A behavioral and cognitive neuroscience perspective on impulsivity, suicide, and non-suicidal self-injury: Meta-analysis and recommendations for future research.

We conducted a meta-analysis of neurobehavioral and neurocognitive indices of impulsivity in relation to suicidal thoughts and behaviors, as well as non-suicidal self-injury (NSSI). In our systematic review, 34 studies were identified and submitted to a random-effects meta-analysis. A small pooled effect size was observed for the association between behavioral impulsivity and NSSI (OR=1.34, p<0.05). A small-to-medium pooled effect size (OR=2.23, p<0.001) was found for the association between behavioral impulsivity and suicide attempts, and a medium-to-large pooled effect size was observed for this outcome in relation to cognitive impulsivity (OR=3.14, p<0.01). Length of time between suicide attempt and impulsivity assessment moderated the strength of the relation between impulsivity and attempts, with a large pooled effect size (OR=5.54, p<0.001) evident when the suicide attempt occurred within a month of behavioral impulsivity assessment. Studies of clinically significant NSSI temporally proximal to impulsivity assessment are needed. Longitudinal research is required to clarify the prognostic value of behavioral and cognitive impulsivity for short-term risk for self-harm.

Depression, social support, and long-term risk for coronary heart disease in a 13-year longitudinal epidemiological study.

Depression has been linked with long-term risk for a variety of physical health ailments, including coronary heart disease (CHD). Little is known about resilience factors that may attenuate this relationship. The current study assessed whether social support moderates the long-term risk for CHD associated with this disorder. Data were drawn from the Americans' Changing Lives study, a nationally representative longitudinal survey of adults in the United States. Participants (unweighted n=1636) completed initial assessments of functional social support, body mass index, recent history of major depression, CHD, hypertension, and diabetes. Participants were again assessed for CHD at a follow-up assessment 13 years later. Social support was found to moderate the relationship between depression and the occurrence of CHD 13 years later. Specifically, among individuals with low social support, depression was prospectively associated with CHD. In contrast, depression was not prospectively associated with CHD among individuals with high social support. The results indicate that social support may function as a resilience factor against the long-term cardiovascular risk associated with depression. Clinical interventions focusing on the development of social support systems are important not only for addressing depression itself, but also for associated long-term physical health outcomes.

Prospective prediction of first lifetime suicide attempts in a multi-site study of substance users.

Although considerable empirical work has been devoted to identifying risk factors for suicide attempts, most longitudinal research has studied recurrent attempts rather than first lifetime attempts. The present study sought to examine prospective predictors of first lifetime suicide attempts among adults receiving treatment for substance use. Data were drawn from the National Treatment Improvement Evaluation Study, a study of addiction treatment programs. Data were collected at treatment intake, treatment exit, and one year post-treatment. Patients (n = 3518) with no lifetime history of suicide attempts at treatment intake were followed at treatment exit and one year post-treatment, when they reported on the occurrence of suicide attempts since the prior assessment. Prospective suicidal behavior was assessed using logistic regression in relation to sociodemographic variables, health-related work impairment, history of psychiatric treatment utilization, history of suicidal ideation, history of depressive symptoms, substance use, and childhood abuse, assessed at intake. Health-related work impairment, history of suicidal ideation, and childhood physical abuse significantly predicted first lifetime attempts in a multivariate analysis. Suicidal ideation, health-related functional impairments, and childhood physical abuse may be particularly important in assessing risk for first lifetime suicide attempts. Findings suggest that future clinical work and research would benefit from considering these factors when identifying individuals at heightened risk of making a first suicide attempt.

Vulnerability-specific stress generation: Childhood emotional abuse and the mediating role of depressogenic interpersonal processes.

Stress generation in depression (i.e. the tendency for depression-prone individuals to experience more life stress that is in part influenced by the individual) has been well established. However, more research is necessary to clarify the role of specific types of life stress in this effect. The current study extends the stress generation hypothesis by examining whether the type of stress involved is contingent upon the nature of the individual's particular vulnerability. Childhood emotional abuse and interpersonal vulnerability factors were predicted to be associated with prospective interpersonal dependent but not non-interpersonal or independent stress. These interpersonal factors were examined as mediators of the association between childhood emotional abuse and interpersonal stress generation. Data were collected from 185 undergraduate participants at two time-points, four months apart. At baseline, participants completed assessments of depressive symptoms, childhood abuse history, interpersonal risk factors (rejection sensitivity, excessive reassurance-seeking, and negative feedback-seeking), and a diagnostic interview for depression. At the follow-up assessment, participants completed a life stress interview. Childhood emotional abuse prospectively predicted greater interpersonal dependent stress, but not non-interpersonal dependent or independent stress. Only rejection sensitivity mediated this relationship. Consistent with the stress generation hypothesis, neither childhood emotional abuse nor the three interpersonal risk factors predicted independent stress. These findings suggest that targeting interpersonal vulnerabilities in clinical settings, particularly rejection sensitivity, among individuals with a history of childhood emotional abuse, may help to reduce the occurrence of interpersonal dependent stress, thus possibly decreasing risk for depression.