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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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Clinical Features of Suicide Attempts After Traumatic Brain Injury
Simpson, G. K., & Tate, R. L. (2005) · The Journal of Nervous and Mental Disease · doi:10.1097/01.nmd.0000180743.65943.c8 · Cited by 75
Genetic aetiology of self-harm ideation and behaviour
Campos, A. I., Verweij, K. J. H., Statham, D. J., Madden, P. A. F., Maciejewski, D. F., Davis, K. A. S., John, A., Hotopf, M., Heath, A. C., Martin, N. G., et al. (2020) · Scientific Reports · doi:10.1038/s41598-020-66737-9 · Cited by 74
Hartley, C. M., Pettit, J. W., & Castellanos, D. (2017) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12325 · Cited by 74
“Overt aggression was conceptually and operationally congruent with reactive aggression (Mann et al., 1999).”
Gender and Risk Factors for Suicide
McGirr, A., Séguin, M., Renaud, J., Benkelfat, C., Alda, M., & Turecki, G. (2006) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.v67n1018 · Cited by 73
Dale, R., Power, K., Kane, S., Stewart, A. M., & Murray, L. (2010) · Archives of Suicide Research · doi:10.1080/13811118.2010.524066 · Cited by 74
“'s ( 1999 ) finding that among psychiatric patients, subjective depressive feelings, hopelessness and severity of suicidal ideation were all significantly greater in those who engaged in suicidal behavior than those who did not.”
BackgroundSuicide in first episode psychosis: A nationwide cohort study
Björkenstam, C., Björkenstam, E., Hjern, A., Bodén, R., & Reutfors, J. (2014) · Schizophrenia Research · doi:10.1016/j.schres.2014.05.010 · Cited by 73
“A potential common denominator for having a history of self-harm, substance use disorder, and criminal delinquency, may be that they all include some degree of impulsivity, which in turn is associated with an increased risk of suicide (Mann et al., 1999; Swann et al., 2005; McGirr et al., 2008).”
BackgroundAn overview of traumatic brain injury and suicide
Wasserman, L. D., Shaw, T., Vu, M. T., Ko, C., Bollegala, D., & Bhalerao, S. (2008) · Brain Injury · doi:10.1080/02699050802372166 · Cited by 73
“It is recognized that suicide attempters have an increased rate of TBI in comparison with patients with no history of suicide attempts [20].”
BackgroundResultDistinguishing the relevant features of frequent suicide attempters
López‐Castromán, J., Pérez-Rodríguez, M. M., Jaussent, I., Alegría, A. A., Artés-Rodrı́guez, A., Freed, P. J., Guillaume, S., Jollant, F., Leiva-Murillo, J. M., Malafosse, A., et al. (2010) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2010.09.017 · Cited by 73
“Protocols and assessment procedures in both centres are based on the Columbia Suicide History Form (Mann et al., 1999).”
MethodBenkő, A., Lazáry, J., Molnár, E., Gonda, X., Tóthfalusi, L., Pap, D., Mirnics, Z., Kurimay, T., Chase, D. S., Juhász, G., et al. (2009) · American Journal of Medical Genetics Part B Neuropsychiatric Genetics · doi:10.1002/ajmg.b.31025 · Cited by 72
“Impulsivity is not the main risk factor of suicidal behavior; however, this trait has been consistently found to characterize suicide attempters [Mann et al., 1999].”
ResultMajor depression, 5HTTLPR genotype, suicide and antidepressant influences on thalamic volume
Young, K. A., Bonkale, W. L., Holcomb, L. A., Hicks, P. B., & German, D. C. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.039180 · Cited by 71
A 6-year longitudinal study of predictors for suicide attempts in major depressive disorder
Eikelenboom, M., Beekman, A. T. F., Penninx, B. W. J. H., & Smit, J. H. (2018) · Psychological Medicine · doi:10.1017/s0033291718001423 · Cited by 75
“…results from studies in other psychiatric samples (persons with a borderline personality disorder, persons admitted to psychiatric hospital) showed also that attempters were characterized by low socio-economic status and low educational achievement (Mann et al., 1999; Soloff and Chiappetta, 2012).”
BackgroundResultInfluentialSher, L., Carballo, J. J., Grunebaum, M. F., Burke, A. K., Zalsman, G., Huang, Y., Mann, J. J., & Oquendo, M. A. (2006) · Bipolar Disorders · doi:10.1111/j.1399-5618.2006.00319.x · Cited by 72
Self-citationBenarous, X., Consoli, A., Cohen, D., Renaud, J., Lahaye, H., & Guilé, J.-M. (2018) · European Child & Adolescent Psychiatry · doi:10.1007/s00787-018-1234-9 · Cited by 70
Severity of personality disorders and suicide attempt
Blasco-Fontecilla, H., Baca‐García, E., Dervic, K., Pérez-Rodríguez, M. M., Sáiz-González, M. D., Sáiz, P. A., Oquendo, M. A., & de León, J. (2008) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2008.01284.x · Cited by 71
“Female None 56 (72) 57 (50) 34 (34) 147 (50) 1 or 2 14 (18) 32 (28) 40 (40) 86 (30) ‡3 8 (10) 24 (2) 27 (26) 59 (20) Total 78 (100) 113 (100) 101 (100) 292 (100) Male§ None 21 (62) 25 (57) 32 (48) 78 (54) 1 or 2 8 (23) 6 (14) 20 (30) 34 (23) ‡3 5 (15) 13 (29) 15 (22) 33 (23) Total 34 (100) 44 (100) 67 (100) 145 (100)”
BackgroundŠedivy, N. Z., Podlogar, T., Kerr, D., & Leo, D. D. (2017) · Health & Place · doi:10.1016/j.healthplace.2017.09.004 · Cited by 73
Suicidal ideation and aggressiveness in school-aged youths
Miotto, P., Coppi, M. D., Frezza, M., Петретто, Д. Р., Masala, C., & Preti, A. (2003) · Psychiatry Research · doi:10.1016/s0165-1781(03)00193-8 · Cited by 71
“In such conditions, poor impulse control might favor the externalization of an aggressive tendency and, according to recent studies, some subjects seem prone to more impulsive behavior, whether self-directed (in the form of suicidal behavior) or externally directed (in the form of aggression against property or other…”
BackgroundResultIntolerance to Delayed Reward in Girls with Multiple Suicide Attempts
Mathias, C. W., Dougherty, D. M., James, L. M., Richard, D. M., Dawes, M. A., Acheson, A., & Hill‐Kapturczak, N. (2011) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2011.00027.x · Cited by 70
Schneider, B., Lukaschek, K., Baumert, J., Meisinger, C., Erazo, N., & Ladwig, K. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.007 · Cited by 73
Lopez-Larson, M. P., King, J. B., McGlade, E., Bueler, E., Stoeckel, A. H., Epstein, D. J., & Yurgelun-Todd, D. A. (2013) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2013.00083 · Cited by 69
“The association of impulsivity, aggression, and suicide risk has been reported in the literature (17, 18, 28, 29).”
BackgroundBatterham, P. J., van Spijker, B. A. J., Mackinnon, A. J., Calear, A. L., Wong, Q. J. J., & Christensen, H. M. (2018) · Depression and Anxiety · doi:10.1002/da.22863 · Cited by 70
Yaseen, Z. S., Gilmer, E., Modi, J., Cohen, L. J., & GALYNKER, I. I. (2012) · PLoS ONE · doi:10.1371/journal.pone.0045157 · Cited by 72
Self-regulation of unattainable goals in suicide attempters: A two year prospective study
O’Connor, R. C., O’Carroll, R. E., Ryan, C., & Smyth, R. (2012) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.04.035 · Cited by 75
“Although our understanding of distal suicide risk factors (e.g., mental disorders) has grown markedly in recent decades (Mann et al., 1999; Hawton and Van Heeringen, 2009), it is not clear how these translate into proximal suicide risk mechanisms.”
BackgroundToward Macro-Insights for Suicide Prevention: Analyzing Fine-Grained Distress at Scale
Homan, C. M., Johar, R., Liu, T., Lytle, M. C., Silenzio, V., & Alm, C. O. (2014) · Workshop on Computational Linguistics and Clinical Psychology (CLPsych) · doi:10.3115/v1/w14-3213 · Cited by 71
“As previously mentioned, many of the risk factors for suicidal behavior may be linked to other expressions of distress, such as aggression and interpersonal violence (Mann et al., 1999).”
BackgroundDifferential Effects of Executive Functioning on Suicide Attempts
Burton, C. Z., Vella, L., Weller, J. A., & Twamley, E. W. (2011) · Journal of Neuropsychiatry · doi:10.1176/jnp.23.2.jnp173 · Cited by 70
Martin, J., Ghahramanlou‐Holloway, M., Lou, K., & Tucciarone, P. (2009) · Journal of Mental Health Counseling · doi:10.17744/mehc.31.2.a6338384r2770383 · Cited by 69
“National Center for Health Statistics. (2003). Self-inflicted injury/suicide.”
BackgroundInfluentialReligion and Suicide Risk in Lesbian, Gay and Bisexual Austrians
Kralovec, K., Fartacek, C., Fartacek, R. R., & Plöderl, M. (2012) · Journal of Religion and Health · doi:10.1007/s10943-012-9645-2 · Cited by 78
Kinnally, E. L., Huang, Y., Haverly, R., Burke, A. K., Galfalvy, H., Brent, D. A., Oquendo, M. A., & Mann, J. J. (2009) · Psychiatric Genetics · doi:10.1097/ypg.0b013e32832a50a7 · Cited by 75
“A more detailed description of the interview process is available elsewhere (Mann et al., 1999).”
BackgroundMethodSelf-citationPersonality and Suicidal Behavior in Old Age: A Systematic Literature Review
Szücs, A., Szántó, K., Aubry, J., & Dombrovski, A. Y. (2018) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2018.00128 · Cited by 75
“J Clin Psychiatry (2004) 65(7):948–58.”
BackgroundResultInfluentialLife Events and Psychopathology in a Group of Suicide Attempters
Osváth, P., Vörös, V., & Fekete, S. (2004) · Psychopathology · doi:10.1159/000077018 · Cited by 68
Increasing seasonality of suicide in Australia 1970–1999
Rock, D. J., Greenberg, D. M., & Hallmayer, J. F. (2003) · Psychiatry Research · doi:10.1016/s0165-1781(03)00165-3 · Cited by 68
“Members of this group (Mann et al., 1999) and others (for review, see van Heeringen, 2001) have previously reported a positive association between impulsivity and suicide.”
BackgroundRecomendaciones preventivas y manejo del comportamiento suicida en España
Ayuso‐Mateos, J. L., Baca‐García, E., Bobes, J., Giner, J., Giner, L., Pérez, V., Sáiz, P. A., & Ruiz, J. S. (2012) · Revista de Psiquiatría y Salud Mental · doi:10.1016/j.rpsm.2012.01.001 · Cited by 84
“Although suicide risk is related to the number of risk factors present, Mann et al.(70,71) proposed a broadened stress-diathesis model, useful in comprehending risk of suicidal behaviour (Fig.”
SUICIDAL DEPRESSED PATIENTS RESPOND LESS WELL TO ANTIDEPRESSANTS IN THE SHORT TERM
López‐Castromán, J., Jaussent, I., Gorwood, P. A. P. M., & Courtet, P. (2016) · Depression and Anxiety · doi:10.1002/da.22473 · Cited by 72
“[63] Interestingly, clinician-rated SI seemed to be more predictive of poor treatment response than patient-rated SI contradicting previous evidence about a better performance of self-reported depression compared to clinical assessment of depression in the management of suicidal risk.[64] We have examined a large and…”
BackgroundDexamethasone suppression test May predict more severe/violent suicidal behavior
Alacreu-Crespo, A., Olié, E., Guillaume, S., Girod, C., Cazals, A., Chaudieu, I., & Courtet, P. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00097 · Cited by 68
“According to the stress-diathesis model, suicidal behavior is the result of the interaction between acute or chronic stress factors and traits of susceptibility to commit suicide (diathesis) (2).”
BackgroundInfluentialCao, J., Chen, J.-M., Kuang, L., Ai, M., Fang, W.-D., Gan, Y., Wang, W., Chen, X.-R., Xu, X.-M., Wang, H.-G., et al. (2015) · Psychiatry Research Neuroimaging · doi:10.1016/j.pscychresns.2014.10.011 · Cited by 64
“The stress-diathesis model of suicidal behavior (Mann et al., 1999) proposes that suicide risk is determined by both psychiatric illness and a trait-related propensity for suicidal behavior independent of psychiatric diagnosis (Mann, 2003).”
BackgroundFuture Suicide Attempt and Responses to Serotonergic Challenge
Keilp, J. G., Oquendo, M. A., Stanley, B., Burke, A. K., Cooper, T. B., Malone, K. M., & Mann, J. J. (2008) · Neuropsychopharmacology · doi:10.1038/npp.2008.28 · Cited by 67
Self-citationTurner, B. J., Jin, H. M., Anestis, M. D., Dixon–Gordon, K. L., & Gratz, K. L. (2017) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2017.09.009 · Cited by 67
Suicide in Northern Ireland: epidemiology, risk factors, and prevention
O'Neill, S., & O'Connor, R. C. (2020) · The Lancet Psychiatry · doi:10.1016/s2215-0366(19)30525-5 · Cited by 67
Risk of suicide ideation in comorbid substance use disorder and major depression
Onaemo, V. N., Fawehinmi, T. O., & D’Arcy, C. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265287 · Cited by 76
“Studies also suggest that suicidal behaviour, aggression, and alcoholism have been linked to abnormally low serotonergic function [63, 64]; and this has been proposed to mediate an individual’s genetic and developmental predispositions [65].”
BackgroundKim, D. (2008) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2008.08.005 · Cited by 67
“Third, this study did not take into account several forms of psychopathology associated directly or indirectly with body dissatisfaction and suicidal ideation, such as depression, aggressiveness, sexual orientation, and eating disorders, because there was limited information on these above variables in the KEEP data […”
BackgroundSymptom components of standard depression scales and past suicidal behavior
Grunebaum, M. F., Keilp, J. G., Li, S., Ellis, S. P., Burke, A. K., Oquendo, M. A., & Mann, J. J. (2005) · Journal of Affective Disorders · doi:10.1016/j.jad.2005.03.002 · Cited by 67
Self-citationZhang, P., ROBERTS, R. E., Liu, Z., Meng, X., Tang, J., Sun, L. J., & Yu, Y. (2012) · PLoS ONE · doi:10.1371/journal.pone.0031044 · Cited by 67
Oh, J., Yun, K., Hwang, J.-H., & Chae, J. (2017) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2017.00192 · Cited by 67
“History of previous suicide attempts has long been considered to be a crucial factor in predicting future suicide attempts (1), but attempts history lacks predictive value as only one-third of suicide attempters have a previous history of suicide attempts (2).”
BackgroundMelancholia and the probability and lethality of suicide attempts
Grunebaum, M. F., Galfalvy, H., Oquendo, M. A., Burke, A. K., & Mann, J. J. (2004) · The British Journal of Psychiatry · doi:10.1192/bjp.184.6.534 · Cited by 67
Self-citationSuicide Terrorists: Are They Suicidal?
Townsend, E. (2007) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2007.37.1.35 · Cited by 66
Stewart, J. G., Kim, J. C., Esposito, E. C., Gold, J., Nock, M. K., & Auerbach, R. P. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.034 · Cited by 70
“One promising marker of risk for suicide is impulsiveness (Gvion and Apter, 2011; Mann et al., 1999), which is often defined as a trait tendency towards unplanned responses to internal and external stimuli with little regard for negative consequences (Braquehais et al., 2010).”
InfluentialDefense styles in depressed suicide attempters
Corruble, E., Grall‐Bronnec, M., Falissard, B., & Hardy, P. (2004) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2004.01233.x · Cited by 66
Suicidal Behavior in Patients with Adjustment Disorders
Kryzhanovskaya, L. A., & Canterbury, R. J. (2001) · Crisis · doi:10.1027//0227-5910.22.3.125 · Cited by 66
“, major depressive or anxiety disorder) does not imply the absence of causal stressful events (Mann et al., 1999).”
BackgroundSuicide in Alcohol-Dependent Individuals
Pirkola, S. P., Suominen, K. H., & Isomets�, E. (2004) · CNS Drugs · doi:10.2165/00023210-200418070-00002 · Cited by 66
Life satisfaction and suicidal attempts among persons with schizophrenia
Ponizovsky, A. M., Grinshpoon, A., Levav, I., & Ritsner, M. S. (2003) · Comprehensive Psychiatry · doi:10.1016/s0010-440x(03)00146-9 · Cited by 66
The Integrated Motivational‐Volitional Model of Suicidal Behavior
O’Connor, R. C., Cleare, S., Eschle, S., Wetherall, K., & Kirtley, O. J. (2016) · Wiley eBooks · doi:10.1002/9781118903223.ch13 · Cited by 68
“The experience of psychiatric illness is characterized as a stressor in Mann’s clinical model of suicidal behavior (Mann et al., 1999, 2005).”
BackgroundOyama, H., Goto, M., Fujita, M., Shibuya, H., & Sakashita, T. (2006) · Crisis · doi:10.1027/0227-5910.27.2.58 · Cited by 65
Perceived Reasons for Living at Index Hospitalization and Future Suicide Attempt
Lizardi, D., Currier, D., Galfalvy, H., Sher, L., Burke, A. K., Mann, J. J., & Oquendo, M. A. (2007) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e3180522661 · Cited by 65
“Yet, only 20%–30% of individuals who commit suicide or attempt suicide have a history of a prior suicide attempt (Mann et al., 1999).”
BackgroundSelf-citationHeart rate variability and suicidal behavior
Wilson, S. T., Chesin, M. S., Fertuck, E. A., Keilp, J. G., Brodsky, B. S., Mann, J. J., Sönmez, C. C., Benjamin-Phillips, C. A., & Stanley, B. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.04.033 · Cited by 66
Self-citationGarcía‐Gutiérrez, M. S., Navarrete, F., Navarro, G., Reyes‐Resina, I., Franco, R., Lanciego, J. L., Giner, S., & Manzanares, J. (2018) · Neurotherapeutics · doi:10.1007/s13311-018-0610-y · Cited by 67
ten Have, M., van Dorsselaer, S., & de Graaf, R. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2012.11.005 · Cited by 63
Anestis, M. D., Kleiman, E. M., Lavender, J. M., Tull, M. T., & Gratz, K. L. (2014) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2014.07.007 · Cited by 64
“, [3]), both theoretical and empirical literature provide strong support for such a model of NSSI.”
BackgroundTimpka, T., Sprečo, A., Dahlström, Ö., Jacobsson, J., Kowalski, J. H., Bargoria, V., Mountjoy, M. L., & Svedin, C. G. (2020) · British Journal of Sports Medicine · doi:10.1136/bjsports-2019-101386 · Cited by 68
Serum lipids, metabolic syndrome and lifetime suicide attempts in patients with bipolar disorder
D’Ambrosio, V., Salvi, V., Bogetto, F., & Maina, G. (2011) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2011.12.009 · Cited by 64
“The stress-diathesis model for suicidal behavior (Mann et al., 1999) states that patients who attempted suicide generally have both a diathesis (lower threshold) for suicidal behavior, and a trigger factor precipitating the suicide attempt (stressor).”
The influence of inflammatory cytokines in physiopathology of suicidal behavior
Miná, V. A. L., Lacerda-Pinheiro, S. D. F., Maia, L. C., Pinheiro, R. F. F., Meireles, C. B., de Souza, S. I. R., Reis, A. O. A., Bianco, B. A. V., & Rolim, M. L. N. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.09.057 · Cited by 67
“In this context, this study hypothesize that elevated KYN may be a marker of suicide attempt risk, independent of depression severity, related to the diathesis for suicidal behavior (Mann et al., 1999) and not to the associated mood disorder (Sublette et al., 2011).”
BackgroundAntecedents and Patterns of Suicide Behavior in First-Admission Psychosis
Bakst, S. S., Rabinowitz, J., & Bromet, E. J. (2009) · Schizophrenia Bulletin · doi:10.1093/schbul/sbp001 · Cited by 69
The Relationship Between Continuous Identity Disturbances, Negative Mood, and Suicidal Ideation
Sokol, Y., & Eisenheim, E. (2016) · The Primary Care Companion For CNS Disorders · doi:10.4088/pcc.15m01824 · Cited by 64
Development of 2‐hour suicide intervention program among medical residents: First pilot trial
Kato, T. A., Suzuki, Y., Sato, R., Fujisawa, D., Uehara, K., Hashimoto, N., Sawayama, Y., Hayashi, J., Kanba, S., & Otsuka, K. (2010) · Psychiatry and Clinical Neurosciences · doi:10.1111/j.1440-1819.2010.02114.x · Cited by 63
Mental Health in Allergic Rhinitis: Depression and Suicidal Behavior
Amritwar, A., Lowry, C. A., Brenner, L. A., Hoisington, A. J., Stiller, J. W., Hamilton, R. G., & Postolache, T. T. (2017) · Current Treatment Options in Allergy · doi:10.1007/s40521-017-0110-z · Cited by 71
Personality trait risk factors for attempted suicide among young women with eating disorders
Youssef, G. J., Plancherel, B., Laget, J., Corcos, M., Flament, M. F., & Halfon, O. (2004) · European Psychiatry · doi:10.1016/j.eurpsy.2003.11.005 · Cited by 63
Developmental psychopathology and neurobiology of aggression
Gollan, J. K., Lee, R., & Coccaro, E. F. (2005) · Development and Psychopathology · doi:10.1017/s0954579405050546 · Cited by 68
Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders
Pawlak, J., Dmitrzak‐Węglarz, M., Skibińska, M., Szczepankiewicz, A., Leszczyńska-Rodziewicz, A., Rajewska‐Rager, A., Zaremba, D., Czerski, P. M., & Hauser, J. (2013) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2013.03.014 · Cited by 64
Multidimensional assessments of impulsivity in subjects with history of suicidal attempts
Wu, C., Liao, S., Lin, K.-M., Tseng, M. M.-C., Wu, E. C., & Liu, S.-K. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.09.006 · Cited by 62
“According to the stress-diathesis model, impulsivity and its related psychopathology such as aggression have been considered as important diatheses for suicidal behaviors by predisposing one to act on suicidal feelings [1].”
BackgroundMechanisms of impulsivity in bipolar disorder and related illness
Swann, A. C. (2010) · Epidemiologia e Psichiatria Sociale · doi:10.1017/s1121189x00000828 · Cited by 67
“Impulsivity confers increased risk for rapid behavioral responses with severe long term consequences, most notably suicide (Cremniter et al., 1999; Gut-Fayand et al., 2001; Mann et al., 1999; Soloff et al., 2000; Swann et al. 2005b).”
BackgroundRapid mood switching and suicidality in familial bipolar disorder
MacKinnon, D. F., Potash, J. B., McMahon, F. J., Simpson, S. G., DePaulo, J. R., & Zandi, P. P. (2005) · Bipolar Disorders · doi:10.1111/j.1399-5618.2005.00236.x · Cited by 62
Weiner, D. A., Abraham, M. E., & Lyons, J. S. (2001) · Psychiatric Services · doi:10.1176/appi.ps.52.6.793 · Cited by 62
Suicidal subtypes, stress responsivity and impulsive aggression
Stanley, B., Michel, C. A., Galfalvy, H. C., Keilp, J. G., Rizk, M. M., Richardson-Vejlgaard, R., Oquendo, M. A., & Mann, J. J. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2019.112486 · Cited by 54
“Impulsivity and aggression have been associated with both suicidal behavior and HPA axis dysfunction (Mann et al., 1999; McGirr and Turecki, 2007; Melhem et al., 2007; Turecki et al., 2012).”
BackgroundSelf-citationSuicide in Hungary-epidemiological and clinical perspectives
Rihmer, Z., Gonda, X., Kapitány, B., & Döme, P. (2013) · Annals of General Psychiatry · doi:10.1186/1744-859x-12-21 · Cited by 61
“Moreover, smokers are significantly more impulsive than nonsmokers [63,64], and it is well demonstrated that impulsive-aggressive personality features are powerful predictors of suicidal behavior [65,66].”
BackgroundImpulsivity in remitted depression: A meta-analytical review
Saddichha, S., & Schuetz, C. (2014) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2014.02.003 · Cited by 61
“In addition, numerous studies have also identified impulsivity as a common correlate and risk factor for suicidal behavior (Wu et al., 2009; Nock et al., 2008; Kingsbury et al., 2001; Apter et al., 1999; Horesh et al., 1999; Mann et al., 1999), regardless of diagnosis (Giegling et al.”
BackgroundSwann, A. C. (2009) · Current Psychiatry Reports · doi:10.1007/s11920-009-0073-2 · Cited by 64
“Impulsive behavior can be destructive and include impulsive aggression [12], impulsive suicide attempts [ 13 ], and other rapid, unplanned acts with severe long-term consequences.”
BackgroundDepression in schizophrenia: the influence of the different dimensions of insight
Misdrahi, D., Denard, S., Swendsen, J., Jaussent, I., & Courtet, P. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.01.039 · Cited by 60
“Relative to the assessment of different constructs, the self-report BDI was chosen because of its common theoretical underpinnings with the BCIS, and because it may help identify subjects presenting a risk of suicidal behavior (Mann et al., 1999).”
Uncomplicated Depression, Suicide Attempt, and the DSM-5 Bereavement Exclusion Debate
Wakefield, J. C., & Schmitz, M. F. (2013) · Research on Social Work Practice · doi:10.1177/1049731513495092 · Cited by 60
Bränström, R., van der Star, A., & Pachankis, J. E. (2019) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-019-01742-6 · Cited by 67
“For instance, both the clinical model of suicide behavior [20] and the interpersonal theory of suicide [21] emphasize psychological and interpersonal factors such as depression, substance abuse, perceived burdensomeness, loneliness, and thwarted belongingness as important explanatory risks for suicide.”
BackgroundHeterogeneity and Polygenicity in Psychiatric Disorders: A Genome-Wide Perspective
Wendt, F. R., Pathak, G. A., Tylee, D. S., Goswami, A., & Polimanti, R. A. (2020) · Chronic Stress · doi:10.1177/2470547020924844 · Cited by 65
“According to the stress-diathesis model, the risk for suicidal acts is determined a stressor (such as psychiatric illness) and a diathesis, such as a tendency to experience more suicidal ideation and be more likely to act on suicidal feelings.(162) Twin, family, and adoption studies identified a 30% to 50% h(2) which…”
BackgroundMeza, J. I., Owens, E. B., & Hinshaw, S. P. (2020) · Development and Psychopathology · doi:10.1017/s0954579420000553 · Cited by 67
Insomnia and suicidal behaviour in prisoners
Carli, V., Roy, A., Bevilacqua, L. M., Maggi, S., Cesaro, C., & Sarchiapone, M. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2009.10.001 · Cited by 60
“The association of insomnia with aggression is of high interest as a high percentage of prisoners has axis II diagnoses and impulsiveaggression is a distal risk factor for suicidal behaviour (Mann et al., 1999; Fazel and Danesh, 2002; Driessen et al., 2006; Passarella and Duong, 2008).”
BackgroundAnterior cingulate volumes associated with trait impulsivity in individuals with bipolar disorder
Matsuo, K., Nicoletti, M., Peluso, M. A. M., Hatch, J. P., Nemoto, K., Watanabe, Y., Nery, F. G., Monkul, E. S., Zunta‐Soares, G. B., Bowden, C. L., et al. (2009) · Bipolar Disorders · doi:10.1111/j.1399-5618.2009.00732.x · Cited by 61
“6 [41–104] for the total score, and 30.”
Tiet, Q., Ilgen, M., Byrnes, H. F., & Moos, R. (2006) · Alcoholism: Clinical and Experimental Research · doi:10.1111/j.1530-0277.2006.00114.x · Cited by 65
“Many psychiatric disorders are associated with suicide attempts, including mood disorders, substance-related disorders, psychotic disorders, anxiety disorders, and personality disorders (Regier et al, 1988; Weissman et al., 1989; Petronis et al., 1990; Clark and Goebel-Fabbri, 1999; Mann et al., 1999; Radomsky et al.,…”
BackgroundDarke, S. G., Ross, J. E., Williamson, A., & Teesson, M. (2005) · Addiction · doi:10.1111/j.1360-0443.2005.01123.x · Cited by 60
O'Connor, D. B., Branley-Bell, D., Green, J. A., Ferguson, E., O'Carroll, R. E., & O'Connor, R. C. (2020) · Journal of Abnormal Psychology · doi:10.1037/abn0000482 · Cited by 60
Predicting acute suicidal ideation on Instagram using ensemble machine learning models
Lekkas, D., Klein, R. J., & Jacobson, N. C. (2021) · Internet Interventions · doi:10.1016/j.invent.2021.100424 · Cited by 59
“…data to find a signal in the noise, and (ii) there was little risk of 4 weeks being too far in the past given that SI, while tending to fluctuate from day-to-day, has also shown long-term predictive validity as a suicidal risk factor (Leon et al., 1990; Mann et al., 1999; Mundt et al., 2013) .”
BackgroundIndividuals with single versus multiple suicide attempts over 10 years of prospective follow-up
Boisseau, C. L., Yen, S., Markowitz, J. C., Grilo, C. M., Sanislow, C. A., Shea, M. T., Zanarini, M. C., Skodol, A. E., Gunderson, J. G., Morey, L. C., et al. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.07.062 · Cited by 59
“Several studies have linked anger and aggression with suicide attempts [19-21]; one study indicated higher levels of trait anger in MSA than SSA adolescents [9].”
Neurocognitive functioning and suicidality in schizophrenia spectrum disorders
Barrett, E. A., Sundet, K. S., Simonsen, C., Agartz, I., Lorentzen, S., Mehlum, L. I., Mork, E., Andreassen, O. A., & Melle, I. S. (2010) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2010.06.001 · Cited by 66
“A model of suicidal behavior has been proposed in which the risk for suicidal acts is influenced by individual trait-like predispositions [13].”
BackgroundInfluentialThe Impact of Parental Suicide on Child and Adolescent Offspring
Kuramoto, S. J., Brent, D. A., & Wilcox, H. C. (2009) · Suicide and Life-Threatening Behavior · doi:10.1521/suli.2009.39.2.137 · Cited by 58
Suicide and suicide attempts in adolescent-onset psychotic disorders
Jarbin, H., & von Knorring, A. (2004) · Nordic Journal of Psychiatry · doi:10.1080/08039480410005611 · Cited by 60
“Nicotine dependence at follow-up, n (%) 16/59 (27) 14/21 (67) 10/31 (32) 8 (80) 4/25 (16) 4/8 (50)*”
BackgroundInfluentialBoldrini, M., Butt, T. H., Santiago, A. N., Tamir, H., Dwork, A. J., Rosoklija, G. B., Arango, V., Hen, R., & Mann, J. J. (2014) · The International Journal of Neuropsychopharmacology · doi:10.1017/s1461145714000844 · Cited by 58
“The pathophysiology of suicide, as opposed to depression, is related to the diathesis for suicidal behavior (Mann et al., 1999).”
Self-citationHorváth, L. O., Győri, D., Komáromy, D., Mészáros, G., Szentiványi, D., & Balázs, J. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.00370 · Cited by 61
“In line with the stress-diathesis models of suicidal behavior (27), the relationship between stressful life events, and particularly”
Backgroundde Lara, C. L., Dumais, A., Rouleau, G. A., LESAGE, A. D., Dumont, M., Chawky, N., Alda, M., Benkelfat, C., & Turecki, G. (2005) · Biological Psychiatry · doi:10.1016/j.biopsych.2005.06.021 · Cited by 62
Hirsch, J. K., Duberstein, P. R., Conner, K. R., Heisel, M. J., Beckman, A., Franus, N., & Conwell, Y. (2007) · Depression and Anxiety · doi:10.1002/da.20224 · Cited by 57
“Mean hopelessness scores for our sample are comparable to other studies of older adult psychiatric patients [Lynch et al., 2003; Mann et al., 1999]; higher BHS scores indicate greater hopelessness.”
ResultHow adolescents who cut themselves differ from those who take overdoses
Hawton, K., Harriss, L., & Rodham, K. (2010) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-009-0065-0 · Cited by 64
“It is unclear, however, to what extent this association reflects transmission of the behaviour by biological [31, 39], social or psychological 0.”
BackgroundA Comparison of Antecedents of Homicide-Suicide and Suicide in Older Married Men
Malphurs, J. E., Eisdorfer, C., & Cohén, D. (2001) · American Journal of Geriatric Psychiatry · doi:10.1097/00019442-200102000-00008 · Cited by 59
Aggressiveness, anger, and hostility in eating disorders
Miotto, P., Pollini, B., Restaneo, A., Favaretto, G., & Preti, A. (2008) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2008.01.004 · Cited by 63
“In general, suicide attempters score significantly higher for lifetime aggression and impulsivity than nonattempters with the same psychiatric illness [42].”
BackgroundRihmer, Z., Gonda, X., Torzsa, P., Kalabay, L., Akiskal, H. S., & Eőry, A. (2013) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.02.010 · Cited by 57
“…decades that suicidality is also associated with certain personality features, such as aggressive/impulsive traits, hopelessness and pessimism, and the risk increases if these traits are present in combination (MacKinnon et al., 2005; Mann et al., 1999; Oquendo et al., 2004; Swann et al., 2007).”
BackgroundRiihimäki, K., Vuorilehto, M. S., Melartin, T. K., Haukka, J. K., & Isometsä, E. T. (2013) · Psychological Medicine · doi:10.1017/s0033291713000706 · Cited by 59
“Other risk factors for suicide attempt include co-morbidity with personality disorders and alcohol abuse, younger age, lacking a partner, and low perceived social support (Duggan et al. 1991; Malone et al. 1995; Mann et al. 1999; Sokero et al. 2003; Oquendo et al. 2004; Haw et al. 2013).”
BackgroundClinical and Cognitive Correlates of Suicide Attempts in Bipolar Disorder
Gilbert, A. M., Garno, J. L., Braga, R. J., Shaya, Y., Goldberg, T. E., Malhotra, A. K., & Burdick, K. E. (2011) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.10m06410 · Cited by 57
Gene-Environment Interaction and Suicidal Behavior
Roy, A., Sarchiapone, M., & Carli, V. (2009) · Journal of Psychiatric Practice · doi:10.1097/01.pra.0000358314.88931.b5 · Cited by 57
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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