Can We Distinguish Types of Suicidal Behavior? Examining the Role of Impulsivity, Physical Aggression, and Emotion Regulation (Board#7)

Abstract : Research

Aims: With suicide remaining a leading cause of death in the United States, and with rates continuing to rise (CDC, 2024), identifying characteristics of those at higher risk for actual suicide attempts is important for successful interventions. Previous research has found that those with a history of aborted suicide attempts (when an individual begins to attempt suicide but stops themself) are twice as likely to have actual attempts than those without any attempts (Barber et al., 1998). Previous work has examined suicide attempts more broadly, but few studies have examined these behaviors separately or investigated potential risk factors that may distinguish suicidal behavior types. One study reported clinical symptom severity was significantly higher in participants with actual suicide attempts compared to participants with only aborted suicide attempts (Turton et al., 2018). Further examination of individual clinically relevant characteristics among these groups may help identify risk factors, or a lack of protective factors, that may be key to preventing suicide attempts. Studies have presented mixed findings on the relationship between impulsivity and suicidal behavior (Anestis et al., 2014), which may be due to a lack of specificity in suicidal behavior types Furthermore, studies that have examined the association between impulsivity and suicidal behavior (Moore et al., 2022) have not probed specific aspects of impulsivity (i.e., premeditation) linked to suicide attempts (Klonsky & May, 2010). Additionally, emotion dysregulation and the related construct of physical aggression are theorized to be positively associated with suicidal behavior, with one model suggesting a harmful feedback process between aggression and self-harm (Shafti et al., 2021). However, little research exists in this area to examine differences in these characteristics among suicidal behavior types (Turton et al., 2021; Rogers et al., 2018). Considering this previous work, we aimed to investigate whether those with actual and aborted suicide attempts differ in impulsivity, emotion dysregulation, and physical aggression.

Methods: Participants were 135 diagnostically diverse young adults (83.7% assigned female sex at birth, M age = 25.4) who experienced suicidal thoughts and/or behaviors in the past four months. Suicidal behaviors were assessed using the Columbia-Suicide Severity Rating Scale (C-SSRS; Posner et al., 2011). The three groups included in the analysis were those with no attempts (n = 63), actual attempts (n = 54), and only aborted attempts (n = 18). Participants with only interrupted attempts or interrupted and aborted attempts were excluded from the sample because of group size (n = 9) and complexity of analysis. One-way ANOVAs with Tukey’s post-hoc tests were used to assess for group differences on the Short UPPS-P Impulsive Behavior scale (SUPPS-P; Cyders et al., 2014), Difficulties in Emotion Regulation Scale (DERS; Gratz & Roemer, 2004), Emotion Regulation Questionnaire (ERQ; Gross & John, 2003), and the NIH Toolbox Physical Aggression scale (Pilkonis et al., 2013). Post-hoc independent sample t-tests were used to further examine differences between the two groups with suicidal behavior (actual attempts vs. only aborted attempts) when Tukey’s tests did not reveal group differences.

Results: Contrary to previous findings, there were no significant group differences in emotion dysregulation measures (DERS and ERQ). Between-group differences emerged for the SUPPS-P total score (F(2,131) = 3.41, p = .036), though there were no significant group differences in post-hoc Tukey’s tests. Post-hoc independent t-test revealed that individuals with actual attempts had significantly higher overall impulsivity compared to individuals with only aborted attempts based on the SUPPS-P total score (t(69) = 2.37, p = .021). The only SUPPS-P subscale with significant group differences was the Lack of Premeditation subscale (F(2,131) = 5.35, p = .006). Post-hoc Tukey’s tests revealed that individuals with actual suicide attempts (M = 8.62) had a higher score for Lack of Premeditation compared to individuals with only aborted attempts (M = 6.94; p =. 037) and no attempts (M = 7.29; p =. 012). A significant group difference was also found for the NIH Toolbox Physical Aggression scale (F(2,132) = 3.52, p = .032), with post-hoc Tukey’s tests showing physical aggression was significantly higher for individuals with actual attempts (M = 52.6) vs. individuals with no attempts (M = 48.2; p = .045).

Conclusions: These findings are consistent with previous research (Klonsky & May, 2010; Moore et al., 2022) that suggest impulsivity and physical aggression are strongly associated with suicidal behavior. Importantly, impulsivity and physical aggression appear to be factors that not only distinguish individuals with actual attempts from individuals without attempts, but also distinguish individuals with different types of suicidal behavior (i.e., actual attempts vs aborted attempts). Of note, lack of premeditation might be a driving factor in this difference in impulsivity amongst those with actual vs. only aborted attempts. Although we did not see significant group differences for emotion dysregulation in general, physical aggression (a related construct of emotion dysregulation) emerged as a distinct characteristic that distinguished between those with actual attempts and no attempts. It will be important for clinicians to measure impulsivity and physical aggression when assessing risk for suicidal behavior. Moreover, among individuals with a history of only aborted attempts, increases in impulsivity and physical aggression may signal increased risk for actual attempts, though longitudinal research is needed to better understand these relationships.