Suicide Attempts Associated With Externalizing Psychopathology in an Epidemiological Sample
Abstract
OBJECTIVE: Borrowing from recent dimensional models of psychopathology, the authors conducted analyses that optimized the common variance shared by internalizing (depression, anxiety) and externalizing (antisocial personality, substance dependence) disorders in statistically predicting suicidal behaviors. These relationships were analyzed in a large epidemiological sample, thus allowing for the examination of gender differences in risk for suicide attempts associated with psychopathology. METHOD: The data were obtained from the Colorado Social Health Survey. Participants (N=4,745) were a community sample recruited by household address. Structured clinical interviews were used to obtain lifetime diagnostic and symptom count information. Symptom counts were included in a factor analysis that yielded two main dimensions of psychopathology: internalizing and externalizing. These factors were used in hierarchical logistic regression analyses to predict history of suicide attempts associated with the presence of internalizing symptoms, externalizing symptoms, and comorbid internalizing and externalizing symptoms. RESULTS: After the investigators controlled for the presence of internalizing symptoms and the comorbidity of internalizing and externalizing symptoms, externalizing symptoms were related to suicidal behavior in both men and women, although comorbidity was most predictive of suicide attempts among women, compared to men. CONCLUSIONS: Suicidal behavior among individuals with externalizing symptoms is not necessarily a result of comorbid depressive or other internalizing disorder. Thus, persons exhibiting antisocial behaviors should receive rigorous assessment for suicidal ideation and behavior.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Among depressed individuals, approximately one-quarter make a non-fatal suicide attempt during their lifetime, and at least 25% report suicidal ideation in the past two weeks.
“among depressed individuals, approximately one-quarter make a non-fatal suicide attempt during their lifetime (Verona, Sachs-Ericsson, & Joiner, 2004), and at least 25% report having experienced suicidal ideation in the past two weeks (Goldney, Dal Grande, Fisher, & Wilson, 2003)”
From The interpersonal theory of suicide. (2010) · cites this paper as Verona, Sachs-Ericsson, & Joiner, 2004
Cites
Tripartite model of anxiety and depression: psychometric evidence and taxonomic implications
Clark, L. A., & Watson, D. (1991) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.100.3.316 · Cited by 4,601 · see citing works
The Structure of Common Mental Disorders
Krueger, R. F. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.10.921 · Cited by 1,881 · see citing works
Toward a clinical model of suicidal behavior in psychiatric patients
Mann, J. J., Waternaux, C., Haas, G. L., & Malone, K. M. (1999) · American Journal of Psychiatry · doi:10.1176/ajp.156.2.181 · Cited by 1,791 · cited 1× · see citing works
“Even in community samples, the risk for suicide among persons exhibiting acting-out behaviors may simply reflect risk associated with the comorbidity of such behaviors with an internalizing axis I disorder, such as depression (9, 10).”
Alcoholics, aggression and antisocial personality.
Jaffe, J. H., Babor, T. F., & Fishbein, D. H. (1988) · Journal of Studies on Alcohol · doi:10.15288/jsa.1988.49.211 · Cited by 86 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
The interpersonal theory of suicide.
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner, T. E. (2010) · Psychological Review · doi:10.1037/a0018697 · Cited by 5,292 · see citing works
Self-citationCrowell, S. E., Beauchaine, T. P., & Linehan, M. M. (2009) · Psychological Bulletin · doi:10.1037/a0015616 · Cited by 1,292 · see citing works
Sareen, J., Cox, B. J., Afifi, T. O., de Graaf, R., Asmundson, G. J. G., ten Have, M., & Stein, M. B. (2005) · Archives of General Psychiatry · doi:10.1001/archpsyc.62.11.1249 · Cited by 824 · see citing works
Modeling psychopathology structure: a symptom-level analysis of Axis I and II disorders
Markon, K. E. (2010) · Psychological Medicine · doi:10.1017/s0033291709990183 · Cited by 311 · see citing works
Chronic Pain Conditions and Suicidal Ideation and Suicide Attempts: An Epidemiologic Perspective
Ratcliffe, G. E., Enns, M. W., Belik, S.-L., & Sareen, J. (2008) · The Clinical Journal of Pain · doi:10.1097/ajp.0b013e31815ca2a3 · Cited by 304 · see citing works
National trends in suicide attempts among adults in the United States.
Olfson, M., Blanco, C., Wall, M., Liu, S.-M., Saha, T. D., Pickering, R. P., & Grant, B. F. (2017) · JAMA Psychiatry · doi:10.1001/jamapsychiatry.2017.2582 · Cited by 229 · see citing works
Bolton, J. M., & Robinson, J. (2010) · American Journal of Public Health · doi:10.2105/ajph.2010.192252 · Cited by 165 · see citing works
Difficulties in emotion regulation and suicide ideation and attempt in adolescent inpatients
Hatkevich, C., Penner, F., & Sharp, C. (2019) · Psychiatry Research · doi:10.1016/j.psychres.2018.11.038 · Cited by 139 · see citing works
High-frequency repetitive TMS for suicidal ideation in adolescents with depression
Croarkin, P. E., Nakonezny, P. A., Deng, Z.-D., Romanowicz, M., Voort, J. L. V., Camsari, D. D., Schak, K. M., Port, J. D., & Lewis, C. P. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.06.048 · Cited by 95 · see citing works
Vander Stoep, A., Adrian, M., Mc Cauley, E., Crowell, S. E., Stone, A., & Flynn, C. (2011) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2011.00031.x · Cited by 86 · see citing works
Childhood Trajectories of Anxiousness and Disruptiveness as Predictors of Suicide Attempts
Brezo, J., Barker, E. D., Paris, J., Hébert, M., Vitaro, F., Tremblay, R. E., & Turecki, G. (2008) · Archives of Pediatrics & Adolescent Medicine · doi:10.1001/archpedi.162.11.1015 · Cited by 77 · see citing works
Moskowitz, A., Stein, J. A., & Lightfoot, M. (2013) · Journal of Youth and Adolescence · doi:10.1007/s10964-012-9793-4 · Cited by 73 · see citing works
Rice, S. M., Kealy, D., Oliffe, J. L., & Ogrodniczuk, J. S. (2019) · Early Intervention in Psychiatry · doi:10.1111/eip.12667 · Cited by 28 · see citing works
- Authors
- Verona, E., Sachs-Ericsson, N., & Joiner, T. E.
- Affiliations
- Kent State University (US)
- Venue
- American Journal of Psychiatry
- Published
- 2004-03-01
- Volume
- 161
- Issue
- 3
- Pages
- 444-451
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2083135866
- Cited by
- 205
- References
- 4
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 7 · 2023: 10 · 2022: 10 · 2021: 13 · 2020: 7 · 2019: 11 · 2018: 14 · 2017: 8 · 2016: 11 · 2015: 9 · 2014: 11 · 2013: 14 · 2012: 8
- FWCI
- 10.23
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (MH-377698)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Keywords
- suicide attempts, externalizing psychopathology, internalizing psychopathology, antisocial personality disorder, substance dependence, depression, anxiety, comorbidities, gender differences, suicidal ideation, dimensional models of psychopathology
- MeSH terms
- Adult, Antisocial Personality Disorder, Anxiety Disorders, Colorado, Depressive Disorder, Female, Health Surveys, Humans, Internal-External Control, Male, Middle Aged, Personality Assessment, Psychometrics, Psychopathology, Regression Analysis, Sex Factors, Suicide, Attempted, Reproducibility of Results, Comorbidity, Risk Assessment, Substance-Related Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
