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Toward a Clinical Model of Suicidal Behavior in Psychiatric Patients
Abstract
OBJECTIVE: Risk factors for suicide attempts have rarely been studied comprehensively in more than one psychiatric disorder, preventing estimation of the relative importance and the generalizability of different putative risk factors across psychiatric diagnoses. The authors conducted a study of suicide attempts in patients with mood disorders, psychoses, and other diagnoses. Their goal was to determine the generalizability and relative importance of risk factors for suicidal acts across diagnostic boundaries and to develop a hypothetical, explanatory, and predictive model of suicidal behavior that can subsequently be tested in a prospective study. METHOD: Following admission to a university psychiatric hospital, 347 consecutive patients who were 14-72 years old (51% were male and 68% were Caucasian) were recruited for study. Structured clinical interviews generated axis I and axis II diagnoses. Lifetime suicidal acts, traits of aggression and impulsivity, objective and subjective severity of acute psychopathology, developmental and family history, and past substance abuse or alcoholism were assessed. RESULTS: Objective severity of current depression or psychosis did not distinguish the 184 patients who had attempted suicide from those who had never attempted suicide. However, higher scores on subjective depression, higher scores on suicidal ideation, and fewer reasons for living were reported by suicide attempters. Rates of lifetime aggression and impulsivity were also greater in attempters. Comorbid borderline personality disorder, smoking, past substance use disorder or alcoholism, family history of suicidal acts, head injury, and childhood abuse history were more frequent in suicide attempters. CONCLUSIONS: The authors propose a stress-diathesis model in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis. This diathesis may be reflected in tendencies to experience more suicidal ideation and to be more impulsive and, therefore, more likely to act on suicidal feelings. Prospective studies are proposed to test this model.
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“The antisuicidal effect estimated here is larger than the effect on mood episodes, 27 28 raising the possibility of a specific effect.33”
From Lithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis (2013) · cites this paper as [33]
In the citing paper
“Numerous reports of associations between suicidal behavior and a range of neurobiological parameters have emerged from studies of mixed age and younger adult samples (52).”
From Suicide in older adults (2011) · cites this paper as [52]
In the citing paper
“First, suicidal behavior is found in many psychiatric disorders and not just in mood disorders and borderline personality disorder, where it is part of the diagnostic symptom list.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“The stress-diathesis model (13, 14) depicts suicidal behavior as a consequence of an interaction between acute stressors or proximal risk factors and a diathesis or distal factors (Figure 1).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Suicidal behavior risk is moderated by a set of psychopathological and cognitive traits that are different from the psychopathology of associated psychiatric illnesses.”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“Second, only a minority of psychiatric patients make suicide attempts, and the presence or absence of suicidal behavior is not simply determined by the presence of a psychiatric illness or the overall severity of illness (12-14).”
From A brain-centric model of suicidal behavior (2020) · cites this paper as [13]
In the citing paper
“A stress-diathesis psychological model explains suicide risk as a combination of stressors in vulnerable persons.”
From Suicide (2020) · cites this paper as [31]
In the citing paper
“Individual vulnerability is considered to express itself in suicidal ideation under stress and is magnified by impulsivity and aggression, which increase the likelihood of acting on suicidal ideas.31”
From Suicide (2020) · cites this paper as [31]
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“As has been well articulated by others (Brent & Mann, 2003a; Mann et al., 1999; Shaffer & Pfeffer, 2001), suicidal behavior may arise through an interaction of two sets of vulnerabilities – major psychiatric disorder, most commonly mood disorder, and a tendency to impulsive aggression, which in turn may have Adolescen…”
MethodYouth Suicide Risk and Preventive Interventions: A Review of the Past 10 Years
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1097/01.chi.0000046821.95464.cf · Cited by 1,264
“To explain the often-replicated finding that serotonin dysregulation is associated with suicidality regardless of diagnosis, Mann et al. (1999) suggested that the dysregulation is a biological trait that predisposes to suicide— a stress-diathesis model.”
BackgroundNeurobiology of suicidal behaviour
Mann, J. J. (2003) · Nature Reviews Neuroscience · doi:10.1038/nrn1220 · Cited by 1,260
Self-citationBogg, T., & Roberts, B. W. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.6.887 · Cited by 1,632
The psychology of suicidal behaviour
O'Connor, R. C., & Nock, M. K. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70222-6 · Cited by 1,193
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The Assessment of Present-Moment Awareness and Acceptance: The Philadelphia Mindfulness Scale
Cardaciotto, L., Herbert, J. D., Forman, E. M., Moitra, E., & Farrow, V. (2008) · Assessment · doi:10.1177/1073191107311467 · Cited by 940
“The BHS has excellent internal consistency (KR-20 coefficients ranging from .82 to .93) and concurrent validity is well established across a wide variety of samples (e.g., Beck, Steer, Beck, & Newman, 1993; Mann, Waternaux, Haas, & Malone, 1999 ).”
BackgroundNock, M. K., Hwang, I., Sampson, N., Kessler, R. C., Angermeyer, M., Beautrais, A., Borges, G., Bromet, E., Bruffaerts, R., de Girolamo, G., et al. (2009) · PLoS Medicine · doi:10.1371/journal.pmed.1000123 · Cited by 912
“Several theoretical models have proposed that some disorders such as depression lead people to desire suicide, and other disorders characterized by anxiety/agitation and problems with impulsecontrol increase the likelihood that people act on such thoughts [56–60].”
BackgroundLithium in the prevention of suicide in mood disorders: updated systematic review and meta-analysis
Cipriani, A., Hawton, K., Stockton, S., & Geddes, J. R. (2013) · BMJ · doi:10.1136/bmj.f3646 · Cited by 920
Miranda-Mendizabal, A., Castellví, P., Parés-Badell, O., Alayo, I., Almenara, J., Alonso, I., Blasco, M. J., Cebrià, A., Gabilondo, A., Gili, M., et al. (2019) · International Journal of Public Health · doi:10.1007/s00038-018-1196-1 · Cited by 886
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Risk factors for suicide in later life
Conwell, Y., Duberstein, P. R., & Caine, E. D. (2002) · Biological Psychiatry · doi:10.1016/s0006-3223(02)01347-1 · Cited by 701
“Based on extensive evidence that abnormalities in central serotonergic function are associated with a predisposition to impulsive and aggressive acts, Mann and others have proposed a stress-diathesis model in which individuals with an impulsive/aggressive style and a tendency to experience suicidal ideation under stre…”
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Mehlum, L., Tørmoen, A. J., Ramberg, M., Haga, E., Diep, L. M., Laberg, S., Larsson, B. S., Stanley, B. H., Miller, A. L., Sund, A. M., et al. (2014) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2014.07.003 · Cited by 616
Family genetic studies, suicide, and suicidal behavior
Brent, D. A., & Mann, J. J. (2005) · American Journal of Medical Genetics Part C Seminars in Medical Genetics · doi:10.1002/ajmg.c.30042 · Cited by 618
“It is possible that ideation is related to depression, which is heritable, but that the unique component of the genetics of suicidal behavior is the tendency to act upon suicidal thoughts [Mann et al., 1999].”
BackgroundSelf-citationMann, J. J., Huang, Y.-Y., Underwood, M. D., Kassir, S. A., Oppenheim, S., Kelly, T. M., Dwork, A. J., & Arango, V. (2000) · Archives of General Psychiatry · doi:10.1001/archpsyc.57.8.729 · Cited by 613
“Aggressive and impulsive traits, alcoholism, and substance abuse all carry an elevated risk of suicide and are also associated with serotonergic abnormalities.(72,73) There is disagreement about whether the 5-HTTLPR genotype is associated with harm avoidance temperament,(66) alcoholism,(74-76) anxiety, or impulsive tr…”
BackgroundSelf-citationOquendo, M. A., Galfalvy, H., Russo, S., Ellis, S. P., Grunebaum, M. F., Burke, A., & Mann, J. J. (2004) · American Journal of Psychiatry · doi:10.1176/appi.ajp.161.8.1433 · Cited by 605
“The subjective rating of depression severity, as measured by the Beck Depression Inventory, predicted future suicidal acts in this study, an association also found in a retrospective study by our group (22).”
BackgroundMethodInfluentialSelf-citationBrezo, J., Paris, J., & Turecki, G. (2006) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00702.x · Cited by 647
Dumais, A., Lesage, A. D., Alda, M., Rouleau, G., Dumont, M., Chawky, N., Roy, M., Mann, J. J., Benkelfat, C., & Turecki, G. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.11.2116 · Cited by 583
Self-citationSilverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.3.248 · Cited by 593
“Beautrais concluded that suicides and medically serious suicide attempts are (Mann, Waternaux, Haas, & Malone, 1999), what may look like an impulsive act may ac-two overlapping populations that share common psychiatric diagnostic and historical fea- tually be a culmination of a thinking and…”
BackgroundTowards an integrated motivational–volitional model of suicidal behaviour
O'connor, R. C. (2011) · International Handbook of Suicide Prevention · doi:10.1002/9781119998556.ch11 · Cited by 552
van Heeringen, K., & Mann, J. J. (2014) · The Lancet Psychiatry · doi:10.1016/s2215-0366(14)70220-2 · Cited by 550
Self-citationConwell, Y., Van Orden, K., & Caine, E. D. (2011) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2011.02.002 · Cited by 555
“Numerous reports of associations between suicidal behavior and a range of neurobiological parameters have emerged from studies of mixed age and younger adult samples (52).”
Impaired decision making in suicide attempters
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“Further, aggression and impulsivity has been closely linked to a history of suicidal behavior (Mann et al., 1999).”
Rodríguez-Cintas, L., Daigre, C., Braquehais, M. D., Palma-Álvarez, R. F., Grau‐López, L., Ros‐Cucurull, E., Rodríguez-Martos, L., Abad, A. C., & Roncero, C. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.09.021 · Cited by 533
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Risk for Suicide Attempts Among Adolescents Who Engage in Non-Suicidal Self-Injury
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“Other researchers have noted that depressive symptoms alone may not be strong predictors of suicide (Mann, Waternaux, Haas et al, 1999 ).”
BackgroundA cognitive model of suicidal behavior: theory and treatment
Wenzel, A., & Beck, A. T. (2008) · Applied and Preventive Psychology · doi:10.1016/j.appsy.2008.05.001 · Cited by 491
Manuck, S. B., Flory, J. D., Ferrell, R. E., Mann, J. J., & Muldoon, M. F. (2000) · Psychiatry Research · doi:10.1016/s0165-1781(00)00162-1 · Cited by 486
Self-citationLinehan, M. M., Comtois, K. A., Brown, M. Z., Heard, H. L., & Wagner, A. (2006) · Psychological Assessment · doi:10.1037/1040-3590.18.3.303 · Cited by 486
“The Suicide Intent Scale (Beck, Schuyler, & Herman, 1974) is the most frequently cited measure of suicide intent in the literature (Groholt et al., 2000; Mann et al., 1999; Strosahl, Chiles, & Linehan, 1992) and is recommended by many suicide experts (Bongar, 1991; Maris, Berman, Maltsberger, & Yufit, 1992).”
BackgroundMethodCarver, C. S., Johnson, S. L., & Joormann, J. (2008) · Psychological Bulletin · doi:10.1037/a0013740 · Cited by 510
Suicide Risk and Mental Disorders
Brådvik, L. (2018) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph15092028 · Cited by 483
“A stress-diathesis model has been proposed in which the risk for suicidal acts is determined not merely by a psychiatric illness (the stressor) but also by a diathesis, such as a tendency to experience more suicidal ideation and to be more likely to act on suicidal feeling [7].”
BackgroundSuicidal ideation in transgender people: Gender minority stress and interpersonal theory factors.
Testa, R. J., Michaels, M. S., Bliss, W., Rogers, M. L., Balsam, K. F., & Joiner, T. (2017) · Journal of Abnormal Psychology · doi:10.1037/abn0000234 · Cited by 455
Brodsky, B. S., Oquendo, M., Ellis, S. P., Haas, G. L., Malone, K. M., & Mann, J. J. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.11.1871 · Cited by 438
Self-citationSwann, A. C., Dougherty, D. M., Pazzaglia, P. J., Pham, M., Steinberg, J. L., & Moeller, F. G. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.9.1680 · Cited by 439
“These findings are consistent with models for suicidal behavior that require some disinhibitory factor even in predominantly premeditated attempts, suggesting that impulsivity increases risk when combined with depression (7, 49, 50).”
BackgroundResultMedia contagion and suicide among the young
Gould, M., Jamieson, P., & Romer, D. (2003) · American Behavioral Scientist · doi:10.1177/0002764202250670 · Cited by 429
Aggression, Impulsivity, and Suicide Behavior: A Review of the Literature
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“Alcohol may influence both the occurrence of self-harm, through contributing to interpersonal and other problems and an individual’s reactions to them, and impulsivity and aggression, both of which are important factors in suicidal behaviour [26].”
BackgroundResilience to suicidality: The buffering hypothesis
Johnson, J., Wood, A. M., Gooding, P. A., Taylor, P. J., & Tarrier, N. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.12.007 · Cited by 463
“First, suicidality can be understood as a continuum (Carter et al., 2005; Mann et al., 1999) with suicidal ideation increasing risk for completed suicide (Funahashi et al., 2000).”
BackgroundEvans, E., Hawton, K., & Rodham, K. (2004) · Clinical Psychology Review · doi:10.1016/j.cpr.2004.04.005 · Cited by 541
A Current Perspective of Suicide and Attempted Suicide
Mann, J. J. (2002) · Annals of Internal Medicine · doi:10.7326/0003-4819-136-4-200202190-00010 · Cited by 568
“One such explanatory and predictive model is the stress– diathesis model ( 10 ).”
BackgroundResultInfluentialSelf-citationSuicidal Behaviour in Bipolar Disorder
Tondo, L., Isacsson, G., & Baldessarini, R. J. (2003) · CNS Drugs · doi:10.2165/00023210-200317070-00003 · Cited by 405
The neurobiology and genetics of suicide and attempted suicide: A focus on the serotonergic system
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“Aggression, impulsivity, alcoholism, and substance abuse all carry an elevated risk of suicide and are also associated with serotonergic abnormalities (Whitaker-Azmitia and Peroutka 1990; Mann et al. 1999).”
BackgroundSelf-citationSilver, J., KRAMER, R. A., Greenwald, S., & Weissman, M. M. (2001) · Brain Injury · doi:10.1080/02699050110065295 · Cited by 396
“[23] found an increased occurrence of TBI in individuals who have made suicide attempts.”
BackgroundNeuropsychological dysfunction in depressed suicide attempters
Keilp, J. G., Sackeim, H. A., Brodsky, B. S., Oquendo, M. A., Malone, K. M., & Mann, J. J. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.5.735 · Cited by 372
Self-citationSuicidal Ideation and Attempts Among Psychiatric Patients With Major Depressive Disorder
Sokero, T. P., Melartin, T. K., Rytsälä, H. J., Leskelä, U. S., Lestelä-Mielonen, P. S., & Isometsä, E. T. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0916 · Cited by 381
Zalsman, G., Huang, Y.-Y., Oquendo, M. A., Burke, A. K., Hu, X.-Z., Brent, D. A., Ellis, S. P., Goldman, D., & Mann, J. J. (2006) · American Journal of Psychiatry · doi:10.1176/ajp.2006.163.9.1588 · Cited by 371
Self-citationProtective Factors Against Suicidal Acts in Major Depression: Reasons for Living
Malone, K. M., Oquendo, M. A., Haas, G. L., Ellis, S. P., Li, S., & Mann, J. J. (2000) · American Journal of Psychiatry · doi:10.1176/appi.ajp.157.7.1084 · Cited by 366
Self-citationSuicide Among Soldiers: A Review of Psychosocial Risk and Protective Factors
Nock, M. K., Deming, C. A., Fullerton, C. S., Gilman, S. E., Goldenberg, M., Kessler, R. C., McCarroll, J. E., McLaughlin, K. A., Peterson, C., Schoenbaum, M., et al. (2013) · Psychiatry · doi:10.1521/psyc.2013.76.2.97 · Cited by 374
“Presence of Mental Illness—The presence of a mental disorder is among the most consistently reported risk factors for suicidal behavior (Gould et al., 1998; Hyman, Ireland, Frost, & Cottrell, 2012; Kessler, Borges, & Walters, 1999; Mann et al., 1999; Nock, Borges, Bromet, Alonso, et al., 2008; Petronis, Samuels, Mosci…”
BackgroundSingle-item measurement of suicidal behaviors: Validity and consequences of misclassification
Millner, A. J., Lee, M. D., & Nock, M. K. (2015) · PLOS ONE · doi:10.1371/journal.pone.0141606 · Cited by 361
“For example, prior research suggests that increased impulsiveness is a risk factor for attempting suicide [16].”
BackgroundThe Psychology and Neurobiology of Suicidal Behavior
Joiner, T. E., Brown, J. S., & Wingate, L. R. (2005) · Annual Review of Psychology · doi:10.1146/annurev.psych.56.091103.070320 · Cited by 481
Keilp, J. G., Gorlyn, M., Russell, M., Oquendo, M. A., Burke, A. K., Harkavy-Friedman, J., & Mann, J. J. (2013) · Psychological Medicine · doi:10.1017/s0033291712001419 · Cited by 350
“Other clinical ratings have been described previously (Mann et al. 1999) and are listed in Table 1.”
BackgroundSelf-citationSuicide risk in schizophrenia: learning from the past to change the future
Pompili, M., AMADOR, X. F., Girardi, P., Harkavy‐Friedman, J., Harrow, M., Kaplan, K. J., Krausz, M. R., Lester, D., Meltzer, H. Y., Modestin, J., et al. (2007) · Annals of General Psychiatry · doi:10.1186/1744-859x-6-10 · Cited by 386
“Researchers have suggested that depression can serve as a stressor or trigger for suicidal behavior among individuals who are at risk for suicidal behavior [67], and this has been demonstrated among individuals with schizophrenia [68].”
Qin, P., Agerbo, E., & Mortensen, P. B. (2002) · The Lancet · doi:10.1016/s0140-6736(02)11197-4 · Cited by 352
Leverich, G. S., Altshuler, L. L., Frye, M. A., Suppes, T. M., Keck, P. E., McElroy, S. L., Denicoff, K. D., Obrocea, G. V., Nolen, W. A., Kupka, R., et al. (2003) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v64n0503 · Cited by 355
Resilience as positive coping appraisals: Testing the schematic appraisals model of suicide (SAMS)
Johnson, J., Gooding, P. A., Wood, A. M., & Tarrier, N. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2009.10.007 · Cited by 347
Familial Pathways to Early-Onset Suicide Attempt
Brent, D. A., Oquendo, M. A., Birmaher, B. B., Greenhill, L. L., Kolko, D. J., Stanley, B., Zelazny, J. M., Brodsky, B., Bridge, J. A., Ellis, S., et al. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.9.801 · Cited by 349
“These data are consistent with a growing literature that associates liability to hostility or aggression in the face of stress, rather than impulsivity, with suicidal behavior.(54) Our data are not consistent with imitation as an explanation for parent-to-child transmission.”
ResultSelf-citationAddiction and suicide: A review
Yuodelis‐Flores, C., & Ries, R. K. (2015) · American Journal on Addictions · doi:10.1111/ajad.12185 · Cited by 345
The Impact of Mental Illness Stigma.
Corrigan, P. W., & Kleinlein, P. (2005) · American Psychological Association eBooks · doi:10.1037/10887-001 · Cited by 361
A meta-analysis of acute use of alcohol and the risk of suicide attempt
Borges, G. L. G., Bagge, C. L., CHERPITEL, C. J. S., Conner, K. R., Orozco, R., & Rossow, I. M. (2016) · Psychological Medicine · doi:10.1017/s0033291716002841 · Cited by 370
“First, consistent with the diathesis–stress model and related approaches (Mann et al. 1999), AUA may trigger suicide attempt in vulnerable individuals.”
ResultConwell, Y., & Thompson, C. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.01.004 · Cited by 333
“The most consistent findings suggest that abnormalities in central serotonergic function predispose individuals to act impulsively and aggressively in the face of dysphoria, hopelessness, and emergent suicidal ideation in the depressed state [52].”
BackgroundSuicide after traumatic brain injury: a population study
Teasdale, T. W. (2001) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.71.4.436 · Cited by 330
“and suicidal ideation and suicide attempts after traumatic brain injury have also been reported.”
BackgroundLife events and suicidal ideation and behavior: a systematic review
Liu, R. T., & Miller, I. (2014) · Clinical Psychology Review · doi:10.1016/j.cpr.2014.01.006 · Cited by 324
“…that life stressors may often function as triggers for suicidal ideation and behavior, particularlywhen interactingwith an underlying diathesis (Mann et al., 1999; O'Connor et al., 2012), and thus should be expected immediately to precede the outcome they are hypothesized to predict.”
BackgroundVeterinary surgeons and suicide: a structured review of possible influences on increased risk
Bartram, D. J., & Baldwin, D. S. (2010) · Veterinary Record · doi:10.1136/vr.b4794 · Cited by 356
Advances in the assessment of suicide risk
Bryan, C. J., & Rudd, M. D. (2005) · Journal of Clinical Psychology · doi:10.1002/jclp.20222 · Cited by 322
Are Suicide Attempters Who Self-Mutilate a Unique Population?
Stanley, B., Gameroff, M. J., Michalsen, V., & Mann, J. J. (2001) · American Journal of Psychiatry · doi:10.1176/appi.ajp.158.3.427 · Cited by 315
Self-citationReconsidering the link between impulsivity and suicidal behavior
Anestis, M. D., Soberay, K. A., Gutierrez, P. M., Hernández, T. D., & Joiner, T. E. (2014) · Personality and Social Psychology Review · doi:10.1177/1088868314535988 · Cited by 307
“Indeed, in explaining the role of impulsivity in suicidal behavior, Mann et al. (1999) noted that, due to their propensity toward impulsive action, suicide attempters “feel more suicidal and are more likely to act on feelings” (p. 186).”
BackgroundSuicidal Behaviour in Mood Disorders—Who, When, and Why?
Isometsä, E. T. (2014) · The Canadian Journal of Psychiatry · doi:10.1177/070674371405900303 · Cited by 328
Low plasma BDNF is associated with suicidal behavior in major depression
Kim, Y.-K., Lee, H.-P., Won, S.-D., Park, E.-Y., Lee, H.-Y., Lee, B.-H., Lee, S.-W., Yoon, D., Han, C., Kim, D.-J., et al. (2007) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2006.06.024 · Cited by 300
Toward a Biosignature for Suicide
Oquendo, M. A., Sullivan, G. M., Sudol, K., Baca-Garcia, E., Stanley, B. H., Sublette, M. E., & Mann, J. J. (2014) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2014.14020194 · Cited by 299
Self-citationThe Neurobiological Basis of Suicide
(2012) · doi:10.1201/b12215 · Cited by 301
The relationship between self-injurious behavior and suicide in a young adult population.
Whitlock, J., & Knox, K. (2007) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.161.7.634 · Cited by 308
Oquendo, M. A., Brent, D. A., Birmaher, B. B., Greenhill, L. L., Kolko, D. J., Stanley, B., Zelazny, J. M., Burke, A. K., Firinciogullari, S., Ellis, S. P., et al. (2005) · American Journal of Psychiatry · doi:10.1176/appi.ajp.162.3.560 · Cited by 305
“Aggression, hostility, and impulsivity have been associated with elevated risk for suicidal behavior in borderline personality disorder (40), major depression (41), and PTSD (16, 42–44).”
BackgroundSelf-citationSuicidal behavior in bipolar mood disorder: clinical characteristics of attempters and nonattempters
Oquendo, M. A., WATERNAUX, C. M., Brodsky, B. S., Parsons, B., Haas, G. L., Malone, K. M., & Mann, J. J. (2000) · Journal of Affective Disorders · doi:10.1016/s0165-0327(99)00129-9 · Cited by 290
Self-citationPlacidi, G. P. A., Oquendo, M. A., Malone, K. M., Huang, Y.-Y., Ellis, S. P., & Mann, J. J. (2001) · Biological Psychiatry · doi:10.1016/s0006-3223(01)01170-2 · Cited by 288
Self-citationRethinking Impulsivity in Suicide
Klonsky, E. D., & May, A. (2010) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2010.40.6.612 · Cited by 283
Impulsivity and phase of illness in bipolar disorder
Swann, A. C., Pazzaglia, P. J., Nicholls, A., Dougherty, D. M., & Moeller, F. G. (2002) · Journal of Affective Disorders · doi:10.1016/s0165-0327(02)00328-2 · Cited by 287
Cigarette Smoking, Suicidal Behavior, and Serotonin Function in Major Psychiatric Disorders
Malone, K. M., WATERNAUX, C. M., Haas, G. L., Cooper, T. B., Li, S., & Mann, J. J. (2003) · American Journal of Psychiatry · doi:10.1176/appi.ajp.160.4.773 · Cited by 288
“Higher levels of lifetime aggression reported to be associated with both substance abuse and suicidal behavior may also reflect this common diathesis (56).”
BackgroundSelf-citationCompton, M., Thompson, N., & Kaslow, N. (2005) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-005-0865-6 · Cited by 229
“…discord or marital distress; lack of a social support network; and stressful life events (such as job problems, financial trouble, legal difficulties, or drop in social status) (Heikkinen et al. 1994; Langhinrichsen-Rohling et al. 1998; Mann et al. 1999; Mina and Gallop 1998; Wagner 1997).”
BackgroundFamilial Transmission of Suicidal Behavior
Brent, D. A., & Melhem, N. (2008) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2008.02.001 · Cited by 329
Orbitofrontal cortex response to angry faces in men with histories of suicide attempts
Jollant, F., Lawrence, N. S., Giampietro, V., Brammer, M. J., Fullana, M. A., Drapier, D., Courtet, P., & Phillips, M. L. (2008) · American Journal of Psychiatry · doi:10.1176/appi.ajp.2008.07081239 · Cited by 262
Batterham, P. J., Ftanou, M., Pirkis, J., Brewer, J. L., Mackinnon, A. J., Beautrais, A., Fairweather-Schmidt, A. K., & Christensen, H. (2015) · Psychological Assessment · doi:10.1037/pas0000053 · Cited by 264
Whitlock, J. L., Muehlenkamp, J. J., & Eckenrode, J. J. (2008) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374410802359734 · Cited by 262
“This in conjunction with the fact just nearly half (46.9%) believed that NSSI was not or is a problem in their life helps to explain why providers often report treatment of NSSI individuals can be difficult (Conterio & Lader, 1998; Walsh, 2006; Whitlock et al., 2007). It also underscores the importance of regular inqu…”
InfluentialImagery about suicide in depression–“Flash-forwards”?
Holmes, E. A., Crane, C., Fennell, M. J. V., & Williams, J. M. G. (2007) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2007.10.004 · Cited by 259
“Suicidal behavior occurs most frequently during a depressive episode (Mann, Waternaux, Haas, & Malone, 1999).”
BackgroundDissecting the suicide phenotype: the role of impulsive–aggressive behaviours
Turecki, G. (2005) · Journal of Psychiatry and Neuroscience · doi:10.1139/jpn.0551 · Cited by 257
Psychological Vulnerability to Completed Suicide: A Review of Empirical Studies
Conner, K. R., Duberstein, P. R., Conwell, Y., Seidlitz, L., & Caine, E. D. (2001) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.31.4.367.22048 · Cited by 256
Psychiatric Diagnoses and Risk of Suicide in Veterans
Ilgen, M. A., Bohnert, A. S. B., Ignacio, R. V., McCarthy, J. F., Valenstein, M. M., Kim, H. M., & Blow, F. C. (2010) · Archives of General Psychiatry · doi:10.1001/archgenpsychiatry.2010.129 · Cited by 311
“By examining overlapping results from these different research methods, the presence of any psychiatric disorder has emerged as a consistent risk factor for suicide, with estimates from psychological autopsy studies of between 90% and 98% of all individuals who die by suicide meeting criteria for at least 1 psychiatri…”
BackgroundResultAustralian and New Zealand Clinical Practice Guidelines for the Treatment of Depression
Ellis, P., & Australian, R. (2004) · Australian & New Zealand Journal of Psychiatry · doi:10.1080/j.1440-1614.2004.01377.x · Cited by 231
“However, unemployment, isolation, impulsivity and misuse of alcohol and drugs increase risk [29,30].”
BackgroundChildhood Abuse as a Risk Factor For Suicidal Behavior in Borderline Personality Disorder
Soloff, P. H., Lynch, K. G., & Kelly, T. M. (2002) · Journal of Personality Disorders · doi:10.1521/pedi.16.3.201.22542 · Cited by 267
Plasma kynurenine levels are elevated in suicide attempters with major depressive disorder
Sublette, M. E., Galfalvy, H. C., Fuchs, D., Lapidus, M., Grunebaum, M. F., Oquendo, M. A., John Mann, J., & Postolache, T. T. (2011) · Brain, Behavior, and Immunity · doi:10.1016/j.bbi.2011.05.002 · Cited by 250
Metadata
- Authors
- Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M.
- Affiliations
- New York State Psychiatric Institute (US)
- Venue
- American Journal of Psychiatry
- Published
- 1999-02-01
- Volume
- 156
- Issue
- 2
- Pages
- 181-189
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2157574219
- Cited by
- 1,791
- References
- 115
- Citations by year
- 2026: 44 · 2025: 62 · 2024: 45 · 2023: 52 · 2022: 55 · 2021: 70 · 2020: 71 · 2019: 69 · 2018: 82 · 2017: 80 · 2016: 99 · 2015: 76 · 2014: 104 · 2013: 91 · 2012: 102
- FWCI
- 41.72
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH48514, MH46745, MH48492, R01MH048492, R01MH048514)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Sociology and Political Science › Homicide, Infanticide, and Child Abuse
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- suicide attempts, suicide risk factors, suicidal behavior, diathesis-stress model, suicidal ideation, impulsivity, aggression, depression severity, psychosis severity, borderline personality disorder, substance use disorders, alcoholism, family history of suicide, childhood abuse, traumatic brain injury, smoking, psychiatric inpatients
- MeSH terms
- Adolescent, Adult, Aged, Mental Disorders, Child Abuse, Female, Craniocerebral Trauma, Humans, Impulsive Behavior, Life Change Events, Male, Middle Aged, Models, Psychological, Personality Disorders, Personality Inventory, Psychiatric Status Rating Scales, Risk Factors, Severity of Illness Index, Sex Factors, Suicide, Attempted, Comorbidity, Chi-Square Distribution, Substance-Related Disorders
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