"Impulsive" suicide attempts: What do we really mean?

Suicide attempts are often regarded as impulsive acts. However, there is little consensus regarding the definition or clinical characteristics of an "impulsive" attempt. To clarify this issue, we examined 3 indicators of the impulsivity of an attempt: (a) preparation, (b) time contemplating the attempt, and (c) self-report that impulsivity motivated the attempt. We examined relationships among the indicators and their relationship to trait impulsivity and characteristics of the suicide attempt. Adult participants (N = 205) with a history of suicide attempts were administered validated interviews and questionnaires. In general, the 3 attempt impulsivity indicators correlated only moderately with each other and not at all with trait impulsivity or with important characteristics of the attempt (e.g., lethality, preattempt communication, motivations). However, there were 2 exceptions. First, intent to die was inversely related to the 3 attempt impulsivity indicators (rs ranged from -.17 to .45) such that more impulsive attempts were associated with lower intent. Second, self-report that the attempt was motivated by impulsivity was related to 3 facets of trait impulsivity (rs ranged from .16 to .41). These findings suggest that individuals endorsing trait impulsivity are likely to describe their attempts as motivated by impulsivity, regardless of the presence of preparation or prolonged contemplation. Overall, study results suggest that the common conception of a unidimensional impulsive attempt may be inaccurate and that the emphasis on general impulsivity in prevention guidelines should be tempered. Implications for suicide risk assessment and prevention are discussed. (PsycINFO Database Record