Abstract
BackgroundSuicidal and violent behaviours are interlinked and share common biological underpinnings. In the present study we analysed the association between violent behaviour as a child, childhood trauma, adult psychiatric illness, and substance abuse in relation to interpersonal violence as an adult in suicide attempters with mood disorders.MethodsA total of 161 suicide attempters were diagnosed with Structured Clinical Interviews and assessed with the Karolinska Interpersonal Violence Scale (KIVS) measuring exposure to violence and expressed violent behaviour in childhood (between 6-14 years of age) and during adult life (15 years or older). Ninety five healthy volunteers were used as a comparison group. A logistic regression analysis was conducted with the two KIVS subscales, expressed violent behaviour as a child and exposure to violence in childhood together with substance abuse, personality disorder diagnoses and age as possible predictors of adult interpersonal violence in suicide attempters.ResultsViolent behaviour as a child, age and substance abuse were significant predictors of adult interpersonal violence. ROC analysis for the prediction model for adult violence with the KIVS subscale expressed violence as a child gave an AUC of 0.79. Using two predictors: violent behaviour as a child and substance abuse diagnosis gave an AUC of 0.84. The optimal cut-off for the KIVS subscale expressed violence as a child was higher for male suicide attempters.ConclusionsViolent behaviour in childhood and substance abuse are important risk factors for adult interpersonal violent behaviour in suicide attempters.
Highlights
Suicidal and violent behaviours are interlinked and share common biological underpinnings
Ninety-five percent of suicide attempters fulfilled criteria for at least one DSM diagnosis (Axis I or II). These patients reported significantly more adult interpersonal violence compared to suicide attempters without any DSM diagnosis (n = 8; p = 0.03, Wilcoxon test)
Suicide attempters with both comorbid substance abuse and personality disorder had significantly higher scores of used adult violence compared to suicide attempters with only mood or anxiety disorder (p = 0.0025 Wilcoxon test) and suicide attempters with comorbid personality disorder (p = 0.047, Wilcoxon test)
Summary
Suicidal and violent behaviours are interlinked and share common biological underpinnings. In the present study we analysed the association between violent behaviour as a child, childhood trauma, adult psychiatric illness, and substance abuse in relation to interpersonal violence as an adult in suicide attempters with mood disorders. Repeaters of violent offences had a twofold higher suicide risk even after controlling for psychiatric inpatient care in a recent longitudinal population based study [2], whereas, in a cross-sectional study of suicidal inpatients, more than 90% reported that they had exposed their partner for violence in the past year [3]. Even though the psychiatric comorbidity is so prevalent, there is a paucity of studies on the impact of psychiatric comorbidity patterns on violence risk in suicide attempters with mood disorders.
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