P ~ ~ c h o l o ~ iReports, cal 1977,41, 19-22. @ Psychological Reports 1977
EXTRAVERSION, NEUROTICISM, AND INTENT IN ATTEMPTED SUICIDES D. J. PALLIS AND J. S. JENKINS Medical Research Council' Summary.-124 subjects completed the Eysenck Personality Inventory soon after a suicide attempt. For males there was an association between low intent to die and impulsivity while for both sexes there was an association between recurrent suicide attempts and neuroticism.
The rising incidence of attempted suicide in the last two decades, often referred to as an "epidemic," is documented in many countries (Weissman, 1974). There is still no adequate explanation for this, though the increasing availability of drugs, particularly psychotropics, is implicated. Clinical reports suggest that a large number of such acts are impulsive in nature. This widely held view rests solely on the subject's report on recovery that the decision to act "is formed in a single moment" (Kessel, 1965). Psychological test data have, however, failed co support this view; as a group, suicide attempters are intsoverted rather than extraverted (Philip, 1970b; Eastwood, et al., 1972; PaUis & Birtchnell, 1976). Because of the population's heterogeneity, there is a need to investigate the role of personality factors in clinically important sub-groups. Suicide attempters can be categorized by the seriousness of suicidal intent or by the tendency to repeat their acts in the future; and divisions on these variables do in fact produce sub-groups which are distinguishable on certain demographic and clinical features (Pallis & Barraclough, 1977; Buglass & Horton, 1974). The present study aimed to test whether ( i ) attempters of high and low intent or (ii) "once only" and "recurrent" attempters differ on the Eysenck Personality Inventory. By assessing seriousness of intent both from the circumstances of the act and from a subjective report, and by identifying the recurrent attempter from a prospective as well as a retrospective inquiry, we aimed to avoid some of the methodological shorccomings of earlier investigations (Murthy, 1969; Philip, 1970a; Kinsinger, 1971).
'
METHOD Subjects were 151 suicide attempters admitted to a general hospital's Accident and Emergency Department. The method and characteristics of the sample have been described elsewhere (Pallis & Sainsbury, 1976). Form A of the Eysenck inventory (Eysenck & Eysenck, 1964) was administered to all admissions up to 48 hr. from medical recovery and prior to a research interview. Completed questionnaires were obtained from 124 subjects (82%). Non'Clinical Psychiatry Unit, Graylingwell Hospital, Chichester, Sussex, England.
D. J. PALLIS
20
&
J. S. JENKINS
responders ( n = 27) were comparable to responders in respect of sex, age, marital status, social class, psychiatric diagnosis, level of suicidal intent, and previous or subsequent suicide attempts. Of the responders, 3 male and 11 female subjects were excluded because of high scores ( 6 f ) on the Eysenck Personality Inventory, Lie Scale. These 14 subjects were older (49.9 i- 19.7) than the remainder (29.2 f 12.1); however, apart from age ( t = 5.50, p < 0.001), the two groups were comparable. Suicidal intent was measured by the first part of the Suicidal Intent Scale (Beck, et aE., 1974) from which ratings of the circumstances of the act can be obtained. Self-reported intent was recorded separately from the subject's recollection of intent at the time of the act ( 1 = wished to die; 2 = uncertain or did not wish to die). Subjects were further categorized as "recurrent attempters" if they had attempted suicide prior to the index attempt or if they had repeated the act within a 2-yr. follow-up period. In none of the inter-group comparisons were there any significant differences in respect of age. RESULTS Table 1 presents the means and standard deviations on extraversion and neuroticism for subjects divided on the sample's median intent score; the two extraversion factors, impulsivity and sociability, were also computed. There was only one significant inter-group difference: males with low scores on the Suicide Intent Scale were more impulsive than males with high scores ( t = 3.05, p < 0.01). For female subjects, this result is consistent with that of TABLE 1 HIGH AND LOW INTBNT GROUPS BY SEX
MEANS AND STANDARD DEVIATIONS FOR
Measure
Males' Intent
High
Neuroticism Extraversion
Impulsivity Sociability
Low
Females' Intent High Low
( n = 25)
( n = 17)
( n= 28)
( n = 40)
14.4k5.1 12.4k2.9 4.02 1.3 6 . 2 2 2.3
16.3k4.1 13.1k3.7 5.321.2 5.322.5
16.724.5 11.8k3.2 4.321.2 5.221.9
15.125.2 12.524.2 4.4k1.7 5.722.2
Kinsinger's (1971), who found no association between a clinical judgment of intent and extraversion or impulsivity. On the other hand, Murthy (1969) also tested females among whom "non-serious" attempters were more "hysteroid" than "serious" attempters. Since these two groups differed on a number of variables related to suicide risk (the former were also younger), Murthy's finding cannot be presumed to demonstrate a real difference in personality. Although subjects reporting a wish to die had a higher mean score on the Suicide Intent Scale than the remainder (males: t = 3.57, fi < 0.001; females: t = 3.68, p < 0.001), there was no difference between these two groups on
PERSONALITY AND SUICIDE
21
any of the Eysenck scales. The finding that those who contemplate their acts for a brief period are less likely to endanger their lives (Kessel, 1965; Birtchnell & Alarcon, 1971) is in accord with the present result; however, the proposition that lack of premeditation or denial of intent implicate impulsivity is not. When recurrent attempters were compared with once-only attempters, no difference in respect of extraversion (or impulsivity and sociability) was obtained. Recurrent attempters, however, had a higher mean neuroticism score 0.01; females: t = 3.22, p than once-only attempters (males: t = 2.74, p 0.005). Philip's (1970a) conclusion that impulsivity increases the tendency to resort to multiple attempts is not supported. What condusions can be drawn from the present findings? First, since men who attempt suicide with minimal intent to die show greater impulsivity than women who make similar attempts, in the event of a personal crisis (a common antecedent of suicide attempts), men are likely to be more restrained than women. This sex difference in threshold may, to some extent, explain why women attempt suicide more often than men and also there are more women among low-intent attempters. Second, since neither an attempter of high intent nor a repeater is excessively impulsive, the occurrence of such acts is not likely to be affected by changes in the availability of drugs, the prevailing method of attempting suicide. If serious attempters in particular do not heed available methods but search for them, thek inclination to suicide may be largely independent of the fortuitous opportunities for self-destruction. T o the extent that one can extrapolate from attempters of high intent to persons who are successful in killing themselves, our results cast some doubt on the proposition that suicides can be prevented by simply reducing certain lethal means in the environment.
EXTRAVERSION, NEUROTICISM, AND INTENT IN ATTEMPTED SUICIDES D. J. PALLIS AND J. S. JENKINS Medical Research Council' Summary.-124 subjects completed the Eysenck Personality Inventory soon after a suicide attempt. For males there was an association between low intent to die and impulsivity while for both sexes there was an association between recurrent suicide attempts and neuroticism.
The rising incidence of attempted suicide in the last two decades, often referred to as an "epidemic," is documented in many countries (Weissman, 1974). There is still no adequate explanation for this, though the increasing availability of drugs, particularly psychotropics, is implicated. Clinical reports suggest that a large number of such acts are impulsive in nature. This widely held view rests solely on the subject's report on recovery that the decision to act "is formed in a single moment" (Kessel, 1965). Psychological test data have, however, failed co support this view; as a group, suicide attempters are intsoverted rather than extraverted (Philip, 1970b; Eastwood, et al., 1972; PaUis & Birtchnell, 1976). Because of the population's heterogeneity, there is a need to investigate the role of personality factors in clinically important sub-groups. Suicide attempters can be categorized by the seriousness of suicidal intent or by the tendency to repeat their acts in the future; and divisions on these variables do in fact produce sub-groups which are distinguishable on certain demographic and clinical features (Pallis & Barraclough, 1977; Buglass & Horton, 1974). The present study aimed to test whether ( i ) attempters of high and low intent or (ii) "once only" and "recurrent" attempters differ on the Eysenck Personality Inventory. By assessing seriousness of intent both from the circumstances of the act and from a subjective report, and by identifying the recurrent attempter from a prospective as well as a retrospective inquiry, we aimed to avoid some of the methodological shorccomings of earlier investigations (Murthy, 1969; Philip, 1970a; Kinsinger, 1971).
'
METHOD Subjects were 151 suicide attempters admitted to a general hospital's Accident and Emergency Department. The method and characteristics of the sample have been described elsewhere (Pallis & Sainsbury, 1976). Form A of the Eysenck inventory (Eysenck & Eysenck, 1964) was administered to all admissions up to 48 hr. from medical recovery and prior to a research interview. Completed questionnaires were obtained from 124 subjects (82%). Non'Clinical Psychiatry Unit, Graylingwell Hospital, Chichester, Sussex, England.
D. J. PALLIS
20
&
J. S. JENKINS
responders ( n = 27) were comparable to responders in respect of sex, age, marital status, social class, psychiatric diagnosis, level of suicidal intent, and previous or subsequent suicide attempts. Of the responders, 3 male and 11 female subjects were excluded because of high scores ( 6 f ) on the Eysenck Personality Inventory, Lie Scale. These 14 subjects were older (49.9 i- 19.7) than the remainder (29.2 f 12.1); however, apart from age ( t = 5.50, p < 0.001), the two groups were comparable. Suicidal intent was measured by the first part of the Suicidal Intent Scale (Beck, et aE., 1974) from which ratings of the circumstances of the act can be obtained. Self-reported intent was recorded separately from the subject's recollection of intent at the time of the act ( 1 = wished to die; 2 = uncertain or did not wish to die). Subjects were further categorized as "recurrent attempters" if they had attempted suicide prior to the index attempt or if they had repeated the act within a 2-yr. follow-up period. In none of the inter-group comparisons were there any significant differences in respect of age. RESULTS Table 1 presents the means and standard deviations on extraversion and neuroticism for subjects divided on the sample's median intent score; the two extraversion factors, impulsivity and sociability, were also computed. There was only one significant inter-group difference: males with low scores on the Suicide Intent Scale were more impulsive than males with high scores ( t = 3.05, p < 0.01). For female subjects, this result is consistent with that of TABLE 1 HIGH AND LOW INTBNT GROUPS BY SEX
MEANS AND STANDARD DEVIATIONS FOR
Measure
Males' Intent
High
Neuroticism Extraversion
Impulsivity Sociability
Low
Females' Intent High Low
( n = 25)
( n = 17)
( n= 28)
( n = 40)
14.4k5.1 12.4k2.9 4.02 1.3 6 . 2 2 2.3
16.3k4.1 13.1k3.7 5.321.2 5.322.5
16.724.5 11.8k3.2 4.321.2 5.221.9
15.125.2 12.524.2 4.4k1.7 5.722.2
Kinsinger's (1971), who found no association between a clinical judgment of intent and extraversion or impulsivity. On the other hand, Murthy (1969) also tested females among whom "non-serious" attempters were more "hysteroid" than "serious" attempters. Since these two groups differed on a number of variables related to suicide risk (the former were also younger), Murthy's finding cannot be presumed to demonstrate a real difference in personality. Although subjects reporting a wish to die had a higher mean score on the Suicide Intent Scale than the remainder (males: t = 3.57, fi < 0.001; females: t = 3.68, p < 0.001), there was no difference between these two groups on
PERSONALITY AND SUICIDE
21
any of the Eysenck scales. The finding that those who contemplate their acts for a brief period are less likely to endanger their lives (Kessel, 1965; Birtchnell & Alarcon, 1971) is in accord with the present result; however, the proposition that lack of premeditation or denial of intent implicate impulsivity is not. When recurrent attempters were compared with once-only attempters, no difference in respect of extraversion (or impulsivity and sociability) was obtained. Recurrent attempters, however, had a higher mean neuroticism score 0.01; females: t = 3.22, p than once-only attempters (males: t = 2.74, p 0.005). Philip's (1970a) conclusion that impulsivity increases the tendency to resort to multiple attempts is not supported. What condusions can be drawn from the present findings? First, since men who attempt suicide with minimal intent to die show greater impulsivity than women who make similar attempts, in the event of a personal crisis (a common antecedent of suicide attempts), men are likely to be more restrained than women. This sex difference in threshold may, to some extent, explain why women attempt suicide more often than men and also there are more women among low-intent attempters. Second, since neither an attempter of high intent nor a repeater is excessively impulsive, the occurrence of such acts is not likely to be affected by changes in the availability of drugs, the prevailing method of attempting suicide. If serious attempters in particular do not heed available methods but search for them, thek inclination to suicide may be largely independent of the fortuitous opportunities for self-destruction. T o the extent that one can extrapolate from attempters of high intent to persons who are successful in killing themselves, our results cast some doubt on the proposition that suicides can be prevented by simply reducing certain lethal means in the environment.
