The Findings:
Impulsivity is an acknowledged personality characteristic for risk of suicidal thoughts and behaviors. Different constructs for impulsivity have been described; the authors selected a three-factor model derived from psychometric testing that includes: deficits in conscientiousness (defined as a lack of perseverance and a lack of premeditation, or, the tendency of individuals to act without forethought), sensation seeking, and urgency. The intent was to examine whether one or more of these three factors is singularly associated with future suicide likelihood in patients following admission to a Level 1 trauma center within 24 hours of a suicide attempt. Suicide likelihood was determined using the Suicidal Behaviors Questionnaire-Revised (SBQ-R). Amongst these elements of impulsivity, deficits in conscientiousness was a unique predictor of suicide likelihood that persisted after accounting for sex, age, number of previous attempts, depression and alcohol use. Notably, it contributes essentially the same extra variance in risk accounted for by depression and problematic alcohol use.

Strengths and Weaknesses:
This study offers a more ‘finely ground’ assessment of impulsivity and its relationship to suicide risk, and thereby also provides at least the potential for more targeted intervention to reduce risk. However, the predictive validity of the suicide likelihood assessment is not known; a follow-up study on the longitudinal experience of these same patients over the next five years would be informative.

Relevance:
The hospital consultation/liaison psychiatrist is regularly asked to assess patients who have been admitted to the general hospital following a suicide attempt; in part, the challenge involves discerning which patients present sufficient risk for future harm that further intensive and/or inpatient psychiatric care is needed and which patients might be safely transitioned to various forms of outpatient care and follow-up. This study suggests that among other known risk factors for future self-harm, assessing a patient’s propensity for acting without forethought provides both an added perspective on risk and a potential target for intervention, i.e., looking for opportunities to strengthen problem-solving skills that teach individuals to engage in thinking before acting.

Type of study: Cross-sectional