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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MethodIncreased efficiency of brain connectivity networks in veterans with suicide attempts
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La douleur sociale au centre des conduites suicidaires
Courtet, P., & Olié, É. (2018) · L Encéphale · doi:10.1016/j.encep.2018.09.005 · Cited by 23
Impulsivity and Suicide Risk: Review and Clinical Implications
Klonsky, E. D., May, A. M., & Ma (2015) · Cited by 22
Stress and Suicidal Ideation: The Role of State or Trait Anhedonia in a Moderated Mediation Model
Yang, X., Wang, D., Liu, S., Liu, G., & Harrison, P. (2019) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12605 · Cited by 22
Παπαδοπούλου, Α., Efstathiou, V., Christodoulou, C., Gournellis, R., Papageorgiou, C., Douzenis, A., & Markianos, M. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112747 · Cited by 22
Wang, M., Alexanderson, K. A. E., Runeson, B., & Mittendorfer‐Rutz, E. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.10.069 · Cited by 22
“, 2013) or by using relatively small sample sizes (Mann et al., 1999; Schneider et al., 2001; Sokero et al., 2003, 2005; Sinclair et al., 2005; Vuorilehto et al., 2006; Hoyer et al., 2009; Holma et al., 2010; Riihimaki et al., 2013).”
BackgroundVanyukov, P. M., Szántó, K., Siegle, G. J., Hallquist, M. N., Reynolds, C. F., Aizenstein, H. J., & Dombrovski, A. Y. (2014) · American Journal of Geriatric Psychiatry · doi:10.1016/j.jagp.2014.10.004 · Cited by 23
“The present study focuses on the coupling of two putative vulnerability factors: chronic interpersonal dysfunction(5) associated with a maladaptive approach to social problems in older suicide attempters and impulsive aggressive traits.(10) To uncover alterations in neural systems that underlie deficits in social func…”
BackgroundYaseen, Z. S., Fisher, K., Morales, E., & GALYNKER, I. I. (2012) · PLoS ONE · doi:10.1371/journal.pone.0044069 · Cited by 24
“reactivity resulting in loss of emotional control are likely to act in ways that appear impulsive [49], including low-plan suicide attempts [50].”
Background[Impulsivity and mental disorders].
Kısa, C., Yildirim, S. G., & Göka, E. (2005) · PubMed · Cited by 22
Impulsivity, Mental Disorder, and Suicide in Rural China
Lin, L., & Zhang, J. (2017) · Archives of Suicide Research · doi:10.1080/13811118.2015.1004478 · Cited by 21
“Furthermore, Mann et al. (1999) found that a significantly impulsive personality characterized individuals at risk for suicide attempts, regardless of psychiatric diagnosis, among 347 consecutive patients who were 14–72 years old (Mann, Waternaux, Haas et al., 1999).”
BackgroundTsafrir, S., Chubarov, E., Shoval, G., Levi, M., Nahshoni, E., Ratmansky, M., Weizman, A., & Zalsman, G. (2013) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2013.08.009 · Cited by 21
Characteristics of depressed suicide attempters with remitted substance use disorders
Rizk, M., Galfalvy, H., Miller, J. M., Milak, M. S., Parsey, R. V., Grunebaum, M. F., Burke, A. K., Sublette, M. E., Oquendo, M. A., Stanley, B., et al. (2020) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.10.041 · Cited by 21
Self-citationEpidemiology of suicide attempters resorting to emergency departments in Karaj, Iran, 2003
Nojomi, M., Malakouti, S. K., Bolhari, J., Shooshtari, M. H., Fleischmann, A., & Bertolote, J. M. (2008) · European Journal of Emergency Medicine · doi:10.1097/mej.0b013e3282f4d12a · Cited by 21
Neuroimaging findings in major depression, suicidal behavior and aggression
Oquendo, M. A., & Mann, J. J. (2001) · Clinical Neuroscience Research · doi:10.1016/s1566-2772(01)00040-8 · Cited by 21
Self-citationSocial, Demographic, and Clinical Factors Related to Disruptive Behaviour in Hospital
Boggild, A. K., Heisel, M. J., & Links, P. S. (2004) · The Canadian Journal of Psychiatry · doi:10.1177/070674370404900206 · Cited by 21
Pompili, M. (2010) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s12044 · Cited by 21
“The stress-diathesis suicide-risk model is helpful for understanding suicidal behavior and its management in schizophrenia.(17) In this model, suicide risk factors may be either distal or proximal.”
Lipophilic Statin Use and Suicidal Ideation in a Sample of Adults With Mood Disorders
Davison, K., & Kaplan, B. J. (2014) · Crisis · doi:10.1027/0227-5910/a000260 · Cited by 21
Cognitive Therapy for Suicidal Patients: Current Status.
Wenzel, A. E., & Jager‐Hyman, S. (2012) · PubMed · Cited by 21
Factors associated with suicide: Case-control study in South Tyrol
Giupponi, G., Innamorati, M., Baldessarini, R. J., Leo, D. D., de Giovannelli, F., Pycha, R., Conca, A., Girardi, P., & Pompili, M. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.09.010 · Cited by 21
Soloff, P. H., Chowdury, A., & Diwadkar, V. A. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.04.050 · Cited by 21
“Suicidal behavior in BPD and other psychiatric disorders is closely associated with temperamental traits of impulsivity and aggressiveness (Brodsky et al., 1997; Mann et al., 1999; McGirr et al., 2007, 2009, Oquendo et al., 2004).”
BackgroundPeriodontal Pathogens and Neuropsychiatric Health
Wadhawan, A., Reynolds, M. A., Makkar, H., Scott, A. J., Potocki, E., Hoisington, A. J., Brenner, L. A., Dagdag, A., Lowry, C. A., Dwivedi, Y., et al. (2020) · Current Topics in Medicinal Chemistry · doi:10.2174/1568026620666200110161105 · Cited by 22
The moderating effects of impulsivity on Chinese rural young suicide.
Zhang, J., & Lin, L. (2014) · Journal of Clinical Psychology · doi:10.1002/jclp.22039 · Cited by 18
López-Moríñigo, J.-D., Fernandes, A. C., Chang, C., Hayes, R. D., Broadbent, M. T. M., Stewart, R. J., David, A. S., & Dutta, R. (2014) · BMC Psychiatry · doi:10.1186/s12888-014-0213-z · Cited by 22
“Regarding classic risk factors, we replicated the role of suicidal history and suicidal ideation, hopelessness, impulsivity and significant loses in suicide risk irrespective of diagnosis [44,46] being highly prevalent, although they were more frequent in the non-SSD group.”
BackgroundHoffman, M. A. (2000) · The Counseling Psychologist · doi:10.1177/0011000000284006 · Cited by 21
(2003) · doi:10.1176/appi.books.9781615377268.lg04 · Cited by 16
Self-citationHazlett, E. A., Blair, N. J., Fernandez, N., Mascitelli, K., Perez‐Rodriguez, M. M., New, A. S., Goetz, R. R., & Goodman, M. (2016) · Psychophysiology · doi:10.1111/psyp.12698 · Cited by 20
Birkbak, J., Stuart, E. A., Lind, B. D., Qin, P., Stenager, E. N., Larsen, K. J., Wang, A. G., Nielsen, A. C., Pedersen, C. M., Winsløv, J.-H., et al. (2016) · Psychological Medicine · doi:10.1017/s0033291716001872 · Cited by 21
“Studies show that people who attempt suicide are characterized by impaired decision making (Jollant et al. 2005) and increased impulsiveness (Mann et al. 1999), which might increase risk-taking behaviours and lower the likelihood of seeking treatment for medical conditions.”
BackgroundImplementing Evidence-Based Suicide Prevention Strategies for Greatest Impact
Melhem, N., Moutier, C. Y., & Brent, D. A. (2023) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/appi.focus.20220078 · Cited by 23
Validation of the Columbia Suicide Severity Rating Scale in Depression Patients
장한아, 전덕인, 홍나래, 홍현주, Jung, M. H., 박은희, & 박희정 (2014) · The Korean Journal of Clinical Psychology · doi:10.15842/kjcp.2014.33.4.008 · Cited by 21
Neurocognition and the Suicidal Process
Rutter, S., Cipriani, N., Smith, E. C., Ramjas, E., Vaccaro, D. H., Lopez, M. M., Calabrese, W. R., Torres, D., Campos-Abraham, P., Llaguno, M., et al. (2020) · Current topics in behavioral neurosciences · doi:10.1007/7854_2020_162 · Cited by 21
Michel, K. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18105301 · Cited by 24
“In Mann’s diathesis-stress model [7] diathesis is understood as a constitutional or acquired vulnerability (for instance, impulsive and aggressive traits) as risk factors for suicide.”
BackgroundMelhem, N., Zhong, Y., Miller, J. M., Zanderigo, F., Ogden, R. T., Sublette, M. E., Newell, M., Burke, A. K., Keilp, J. G., Lesanpezeshki, M., et al. (2021) · The International Journal of Neuropsychopharmacology · doi:10.1093/ijnp/pyab060 · Cited by 20
“These clinical differences are all reported clinical correlates of suicidal behavior(Mann et al., 1999; Melhem et al., 2007; Brent et al., 2015).”
BackgroundSelf-citationAlacreu‐Crespo, A., Hidalgo, V., Girod, C., Olié, É., & Courtet, P. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.10.008 · Cited by 21
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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