The DOI matches its Crossref record; 116 of the 116 references it cites were found in a registry or an index.
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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“Among psychiatric inpatients, individuals without a history of suicide attempts report significantly more reasons for living than do their counterparts who have attempted suicide in the past, especially moral objections to suicide (Dervic et al., 2004; Lizardi et al., 2008; Malone et al., 2000; Mann et al., 1999; Osma…”
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“Distal psychosocial (eg, adverse childhood experiences), temperamental and affective (eg, depression, anger) similarities in suicide attempters and violent offenders have also been reported (Engstrom, Persson, & Levander, 1999 ; Mann, Waternaux, Haas, & Malone, 1999 ; Plutchik, 1995 ).”
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“By contrast, in a stress–diathesis model (Mann et al., 1999) and an integrative view (Henkel et al.”
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Multimodal Elements of Suicidality Reduction After Transcranial Magnetic Stimulation
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“A meaningful e ff ort has been undertaken to develop a brain-centric model of suicidal behavior, one of the most comprehensive being the Mann and Rizk stress-diathesis model of suicidal behavior [13] (an update of the earlier neurobiological models of suicide presented in [14, 15]).”
Risk factors of suicide re-attempt: A two-year prospective study
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“Diathesis stress models have shown that certain personality traits play a role in the susceptibility to suicide; in fact, it is the interaction between these traits and acute stressors that may trigger suicidal behaviours (Mann et al. 1999).”
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“For example, serotonergic transmission has been implicated in impulsivity, depression, substance disorders, suicide and a number of other disturbances [ 18 , 45, 46].”
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Kosaraju, S. K. M., Vadlamani, L. N., Bashir, M. S. M., Kalasapati, L. K., Rao, G. L. V. C., & Rao, G. P. (2015) · Indian Journal of Psychological Medicine · doi:10.4103/0253-7176.150813 · Cited by 17
“,[16] also reported that, constructs related to aggression and impulsivity confers additional risk for suicidal behavior among persons with alcohol dependence.”
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“But what seems to facilitate suicidal behaviour more than anything else is impulsivity, a personality trait that has been found to be a predictor for suicidal behaviour across a wide range of psychiatric disorders (Mann et al., 1999; Soloff et al., 2000).”
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Recurrence of suicidal thoughts and behaviors during one year of follow-up: An exploratory study.
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Validation of the Beck Hopelessness Scale in patients with suicide risk
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“The correlation with the number of suicide attempts had been determined previously.(29) The positive correlation with the SBQ-R had also been documented.”
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Mann, J. J., Metts, A. V., Ogden, R. T., Mathis, C. A., Rubin‐Falcone, H., Gong, Z., Drevets, W. C., Zelazny, J. M., & Brent, D. A. (2017) · Archives of Suicide Research · doi:10.1080/13811118.2017.1417185 · Cited by 16
Self-citationScocco, P., Macis, A., Ferrari, C., Bava, M., Bianconi, G., Bulgari, V., Candini, V., Carrà, G., Cavalera, C., Clerici, M., et al. (2019) · Scientific Reports · doi:10.1038/s41598-019-53993-7 · Cited by 16
Itzhaky, L., Gratch, I., Galfalvy, H., Keilp, J. G., Burke, A. K., Oquendo, M. A., Mann, J. J., & Stanley, B. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.03.008 · Cited by 17
Self-citationMcKey, S., Quirke, B., Fitzpatrick, P., Kelleher, C., & Malone, K. M. (2020) · Irish Journal of Psychological Medicine · doi:10.1017/ipm.2020.108 · Cited by 16
“…a burgeoningmainstream scientific literature on many biological, psychological and social facets associated with understanding suicide in society (Mann et al. 1999; Fazel & Runeson, 2020), this rapid review identified only 24 peerreviewed scientific publications over the past 20 years examining…”
BackgroundSelf-citationAndersson, A.-L., & Sokolowski, M. (2021) · Journal of Safety Research · doi:10.1016/j.jsr.2021.11.004 · Cited by 16
Predictors of Severe and Repeated Aggression in a Maximum-Security Forensic Psychiatric Hospital
Bader, S. M., & Evans, S. E. (2015) · International Journal of Forensic Mental Health · doi:10.1080/14999013.2015.1045633 · Cited by 16
One‐Year Follow‐Up Study of Suicide Attempters Treated for Drug Dependence
Agosti, V., & LEVIN, F. R. (2006) · American Journal on Addictions · doi:10.1080/10550490600754333 · Cited by 16
Zhang, J., & Lin, L. (2014) · Community Mental Health Journal · doi:10.1007/s10597-014-9811-y · Cited by 16
“Impulsivity indeed plays an important role in suicide, and several suicide risk models have verified its role in suicide and suggested that impulsivity should be highest in those who act on suicidal attempts behavior (Joiner et al. 1999; Mann et al. 1999).”
BackgroundPharmacotherapy of Suicidal Behavior in Bipolar Disorder
Oquendo, M. A., Chaudhury, S. R., & Mann, J. J. (2005) · Archives of Suicide Research · doi:10.1080/13811110590929424 · Cited by 16
Self-citationPerturbação mental e ideação suicida entre reclusos preventivos
Moreira, N. A. C., & Gonçalves, R. A. (2012) · Análise Psicológica · doi:10.14417/ap.259 · Cited by 17
Clinical features of depressed patients with or without a family history of alcoholism
Sher, L., Oquendo, M. A., Conason, A., Brent, D. A., Grunebaum, M. F., Zalsman, G., Burke, A. K., & Mann, J. J. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2005.00591.x · Cited by 16
Self-citationSakamoto, S., Tanaka, E., NEICHI, K., Sato, K., & Ono, Y. (2006) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2006.01582.x · Cited by 15
“depression), previous studies have shown that people who often experience subthreshold depression are more likely to suffer from major depression,(10,11) and people who experience suicidal ideation are more likely to commit suicide.(12) The authors believe people who have experienced suicidal ideation (depression) rep…”
Background[The prevalence of suicide ideation and suicide attempts in Manisa City Centre].
Deveci, A., Taşkin, E. O., Dündar, P. E., Demet, M. M., Kaya, E., Özmen, E., & Dinç, G. (2005) · PubMed · Cited by 19
Riesgo de suicidio en población sin hogar
Calvo, F., Giralt, C., Calvet-Roura, A., & Carbonell, X. (2016) · Clínica y Salud · doi:10.1016/j.clysa.2016.05.002 · Cited by 16
Firearms on College Campuses: Research Evidence and Policy Implications
Donohue, J. J. (2016) · Cited by 16
Stress and Vulnerability: A Developing Model for Suicidal Risk
López‐Castromán, J., Olié, É., & Courtet, P. (2014) · Springer eBooks · doi:10.1007/978-3-319-09964-4_5 · Cited by 17
“5 % for subsequent ones (Mann et al. 1999).”
BackgroundSuicide in classical mythology: cues for prevention
Preti, A., & Miotto, P. (2005) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2004.00488.x · Cited by 16
“Such a genetic background could be related to the propensity to aggression that is often associated to suicide ideation and attempt, or to the frequent relationship with impulse dyscontrol (35, 36).”
BackgroundIsometsä, E. T. (2000) · Current Opinion in Psychiatry · doi:10.1097/00001504-200003000-00002 · Cited by 16
Sobanski, T., Peikert, G., Kastner, U. W., & Wagner, G. (2022) · World Journal of Psychiatry · doi:10.5498/wjp.v12.i9.1115 · Cited by 17
Impulsivity, aggression, and impulsive aggression in suicidality
Moore, F. R., Allott, C., & O’Connor, R. C. (2022) · Personality and Individual Differences · doi:10.1016/j.paid.2022.111971 · Cited by 15
“…our results are consistent with models in which physical aggression and impulsivity are treated as a single phenotype in relation to suicide (e.g. Mann et al., 1999; Mann & Currier, 2010; Seroczynski et al., 1999), and we argue that aggression should be targeted in suicide intervention, further…”
BackgroundResultYang, W., Wang, X., Kang, C., Yang, L., Liu, D., Zhao, N., & Zhang, X. (2023) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2023.103732 · Cited by 15
Wang, Y., Shen, X., & Wang, P. (2023) · International Journal of Colorectal Disease · doi:10.1007/s00384-023-04520-8 · Cited by 15
“As a precursor to suicide, suicide ideation (SI) refers to the wish for one’s life to end or thoughts of harming or killing oneself [16, 17].”
Zhou, L., Qiao, C., Huang, J., Lin, J., Zhang, H., Xie, J. M., Yuan, Y., & Hu, C. (2024) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s444729 · Cited by 17
“57 Furthermore, among the five types of life events, punishment (β = 0.802, P 0.001) and interpersonal relationships ( β = 0.749, P 0.001) were found to be most closely associated with adolescent NSSI.”
BackgroundInfluentialGiupponi, G., Pycha, R., Innamorati, M., Lamis, D. A., Schmidt, E. D., Conca, A., Kapfhammer, H., Lester, D., Girardi, P., & Pompili, M. (2012) · International Journal of Social Psychiatry · doi:10.1177/0020764012461209 · Cited by 14
Self-inflicted traumatic brain injury: Characteristics and outcomes
Brenner, L. A., Carlson, N. E., Harrison-Felix, C. L., Ashman, T. A., Hammond, F. M., & Hirschberg, R. E. (2009) · Brain Injury · doi:10.3109/02699050903379362 · Cited by 15
“Overall, the findings highlight the vulnerable nature of this population and support previous research among the general population which suggests that those with a history of suicide attempts ‘have a predisposition to suicidal acts’ ([18], p.”
ResultNierenberg, A. A., Alpert, J. E., Gaynes, B. N., Warden, D., Wisniewski, S. R., Biggs, M. M., Trivedi, M. H., Barkin, J. L., & Rush, A. J. (2007) · Journal of Affective Disorders · doi:10.1016/j.jad.2007.10.011 · Cited by 15
“Yet, MDD and suicide have distinct heritable components (Brent and Mann, 2005; Mann et al., 1999; Roy, 1983).”
BackgroundAge of First Suicide Attempt in Men and Women: An Admixture Analysis
Blasco-Fontecilla, H., Alegría, A. A., Delgado‐Gómez, D., Legido, T., Sáiz, P. A., Oquendo, M. A., & Baca‐García, E. (2012) · The Scientific World JOURNAL · doi:10.1100/2012/825189 · Cited by 15
“In accordance with previous research [45], the majority of suicide attempters of both sexes presented with one or more stressful life events, particularly problems related to their primary support group.”
ResultMortality in offspring of mothers with psychotic disorder
Suvisaari, J., Häkkinen, L., Haukka, J. K., & Lönnqvist, J. K. (2007) · Psychological Medicine · doi:10.1017/s0033291707002383 · Cited by 16
“Second, maternal and offspring’s aggressivity are correlated (Cadoret et al. 1995), and lifetime aggression and impulsivity are related to suicide attempts (Mann et al. 1999), accidents (Cobb et al. 1995) and higher total mortality risk (Räsänen et al. 1998).”
BackgroundInfluentialUmut, G., Altun, Z. Ö., Danışmant, B. S., Küçükparlak, İ., Karamustafalıoğlu, N., & İlnem, M. C. (2013) · Dusunen Adam The Journal of Psychiatry and Neurological Sciences · doi:10.5350/dajpn2013260403 · Cited by 15
“It has been shown that major depression triggers suicide attempts and that depressive affect and hopelessness are associated with suicidal ideations (49,50).”
BackgroundSuicidal Ideation and Associated Factors Among School-Going Adolescents in Harare, Zimbabwe
Rudatsikira, E., Siziya, S., & Muula, A. S. (2007) · Journal of Psychology in Africa · doi:10.1080/14330237.2007.10820150 · Cited by 14
Campos, R. C., Holden, R. R., Caçador, B., Fragata, A. S., & Baleizão, C. (2017) · Personality and Individual Differences · doi:10.1016/j.paid.2017.12.004 · Cited by 17
Bornheimer, L. A., Zhang, A., Tarrier, N., Verdugo, J. L., Ning, Y., & Himle, J. A. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.06.014 · Cited by 16
Factores de riesgo asociados al suicidio en Nariño (Colombia): estudio de casos y controles*
Morales, E. J. M., & Gutiérrez, M. I. (2010) · Revista Colombiana de Psiquiatría · doi:10.1016/s0034-7450(14)60252-3 · Cited by 15
Carballo, J. J., Currier, D., Figueroa, A. E., Giner, L., Kelly, S. A., Sublette, M. E., & Oquendo, M. A. (2009) · The European Journal of Psychiatry · doi:10.4321/s0213-61632009000400005 · Cited by 15
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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