Is there an empirical link between impulsivity and suicidality in bipolar disorders? A review of the current literature and the potential psychological implications of the relationship
Article first published online: 4 JUL 2013
© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
Special Issue: Guest Editors – Frederick Cassidy and Christopher Baethge
Volume 15, Issue 5, pages 542–558, August 2013
How to Cite
Is there an empirical link between impulsivity and suicidality in bipolar disorders? A review of the current literature and the potential psychological implications of the relationship. Bipolar Disord 2013: 15:542–558. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd., .
- Issue published online: 6 AUG 2013
- Article first published online: 4 JUL 2013
- Manuscript Accepted: 28 AUG 2012
- Manuscript Received: 26 JUL 2011
- bipolar disorder;
- suicide attempts
Suicide is highly prevalent among individuals with bipolar disorder and understanding the factors that increase risk for suicide may help to develop targeted interventions to prevent attempts. Impulsivity is thought to be an influential factor associated with suicidality and is also discussed as a key construct of bipolar disorder. The aim of this paper was to systematically review the current evidence to examine the association between impulsivity and suicidality in bipolar disorder.
PsycInfo, Medline, and Web of Knowledge databases were searched for articles published up until March 2012. Papers were included if they assessed an adult sample of individuals with bipolar disorders, focused on suicidality (ideation with intent to die, suicide attempts, or completion), and used a validated measure to determine impulsivity.
Sixteen papers were identified. Contrary to widespread belief, we found (i) a very inconsistent picture of results including positive, negative, and insignificant associations between impulsivity and suicidality; and (ii) some studies do not take into account important aspects such as state-trait or measurement issues.
The link between suicidality and impulsivity is less straightforward than often assumed. Drawing clear conclusions about the association is hampered by factors such as inconsistencies in defining suicidality, measuring impulsivity, and differentiating between impulsivity as a personality trait and impulsivity as a state (e.g., a consequence of substance use or premeditation of the attempt). We suggest that the association is less direct and that psychological models (e.g., Joiner's theory of suicidality) can help foster a more in-depth understanding regarding the relationship.