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Mental health
Research
Correlation of impulsivity with self-harm and suicidal attempt: a community study of adolescents in Taiwan
  1. Yu-Hsin Huang1,2,3,4,
  2. Hui-Ching Liu2,3,4,
  3. Fang-Ju Tsai5,6,7,
  4. Fang-Ju Sun4,8,
  5. Kuo-Yang Huang9,
  6. Yu-Ching Chiu10,
  7. Yen-Hsun Huang11,
  8. Yo-Ping Huang12,
  9. Shen-Ing Liu1,2,3,4,8
  1. 1 Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
  2. 2 Department of Psychiatry, MacKay Memorial Hospital, Taipei, Taiwan
  3. 3 Suicide Prevention Centre, MacKay Memorial Hospital, Taipei, Taiwan
  4. 4 MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
  5. 5 Department of Psychiatry, En Chu Kong Hospital, New Taipei City, Taiwan
  6. 6 Department of Psychiatry, College of Medicine, National Taiwan University, Taipei, Taiwan
  7. 7 Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
  8. 8 Department of Medical Research, MacKay Memorial Hospital, Taipei, Taiwan
  9. 9 Department of Psychiatry, Taiwan Adventist Hospital, Taipei, Taiwan
  10. 10 Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan
  11. 11 Department of Psychiatry, Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan
  12. 12 Department of Electrical Engineering, National Taipei University of Technology, Taipei, Taiwan
  1. Correspondence to Dr Shen-Ing Liu; maryliuyip{at}gmail.com

Abstract

Objectives The aim of this study was to investigate differences and similarities in risk factors for deliberate self-harm (DSH) and suicidal attempt (SA), and the role of impulsivity among a group of community adolescents.

Setting This is a cross-sectional study conducted at high schools in Northern Taiwan.

Data and participants We recruited grade 1 students from 14 high schools. A total of 5879 participants (mean age 16.02 years, female adolescents: 57.7%) completed the online assessment.

Outcome measures Participants completed online questionnaires about sociodemographic data, suicidality, history of DSH and SA, depressed mood, self-esteem, social support, family discord, impulsivity (Barratt Impulsiveness Scale Version 11 (BIS-11)) and the use of alcohol, tobacco and illicit drugs. A subsample was interviewed about lifetime SA, and the results were compared with those from the online questionnaires.

Results In our sample, 25% of the students had lifetime DSH and 3.5% had lifetime SA. Two hundred and seventy-two students received face-to-face interviews. The concordance between the online questionnaires and interviews in terms of ascertaining cases of SA was moderate (concordance rate 82.76%; kappa value 0.59). Similar risk factors for DSH/SA among the whole sample included female gender, lower academic performance, depression, substance use (tobacco and alcohol) and low self-esteem. The BIS-11 score was correlated with DSH. Factor 3 score of the BIS-11 (novelty seeking) was correlated with DSH in both boys and girls, whereas factor 2 score (lack of self-control) was correlated with SA in boys. Social support was a protective factor against SA among the female adolescents. Gender modulated the association of impulsivity and DSH/SA. Associations between impulsivity and DSH and SA were particularly strong among boys.

Conclusions Risk factors for DSH and SA were similar, but not identical. Early identification of those at risk and appropriate interventions may be helpful.

  • adolescence
  • deliberate self-harm
  • impulsivity
  • suicide
  • suicidal ideation
  • substance use disorders

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/bmjopen-2017-017949

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    Footnotes

    • Contributors Y-HH: contributed the data collection, performed the data analysis and drafted the article. H-CL: drafted the study protocol and helped in the data collection process. F-JT, K-YH and Y-HH: helped in the diagnostic interview process. F-JS: contributed in statistical analyses. Y-CC: contributed in counseling of at-risk adolescents, reviewing the article and revising it critically for important intellectual content. Y-PH: contributed in reviewing the article and revising it critically for important intellectual content. S-IL: monitored and guided the designing and implementation of the study, data collection, statistical analyses, interpreting findings and revising the article. All authors approved the manuscript submission for publication.

    • Funding Supported by grants from the Ministry of Science and Technology, Taiwan, Republic of China (NSC 9802314-B-195-011 MY3) and Mackay Memorial Hospital (9838, 9880), Taiwan.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval Institutional Review Board of MacKay Memorial Hospital.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement No additional data are available.