One longstanding belief about suicide is that many suicide attempts are impulsive acts—that people who attempt to kill themselves often do so with little planning, reacting to the emotions of the moment. This would imply that among potentially suicidal individuals, those who are more impulsive by nature are at a higher risk for attempting suicide—an important piece of information for clinicians and others who treat patients, including Veterans and active members of the Armed Forces, who have contemplated suicide. However, a group of MSRC researchers led by Michael Anestis at the University of Southern Mississippi, has studied the link between impulsivity and suicide and found that it is not at all what it has been assumed to be. Their work offers some new insights into the types of patients who are most at risk of attempting suicide.
To examine the link between impulsivity and suicide, the group—which also included MSRC scientists Kelly Soberay, Peter Gutierrez, Theresa Hernández, and Thomas Joiner—made a careful examination of the many existing studies that have been published on the topic. This examination, which was published in 2014 in Personality and Social Psychology Review, consisted of two parts, each of which offered its own insights into the link between impulsivity and suicide.
First, the group performed a meta-analysis of a large number of studies that had looked for an association between individuals’ impulsivity and the likelihood that they would attempt suicide. Roughly speaking, a meta-analysis is a way of amalgamating the results of many studies to get a combined result with greater statistical power. The results of the meta-analysis indicated that there is indeed a statistically significant correlation between impulsivity and suicide risk but that the correlation between the two is relatively small, indicating that impulsivity is not a major factor in suicide risk.
This is not really a surprising finding, Anestis commented. It is not easy to kill yourself, given most people’s natural aversion to causing themselves pain or harm. “People have to work up to it,” Anestis explained. “It’s not something that can be done on the spur of the moment on impulse.”
So why is there any link at all between impulsivity and suicide risk? That was the question the research group sought to answer with their second study. In this one they examined a number of published studies that analyzed the role impulsivity played individual suicide attempts. In this way they were able to get richer, more detailed accounts of individuals’ states of mind in the hours and days leading up to a suicide attempt. A consistent pattern was that the more impulsive an attempt was—that is, the less time a person had spent time thinking about it before the attempt—the less lethal it was. In other words, it is the people who are less impulsive in attempting suicide who are most likely to succeed in the attempt.
Anestis and his group believe they understand what is going on. Because it is so difficult to kill yourself, people who do so successfully are generally those who have, over time, developed that capacity. They may develop that capacity, for instance, by being regularly exposed to death and risky situations, which makes the idea of their own death less scary. This is probably at least part of the reason why there is a higher risk of suicide among soldiers and police officers. People may also develop the capacity to harm themselves through a history of painful experiences, either from accidents of the sort that, say, professional motorcycle racers experience or else from self-inflicted pain, such as the cutting that some depressed people engage in.
And this, Anestis said, may hold the key to explaining the small correlation that exists between impulsivity and suicide risk. People who are impulsive tend to jump into things without planning, and this means that, over the course of their lives, they are more likely than non-impulsive people to have the sorts of painful or scary experiences that give them the capacity to take their own lives. Thus they are more likely than non-impulsive people, on average, to attempt suicide, but it is not because they are more likely to decide on impulse to kill themselves. Instead it is because a lifetime of impulsivity has helped them get to the point where suicide does not seem as daunting as it might for someone who has had fewer painful or scary experiences.
This different understanding of the connection between impulsivity and suicide risk has important implications for the researchers and clinicians who are interested in lowering the rates of suicide among Veterans and active members of the military. In particular, it helps in identifying which Veterans and service members are most at risk: It is not those who are impulsive but rather those who are more capable of harming themselves. Furthermore, Anestis said, those who do attempt suicide do not do it impulsively, but rather the act is the product of a great deal of forethought and planning. Understanding this is an important step in addressing the scourge of suicide among U.S. Veterans and service members.