Pathways to high-lethality suicide attempts

The purpose of this study was to develop a model of the trajectory to high-lethality suicidal behavior for individuals with Major Depressive Disorder (MDD) and Borderline Personality Disorder (BPD). An increased number of previous suicide attempts, substance use immediately prior to the attempt, and objective planning were proposed to lead directly to an attempt of higher lethality. Meanwhile, aggression and impulsivity were hypothesized to lead indirectly, through their association with past suicidal behavior, to a higher lethality attempt. Path analysis revealed a revised model that applied only to individuals with BPD. In this final model, impulsivity was found to be significantly associated with higher-lethality suicide attempts and the frequency of an individual's past suicidal behavior. Additionally, the traits of impulsivity and aggression were found to be significantly correlated in the multivariate model. Pathways linking alcohol use at the time of the attempt to the lethality of suicidal behavior and aggression to the frequency of an individual's past suicidal behavior were not found to be significant, and no model using the variables of interest in this study could be determined for individuals with MDD. These results are discussed in light of current theories of suicidal behavior and in terms of their implications for clinical practice