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Highly variable suicidal ideation: a phenotypic marker for stress induced suicide risk
Maria A Oquendo1, Hanga C Galfalvy2, Tse-Hwei Choo2
1University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA. moquendo@pennmedicine.upenn.edu.
Molecular Psychiatry
|June 25, 2020
Summary
Childhood trauma, aggression, and impulsivity influence suicidal ideation (SI) variability. Highly variable SI increases after stressors and appears to be a stable trait over two years, potentially increasing impulsive suicidal behavior risk.
Area of Science:
- Psychiatry
- Psychology
- Neuroscience
Background:
- Suicidal behavior (SB) presents with diverse characteristics, including impulsivity, methodical planning, and varying precipitants.
- Understanding predictors of suicidal ideation (SI) variability is crucial for risk assessment and intervention.
Purpose of the Study:
- To investigate whether childhood trauma, affective lability, and aggressive/impulsive traits predict SI variability.
- To determine if affective lability, aggression, or impulsivity mediate the relationship between childhood trauma and SI variability.
- To examine SI variability's response to stressors and its longitudinal trajectory over two years.
Main Methods:
- Ecological momentary assessments (EMA) over 7 days were conducted at multiple time points over 24 months in 51 depressed participants.
- SI variability was quantified using the square Root of the Mean Square of Successive Deviations.
- Mixed Effects Models were employed to analyze the data.
Main Results:
- Physical abuse was associated with aggression, affective lability, and SI variability.
- Aggression and impulsivity, rather than physical abuse directly, predicted SI variability.
- Individuals with high SI variability showed greater SI increases following stressful events.
- SI variability did not significantly change over the 2-year study period, suggesting a trait-like nature.
Conclusions:
- Childhood trauma, particularly physical abuse, contributes to SI variability indirectly through aggression and impulsivity.
- Highly variable SI is linked to heightened responses to stressors and may represent a stable risk factor for impulsive suicidal behavior.