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Citation
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Brent DA, Johnson B, Bartle S, Bridge JA, Rather C, Matta J, Connolly J, Constantine D. J. Am. Acad. Child Adolesc. Psychiatry 1993; 32(1): 69-75. |
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Abstract
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Inpatient suicide attempters (n = 37) were compared with never-suicidal psychiatric controls (n = 29) with respect to prevalence and severity of personality disorder, history of aggression and assaultive behavior, and other measures of impulsive violence. Attempters, compared with controls, were more likely to show evidence of personality disorder or trait, particularly those of the borderline type. Attempters showed greater number of borderline symptoms than did controls, even after removing the item relating to suicidality. There were no differences between the groups with respect to lifetime history of aggression, history of assaultive behavior, or self-report measures of a tendency to impulsive aggression. Those attempters with personality disorder were much more likely to have made a previous attempt. The apparently high prevalence of personality disorder among adolescent inpatient suicide attempters indicates that the social impairment associated with personality disorder be viewed as an important aspect of treatment.
VioLit summary:
OBJECTIVE:
The purpose of this article by Brent et al. was to examine personality disorder and history of aggression in a sample of inpatient suicide attempters and a control group of inpatient non-attempters in order to test hypotheses generated from a comprehensive review of literature. Hypotheses tested were: attempters when compared with non-attempters will be more likely to have been diagnosed with a personality disorder; attempters will measure higher scores on impulsivity and novelty seeking; attempters will show higher scores on items measuring hostility, impulsive violence, and history of assaultive behavior; within the attempter group those with personality disorder will show attempts of higher intent, lethality and will be more likely to have a history of recurrent suicidal behavior.
METHODOLOGY:
The authors utilized a quasi-experimental cross-sectional design to gather data from a sample containing two groups, suicide attempters and non-attempters, of adolescent inpatients hospitalized at Western Psychiatric Institute and Clinic. The groups were comprised of adolescents between the ages of 13 and 19. Suicide attempters were defined as those who had made a suicide attempt within one year of admission, had shown active suicidal intent and engaged in self-destructive behavior with lethal intent. The never suicidal group contained inpatients who had never engaged in suicidal behavior. These patients had never planned out a suicidal attempt. The never suicidal group had a high proportion of males and a greater number of patients who had histories of conduct disorder. The suicide attempters had more females and had a greater number of individuals with affective illness. At least one parent had to be available and cooperative for direct interview. Informed consent was received from all respondents in both groups. The instrument used in this study was semi-structured interviews administered by masters' level clinicians. Suicidal intent was measured using the Beck Suicidal Intent Scale. Lethality was measured by the risk Rescue Rating Scale which revealed the degree of medical damage to the attempter and the extent to which the attempter tried to avoid rescue. Lifetime and current symptomatology was assessed according to DSM-III criteria using the School Age Schedule for Affective Disorders and Schizophrenia, Epidemiological version. Axis II, personality disorders, were measured using the Structured Clinical Interview for the DSM-III-R. Both the adolescent and the parent were given the Brown-Goodwin Assessment for Lifetime History of Aggression. Internal consistency of this measure was .96 using Cronbach's alpha. Three dimensions of the personality; novelty seeking, harm avoidance, and reward dependence, were measured using the Tridimension Personality Questionnaire. The reward dependence category was found to have low internal reliability, while novelty seeking and harm avoidance had adequate internal consistency. Aggressive personality traits were measured using the Buss-Durkee Hostility Inventory. Internal consistency of this instrument was high. The authors used standard univariate parametric and nonparametric procedures, along with logistic regression and analysis of covariance to examine the data.
FINDINGS/DISCUSSION:
Suicide Attempters were more likely than the psychiatric controls to have a diagnosis of personality disorder. The hypothesis which stated that personality disorder was associated with attempted suicide in psychiatrically ill adolescents was confirmed. Personality disorder was found to be related with recurrent suicidal behavior. Attempters did not show higher scores on dimensional measurers of novelty seeking and impulsivity. Attempters did not score higher on measures of hostility, impulsive violence, or lifetime history of aggression. These results contradict the authors hypothesis. The results confirmed the hypothesis that attempters with personality disorder were more likely to have had a history of recurrent suicidal behavior. The hypotheses which stated that attempters with personality disorders were more likely to show attempts with higher lethality or intent was not supported.
AUTHORS' RECOMMENDATIONS:
The authors recommended that studies be done to explore the long-term stability of personality disorder identified in adolescents. They suggested that the psychological and neurobiologic correlates of both personality disorder and of suicidal behavior be looked at longitudinally along with the impact of personality disorders on suicidal behavior.
(CSPV Abstract - Copyright © 1992-2007 by the Center for the Study and Prevention of Violence, Institute of Behavioral Science, Regents of the University of Colorado)
KW - Juvenile Aggression
KW - Juvenile Violence
KW - Juvenile Suicide
KW - Juvenile Offender
KW - Suicidal Behavior
KW - Suicide Attempted
KW - Mental Illness
KW - Mentally Ill Offender
KW - Personality Disorder
KW - Personality Characteristics
KW - Offender Characteristics
KW - Offender Personality
KW - Psychological Factors
KW - Aggression Causes
KW - Violence Causes
KW - Impulsive Behavior
KW - Juvenile Behavior
KW - Suicide Causes
KW - Behavior Causes
Language: en |