Abstract
The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p < 0.001) and in Florence (OR 1.11, 95% CI 1.01–1.22; p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p < 0.001) and in Madrid (OR 1.03, 95% CI 1.02–1.05; p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention.
Highlights
Since there are no psychiatric hospitals in this area, the vast majority of suicide attempters are referred to this hospital so they can be admitted to the psychiatric ward as appropriate
Patients were found to have the highest levels of aggression, these results were not replicated for impulsivity, with Florence subjects having higher impulsivity levels than those from New York City (NYC) or Madrid, which partially conflicted with our hypothesis
Impulsivity has been established as a risk factor for suicidal behavior (SB) both in adults and in children [35], and we showed impulsivity levels to distinguish suicide attempters from nonattempters in NYC and in Madrid
Summary
Of concern, is the fact that suicide rates are likely to significantly increase worldwide due to the COVID-19-related economic turndown [2,3,4,5], consistent with previous economic recessions [6]. In the US over 48,000 people took their lives in 2018, which represents an overall increase in approximately 35% in comparison with 1999 [7]. According to psychological autopsy studies, up to 74% of those who ended their lives met criteria for depression [8]. Consistent with the stress-diathesis model of suicide, aggression and impulsivity have been established as risk factors for suicidal behavior (SB) [9,10,11], in unipolar [12] and bipolar depression [13]. Aggression and impulsivity were reported to share neurobiological mechanisms with
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