Background
Methods
Participants and recruitment
Inclusion and exclusion criteria
SA early | SA late | |
---|---|---|
Inclusion criteria | • Suicide attempt < 3 months • Age >18 • Affective spectrum disorder (major depression, dysthymia, depression NOS, adjustment disorder with depression • Ability to understand and provide informed consent | • Suicide attempt > 6 months; < 5 years • Age >18 • Ability to understand and provide informed consent |
Exclusion criteria | • Indication for long-term lithium therapy or contraindications for lithium therapy • Lithium therapy • Organic brain diseases, schizophrenia, unstable physical illness, • Kidney abnormalities, Mb. Addison, diseases with electrolyte disturbances, thyroid diseases, pregnancy and lactation | • Organic brain diseases, schizophrenia, instable physical illness • Lithium therapy |
Clinical and personality assessment
Scale | Reference | Measure | Items | Remarks |
---|---|---|---|---|
MINI Mini-International Neuropsychiatric Interview | Sheehan et al., 1998 | 15 major adult Axis I diagnostic categories, 1 Axis II disorder and suicidality according ICD 10 and DSM IV | Semi-structured interview | |
HAM-D21 Hamilton Rating Scale for Depression | Hamilton 1969 | Depressive symptoms | 21 items, 5 point scale rating from 0 to 4 overall score: >23: very severe; 19–22: severe, 14–18: moderate, 8–13: mild, 0–7: no depression | Multiple choice questionnaire expert rating |
SSI Scale for Suicide Ideation | Beck et al., 1979 | Suicidal ideation; 3 dimensions: active suicidal desire, specific plans for suicide, passive suicidal desire | 19-items; 3 point scale rating from 0 to 2; range of score: 0 –38, higher scores indicate greater suicidal ideation | Semi-structured interview |
TCI Temperament and Character Inventory | Cloninger et al. 1994 | 7 dimensions: temperament (Novelty seeking, Harm Avoidance, Reward Dependence, Persistence) and character traits (Self-directedness, Cooperativeness, Self-transcendence) | Each of the dimension has a varying number of subscales, e.g.,: Novelty seeking (NS): Exploratory excitability (NS1), Impulsiveness (NS2), Extravagance (NS3), Disorderliness (NS4), | Self- questionnaire in total 240 yes/no items |
BIS Barratt Impulsivity Scale | Barratt 1965 | Impulsivity; 3 dimensions: non-planning, motor impulsiveness, attentional impulsiveness | 30-items; 4 point rating from 1 to 4 Overall score reflects the intensity of impulsiveness | Self-rating scale evaluation of lasting personality-markers |
Statistics
Results
Sociodemographic factors
Diagnoses N (%) | SA early (N = 81) | SA late (N = 32) |
p
| |
---|---|---|---|---|
Major depression | 58 (71.6) | 19 (59.4) | 0.37 | Chi2 = 5.402 df = 4 effect size Cohen’s w = 0.21 |
Dysthymia | 5 (6.2) | 0 | ||
Adjustment Disorder | 18 (22.2) | 8 (25) | ||
Personality disorder | 0 | 1 (3,1) | ||
No psychiatric diagnoses | 0 | 4 (12.5) |
Sociodemographic variables | SA early (N = 81) | SA late (N = 32) |
p
| |
---|---|---|---|---|
Age mean ± SD | 39.4 ± 13.5 | 41.9 ± 13.9 | 0.5 | U = 1205.0; Z = −0.675 effect size r = 0.06 (r = Z/√N) |
Sex (female/male) N (%) | 51/31 (62.3/37.8) | 20/12 (62.5/37.5) | 0.98 | Chi2 = 0.001; effect size w = 0 df = 1 |
Marital status N (%): | 0.53 | Chi2 = 2.23 effect size w = 0.15 df = 3 | ||
Single | 31 (37.8) | 11 (34.4) | ||
Married | 26 (31.7) | 7 (21.9) | ||
Divorced | 21 (25.6) | 11 (34.4) | ||
Widowed | 4 (4.9) | 3 (9.4) | ||
Highest qualification N (%): | 0.13 | Chi2 = 4.101 effect size w = 0.25 df = 2 | ||
Secondary general school | 28 (34.1) | 5 (15.6) | ||
Intermediate secondary school | 35 (42.7) | 16 (50) | ||
Grammar school | 19 (23.2) | 11 (34.4) | ||
Occupational status N (%): | 0.11 | Chi2 = 10.52 effect size w = 0.31 df = 6 | ||
Employed | ||||
Full-time | 36 (43.9) | 13 (40.6) | ||
Part-time | 9 (11.0) | 1 (3.1) | ||
Unemployed | 13 (15.9) | 9 (28.1) | ||
Homemaker | 3 (3.7) | 0 | ||
In apprenticeship | 15 (18.3) | 3 (9.4) | ||
Invalidity pension | 3 (3.7) | 1 (3.1) | ||
Retirement | 3 (3.7) | 5 (15.6) | ||
Living situation N (%): | 0.37 | Chi2 = 3.2 effect size w = 0.19 df = 3 | ||
Alone | 33 (40.2) | 14 (43.8) | ||
With both parents | 9 (11.0) | 1 (3.1) | ||
With husband/wife/common-law | 37 (45.1) | 17 (53.1) | ||
With other person | 3 (3.7) | 0 |
Clinical features
Personality traits measured with TCI
Dependent variable | SA early (mean ± SD) | SA late (mean ± SD) | F(2,111) |
p
| Partielles Eta-Quadrat | Cohen’s d |
---|---|---|---|---|---|---|
Novelty seeking | 19.26 ± 4,3 | 19.84 ± 5,4 | 0.19 | 0,830 | 0.003 | 0.125 |
Harm avoidance | 18.94 ± 3,2 | 12.55 ± 4,3 | 22.13 | <0,001 | 0.285 | 1.806 |
Reward dependence | 12.5 ± 2,5 | 14.81 ± 3,5 | 7.71 | 0,001 | 0.122 | 0.821 |
Persistence | 3.38 ± 1,4 | 4.41 ± 1,8 | 5.37 | 0,006 | 0.088 | 0.677 |
Self-directedness | 22.43 ± 5,2 | 24.38 ± 4,2 | 1.75 | 0,179 | 0.031 | 0.394 |
Cooperativeness | 22.36 ± 3,3 | 21.22 ± 3,6 | 1.74 | 0,181 | 0.030 | 0.337 |
Self-transcendence | 11.15 ± 5 | 11.16 ± 4,3 | 0.05 | 0,954 | 0.001 | 0.002 |
Subscale impulsivity | 5.92 ± 1.91 | 4.21 ± 2.85 | 7.35 | 0,001 | 0.117 | 0.774 |
Impulsivity
Dependent variable | SA early (mean ± SD) | SA late (mean ± SD) |
---|---|---|
BIS “Non-Planning” | 24.02 ± 4.52 | 22.97 ± 3.51 |
BIS “Motor Impulsiveness” | 23.46 ± 5.13 | 21.38 ± 4.61 |
BIS “Attentional Impulsiveness” | 28.13 ± 4.89 | 25.91 ± 3.56 |
BIS Overall Score | 75.62 ± 11.3 | 70.25 ± 9.25 |
Scale | Pearson’s correlation coefficient |
p for two-sided significance |
---|---|---|
Novelty seeking | 0.073 | 0.514 |
Harm avoidance | 0.451 | 0.023 |
Reward dependence | 0.058 | 0.607 |
Persistence | 0.108 | 0.333 |
Self-directedness | 0.156 | 0.16 |
Cooperativeness | 0.149 | 0.183 |
Self-transcendence | −0.006 | 0.956 |
TCI subscale (impulsivity) | 0.057 | 0.546 |
BIS overall score | 0.14 | 0.136 |
BIS “Non-Planning” | 0.003 | 0.975 |
BIS “Motor Impulsiveness” | 0.144 | 0.127 |
BIS “Attentional Impulsiveness” | 0.173 | 0.066 |