Interacting immediate and long-term action regulation in suicidal behavior

Background: Suicide is a prominent cause of death across the lifespan, especially between 10 and 34 years old. Most suicides are first attempts, during crises with unpredictably fluctuating risk, arising insidiously from mechanisms related to long-term exposure to psycho-bio-social risk factors. Identifying susceptibility from interacting immediate and long-term mechanisms of action regulation could prevent suicidal crises. Methods: We investigated interacting immediate and long-term regulation of action in risk for suicide. Immediate processes were assessed through affective and behavioral symptoms and a computer measure of impaired action-regulation, the Immediate Memory Task (IMT). Long-term processes included history of trauma, stress, and addictive behaviors. We used Beck Suicidal Ideation at its Worst (SSI-W) to measure global suicidal behavior. Participants were 28 survivors of medically severe suicide attempt (MSSA) within the previous 9 months compared to 23 age, sex, and diagnosis-similar psychiatric controls with previous suicidal ideation but without attempt (NA). Results: MSSA was related, independent of SSI-W, to IMT impulsive responses, Internal State Scale (ISS) activation, and Lifetime Cumulative Adversity (LCA). MSSA was indirectly related, through SSI-W, to depression, aggression, alcohol-use severity and IMT stimulus discrimination. Minimization-denial of childhood trauma directly increased MSSA,but indirectly reduced apparent MSSA through reduced SSI-W reporting. Discussion: MSSA combines characteristics independent of and dependent on SSI-W, reinforced by minimization/denial of childhood trauma. Stress-related hyperarousal and denial of early trauma facilitate MSSA through ISS activation, LHA, and impulsive IMT responses. These characteristics can identify individuals who, without previous suicide attempt or conventional psychiatric diagnosis, need preventive treatment of suicide risk.