This article reviews the literature on the association between impulsivity aggression and suicide. The key words impulsivity, aggression, and suicide were entered into the pubmed, psychlit, and proqest databases. Significant articles were scrutinized for relevant information. Impulsivity and aggression are highly correlated with suicidal behavior across psychiatric samples, nosological borders, and non-psychiatric populations. Impulsivity and aggression are related but the nature of this relationship remains unclear. The literature is confusing and contradictory. This is probably due to the difficulty in defining and separating out these concepts and the fact that there is much overlap between them. Future research should aim at clarifying and refining these concepts as well as their link to all the different forms of suicidal behavior.

BackgroundOne of the main obstacles in studying suicide risk factors is the difference between cases in which the individual died by suicide and those in which the individual engaged in suicidal behavior. A promising strategy that overcomes this obstacle is the study of survivors of serious suicide attempt (SSA), i.e., an attempt that would have been lethal had it not been for the provision of rapid and effective emergency treatment. Serious suicide attempters are epidemiologically very much like those who died by suicide, and thus may serve as valid proxies for studying suicides. This paper aims to define the specific risk factors for SSAs by conducting a qualitative data synthesis of existing studies.MethodsFollowing Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a systematic search of the literature in PubMed, ProQuest, and Psychlit electronic research-literature databases. Search terms were “serious” “OR” “near lethal,” combined with the Boolean “AND” operator with “suicide*.” In addition, we performed a manual search on Google Scholar for further studies not yet identified.ResultsThe preliminary search identified 683 citations. A total of 39 research reports that met the predefined criteria were analyzed. Mental pain, communication difficulties, decision-making impulsivity, and aggression, as well as several demographic variables, were found to be major risk factors for SSAs.LimitationsWe found a variability of definitions for SSA that hamper the ability to draw a model for the risk factors and processes that facilitate it. Moreover, the role of suicide intent and planning in SSA is still unclear. Further studies should aim to clarify and refine the concepts and measures of SSA, thereby enabling more specific and concrete modeling of the psychological element in its formation.ConclusionSSA is a distinguishable phenomenon that needs to be addressed specifically within the scope of suicidal behavior. Interpersonal problems, as well as impulsivity and aggression, seem to facilitate SSA when mental pain serves as a secondary factor. Healthcare professionals should be aware of SSA, and familiar with its specific risk factors. Moreover, psychological and suicidal risk assessment should include a designated evaluation of these risk factors as part of intervention and prevention models for SSA.

Suicidal behavior is a major public health problem. As it has for decades, suicide remains one of the leading causes of death in the western world. This paper reviews the literature and the latest developments on the research and knowledge of suicide behavior and death from suicide. The keywords: suicide, psychopathology, mental pain, impulsivity, aggression and communication difficulties were entered into databases: PubMed, PsychLit and ProQuest. Significant articles were scrutinized for relevant information. According to WHO estimates for the year 2020, approximately 1.53 million people will die from suicide, and ten to 20 times more people will attempt suicide worldwide. These estimates represent on average one death every 20 seconds and one attempt every one to two seconds. Although of low predictive value, the presence of psychopathology is probably the single most important predictor of suicide. Accordingly, approximately 90 percent of suicide cases meet criteria for a psychiatric disorder, particularly major depression, substance use disorders, cluster B personality disorders and schizophrenia. Other more transient factors that reflect an imminent risk of suicide crisis and therefore require immediate intervention include unbearable mental pain and related experiences of depression and hopelessness. Problems with help-seeking, social communication and self-disclosure also pose a suicide risk, as do personality traits of aggression and impulsivity. All these factors are highly correlated with suicidal behavior across psychiatric samples and nosological borders. Although suicidal behavior has been well studied, empirically and clinically, the definition of the different subtypes and phenotypes of suicidal behaviors and mechanisms underlying some of the risk factors (such as aggression, impulsivity, suicide intent) remain unclear. Reducing the increasing trend of suicide rates among the most vulnerable populations will require further research. Hopefully this review will contribute to the understanding of this phenomenon and to the development of preventive initiatives

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Medical severe suicide attempts (MSSA) are epidemiologically very similar to individuals who complete suicide. Thus the investigation of individuals who have made MSSAs may add to our understanding of the risk factors for completed suicide. The aim of this study was to assess the role of mental pain and communication difficulties in MSSA. A total of 336 subjects were divided into 4 groups: 78 meeting criteria for MSSA compared with116 subjects who made a medically non-serious suicide attempt (MNSSA), 47 psychiatric controls with no history of suicidal behavior, and 95 healthy controls. Mental pain variants (e.g., hopelessness), facets of communication difficulties (e.g., self-disclosure), as well as socio-demographic and clinical characteristics were assessed. The MSSA had significantly higher communication difficulties than the other 3 groups. Moreover, the interaction between mental pain and communication difficulties explained some of the variance in suicide lethality, above and beyond the contribution of each component alone. This report underlines the importance of mental pain for suicide attempts in general while difficulties in communication abilities play a critical role in differentiating MSSA from MNSSA. The co-existence of unbearable mental pain with difficulties in communication significantly enhances the risk for more lethal forms of suicidal behavior.