the sample stratified by BPD status.

Results. As expected, BPD subjects scored significantly higher than non-BPD subjects on all three trait measures. Stratifying by BPD status, however, eliminated attempter/non-attempter differences in impulsiveness and hostility in both patient subgroups. Past suicide attempters in each of the two subgroups of patients were only distinguished by higher levels of aggressiveness.

Conclusions. Once BPD is accounted for, a history of aggressive behavior appears to be the distinguishing trait characteristic of suicide attempters with major depression, rather than global personality dimensions such as impulsiveness or hostility. Aggressiveness, and not these related traits, may be the ideal target for behavioral, genetic and biological research on suicidal behavior, as well as for the clinical assessment of suicide risk.

Type
Original Article
Information
Psychological Medicine , Volume 36 , Issue 12 , December 2006 , pp. 1779 - 1788
Copyright
© 2006 Cambridge University Press

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