Impulsivity, emotional dysregulation, aggression, and hopelessness in suicide attempts among bipolar disorder patients: A cross sectional study

Abstract

ABSTRACT Background: Suicide attempts are common in bipolar affective disorder (BPAD), but the contribution of enduring psychological traits to suicidal behavior during remission remains unclear. Aim: To compare impulsivity, aggression, emotional dysregulation, and hopelessness between remitted BPAD patients with and without a lifetime history of suicide attempts, and to identify independently associated factors of suicidal behavior. Materials and Methods: This cross-sectional comparative study included 150 remitted BPAD patients recruited from a tertiary-care psychiatry center in India. Participants were divided into suicide-attempt (n = 72) and non-attempt (n = 78) groups. The sample included 86 females and 64 males. Trait variables were assessed using the Barratt Impulsiveness Scale–11, Buss–Perry Aggression Questionnaire, Difficulties in Emotion Regulation Scale, and Beck Hopelessness Scale. Results: Patients with a lifetime history of suicide attempts had significantly higher impulsivity, aggression, and emotional dysregulation scores compared to non-attempters (all P < 0.001). Hopelessness scores were also higher among suicide attempters (P = 0.050). Logistic regression analysis identified impulsivity (OR = 1.05, 95% CI: 1.02–1.08, P < 0.001) and emotional dysregulation (OR = 1.03, 95% CI: 1.01–1.05, P = 0.002) as independently associated with suicide attempts, whereas aggression and hopelessness were not independently associated. Conclusion: Impulsivity and emotional dysregulation appear to represent important trait-related vulnerabilities associated with suicide attempts in patients with remitted BPAD. Incorporating assessment of these dimensions into routine clinical evaluation may improve long-term suicide prevention strategies in bipolar disorder.