The role of impulsivity and aggression in suicidal ideation and behavior among military veterans

Suicide rates among veterans are substantially higher than non-veterans and continue to rise according to the most recent data. However, specific mechanisms underlying suicide risk are poorly understood and understudied in this population. We investigated the role of impulsivity and aggression in the suicide process in veterans.

A total of 93 veterans (26 with no history of suicidal ideation or attempt, 38 with a history of suicidal ideation but no attempt, and 29 with a history of suicide attempt) were assessed for impulsivity and aggression traits, depression, and suicide status. Multivariate logistic regressions examined the domains of impulsivity and aggression that were associated with suicidal ideation and attempt.

Higher odds of suicidal ideation (vs. no suicidal ideation) were associated with greater hostility, odds ratio (OR)=1.23, 95 % confidence interval (CI)=1.03-1.47, p=.025. Negative urgency (OR [95 % CI]=5.40 [1.18-24.78], p=.030) and physical aggression (OR [95 %CI]=1.27 [1.09-1.49], p=.002) were risk factors for suicide attempt (vs ideation only) while greater verbal aggression (OR [95 % CI]=0.78 [0.63-0.98], p=.035) and positive urgency (OR [95 % CI]=0.017[0.04-0.77], p=.021) were associated with lower odds of suicide attempt. Attempters with higher verbal aggression had less lethal suicide attempts. Depression was associated with suicide attempts only among those with low negative or positive urgency but not in those high in these traits.

Results suggest that specific domains of impulsivity and aggression, and their interaction with depression, play a role in the suicide process. These findings offer insight into strategies to enhance suicide detection and targeted intervention efforts.