ATLANTA, Georgia — While the top risk factor for completed suicide is a history of previous attempts, childhood trauma and impulsivity have also been found to increase the risk of suicidality in adults.1,2 However, there have been few investigations into whether these 2 variables influence each other in their association with suicidal ideation and attempts.
Prior research has linked childhood trauma with increased frequency of a range of psychiatric disorders, such as depression, posttraumatic stress disorder, eating disorders, panic disorder, and substance abuse.1 Additionally, a correlation between impulsivity and risky behaviors — including suicidality — has been found, and research published in 2014 discovered higher levels of impulsivity among patients with a self-reported history of at least 1 suicide attempt, compared to those with no reported previous attempts.3
“People with histories of childhood trauma often develop difficulties with managing negative emotion, coping with stress, and maintaining optimism in the face of life stressors,” Lisa Cohen, PhD, a professor of psychiatry at Icahn School of Medicine at Mount Sinai Beth Israel in New York, told Psychiatry Advisor. “Impulsivity is a risk factor for all types of reckless behavior, including suicidal behavior,” she added.
Dr Cohen and others, including lead author Laura DeRubeis, a doctoral student at Adelphi University in New York, recently sought to determine whether impulsivity mediates the relationship between childhood trauma and suicidality in a sample of 113 adult inpatients.4 They hypothesized that after impulsivity was controlled for, childhood trauma would no longer predict suicidality at a statistically significant level.
As part of a larger investigation, participants were administered several questionnaires: the Childhood Trauma Questionnaire (CTQ), a Likert-type scale that measures emotional, physical, and sexual abuse, as well as emotional and physical neglect; the Barratt Impulsiveness Scale (BIS-11) and the Behavioral Activation Scale (BAS) of the Behavioral Inhibition and Activation Scales (collectively known as BIS/BAS, not to be confused with the BIS-11); and select items from the Columbia Suicide Severity Rating Scale (C-SSRS) to assess ideation and attempts.
According to the results, which were presented at the 2016 Annual Meeting of the American Psychiatric (APA) in Atlanta, Georgia, both childhood trauma and impulsivity had independent effects on suicidal ideation. However, childhood trauma was found to have an independent association with suicide attempts, while impulsivity was not. “We expected childhood trauma to influence suicidal ideation and attempts through a pathway of impulsivity, so that trauma leads to impulsivity which then leads to suicidal ideation and attempts,” explains Dr Cohen. Instead, they found that impulsivity was only related to suicidal ideation, and when childhood trauma was controlled for, impulsivity no longer predicted attempts.
Though these findings are in line with previous data on the correlation between childhood trauma, impulsivity, and suicidal ideation, they contradict the hypothesis of the current study as well as results of other studies suggesting that impulsivity is a risk factor for suicide attempts. “Childhood trauma seems to have a potent independent effect on both suicidal ideation and suicidal attempts,” the authors concluded in their paper.
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1. O’Brien BS, Sher L. Child sexual abuse and the pathophysiology of suicide in adolescents and adults. Int J Adolesc Med Health. 2013;25(3):201-205.
2. Wedig MM, Silverman MH, Frankenburg FR, Reich DB, Fitzmaurice G, Zanarini MC. Predictors of suicide attempts in patients with borderline personality disorder over 16 years of prospective follow-up. Psychol Med. 2012;42(11):2395-2404.
3. Mccullumsmith CB, Williamson DJ, May RS, A, Bruer EH, Sheehan DV, Alphs LD. Simple measures of hopelessness and impulsivity are associated with acute suicidal ideation and attempts in patients in psychiatric crisis. Innov Clin Neurosci. 2014;11(9-10): 47-53.
4. DeRubeis L, Kim KHS, Ardalan F, Tanis T, Galynker I, Cohen L. The relationship between childhood trauma, impulsivity, and suicidality in an inpatient sample. Poster presentation at: 2016 Annual Meeting of the American Psychiatric Association; May 14-18, 2016; Atlanta, GA. Young Investigators’ New Research 1–017.