Hypomanic symptoms among first‐time suicide attempters predict future multiple attempt status

Abstract

Past conceptual and empirical works have identified unique differences between multiple suicide attempters, single attempters, and zero attempters, but have overlooked two distinct subgroups of single attempters: true single attempters who will not attempt suicide again, and future multiple attempters who will. Consistent with fluid vulnerability theory, the authors hypothesized that subgroups should have differences in personality traits that can predict if a first-time attempter is likely to attempt suicide again. In a sample of 127 military members (81% male, 19% female) participating in a clinical intervention study for suicidal behaviors, hypomanic symptoms -- not personality traits -- predicted future multiple attempters, and future multiple attempters more frequently met criteria for a bipolar-spectrum disorder. Clinical implications and convergence of findings with fluid vulnerability theory and existing research are discussed.

Depression Mediates the Relation of Insomnia Severity With Suicide Risk in Three Clinical Samples of U.S. Military Personnel

“…From a clinical perspective, it is possible that insomnia severity serves as an indicator of physiological arousal and psychic agitation. A growing body of research supports the value of agitation as a predictor of future suicide attempts and deaths among psychiatric patients . For example, overarousal and agitation are observed in more than 80% of psychiatric inpatients who die by suicide and suicide attempters admitted to emergency departments .…”

“…A growing body of research supports the value of agitation as a predictor of future suicide attempts and deaths among psychiatric patients. [14,41] For example, overarousal and agitation are observed in more than 80% of psychiatric inpatients who die by suicide and suicide attempters admitted to emergency departments. [42,43] Agitated mood states are more common among men than women, [44][45][46][47] and have a much stronger association with suicide ideation and attempts among men.…”

Impulsivity in mania

“…Reinforcing the importance of impulsivity and activation in suicidal behavior, a study of 127 military personnel with suicidal behavior showed that severity of hypomanic symptoms-and not personality disorder-predicted subsequent suicidal behavior [43]. The presence of a substance use disorder increased the risk of suicide attempts; this risk was associated with increased aggression and impulsivity [44].…”

The New Hamburg-Hannover Agitation Scale in Clinical Samples: Manifestation and Differences of Agitation in Depression, Anxiety, and Borderline Personality Disorder

“…It is known that agitation is linked to suicide, suicidal ideation, and suicide attempts [22][23][24][25][26] , thus making careful diagnosis and treatment very important [24,[26][27][28] . Agitation has lately been studied in BPD [29] , agitated depression [27] , bipolar disorder [30] , and schizophrenia [31] , demonstrating that it is an important therapeutic target [6,18] .…”

“…Agitation has also been shown to potentially predict the response to novel antidepressant treatment approaches with botulinum toxin [33] . More importantly, it has been found to predict suicidal ideation, suicide attempts, and -using retrospective data -actual suicide [22][23][24][25][26] .…”