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Sunday, July 7, 2024

Impulsivity in fatal suicide behaviour: A systematic review and meta-analysis of psychological autopsy studies

Sanz-Gómez, S., et al. (2024).
Psychiatry research, 337, 115952. 
Advance online publication.


Our aim is to review and perform a meta-analysis on the role of impulsivity in fatal suicide behaviour. We included papers who used psychological autopsy methodology, assessed adult death by suicide, and included assessment of impulsivity. We excluded papers about assisted suicide, terrorist suicide, or other cause of death other than suicide or postmortem diagnosis made only from medical records or database. 97 articles were identified. 33 were included in the systematic review and nine in the meta-analysis. We found that people who die by suicide with high impulsivity are associated with younger age, substance abuse, and low intention to die, whereas those with low impulsivity were associated with older age, depression, schizophrenia, high intention to die and low social support. In the meta-analysis, suicide cases had higher impulsivity scores than living controls (Hedges' g = 0.59, 95 % CI [0.28, 0.89], p=.002). However, studies showed heterogeneity (Q = 90.86, p<.001, I2=89.0 %). Impulsivity-aggressiveness interaction was assessed through meta-regression (β=0.447, p=.045). Individuals with high impulsivity would be exposed to a higher risk of fatal suicide behaviour, aggressiveness would play a mediating role. People who die by suicide with high and low impulsivity display distinct characteristics, which may reflect different endophenotypes leading to suicide by different pathways.

Here is the conclusion.

This systematic review has shed light on the role of impulsivity on fatal suicide behaviour. This topic has been subject to less attention than impulsivity in other behaviours of the suicidal spectrum, mostly due to the methodological barriers that it entails. We found that impulsivity as a trait plays a role in deaths by suicide. Individuals with high impulsivity traits who die by suicide exhibit distinct characteristics such as younger age, substance abuse and low intent to die, whereas non-impulsive people who die by suicide tend to be older age, experience depression or schizophrenia and have high intent to die. Social support is not a protective factor for death by suicide in people with high impulsivity which poses challenges for suicide prevention in this population.