Impulsivity and Crises

While some suicides are deliberative and involve careful planning, many appear to have an impulsive component and occur during a short-term crisis. Chronic, underlying risk factors such as substance abuse and depression are also often present, but the acute period of heightened risk for suicidal behavior is often only minutes or hours long (Hawton 2007).

  • The Houston study interviewed 153 survivors of nearly-lethal suicide attempts, ages 13-34. Survivors of nearly-lethal attempts were thought to be more like suicide completers due to the medical severity of their injuries or the lethality of the methods used. They were asked: “How much time passed between the time you decided to complete suicide and when you actually attempted suicide?”

One in four deliberated for less than 5 minutes! And nine out of ten deliberated less than a day (Simon 2005).

24% said less than five minutes

24% said 5-19 minutes

23% said 20 minutes to 1 hour

16% said 2-8 hours

13% said 1 or more days

  • An Australian study of emergency department visits found 40% of attempters took action within 5 minutes of deciding to attempt (Williams 1980). The authors summarized seven earlier studies that found one-third to four-fifths of attempts were impulsive.
  • Nearly half (48%) of suicide attempt patients reported less than 10 minutes elapsed from first thought of suicide to actual attempt in an Austrian study (Deisenhammer 2009).
  • In an Australian study of survivors of self-inflicted gunshot wounds, 21 of 33 subjects (64%) stated that their attempt was due to an interpersonal conflict with a partner or family member (deMoore 1994). Most survivors were young men who did not suffer from major depression or psychosis, and the act was almost always described as impulsive. A similar study in Texas with 30 firearm attempters found 60% had experienced an interpersonal conflict during the 24 hours preceding their attempt (Peterson 1985).
  • At least one-third of suicide decedents under age 18 experienced a crisis within 24 hours of taking their life, according to NVISS data drawn from police and coroner/medical examiner reports. The proportion with a crisis declined with age. In some cases the crises were not just same-day but virtually same-moment (as when decedents shot themselves in the midst of an argument).
  • Interviews with 268 patients hospitalized for a poisoning suicide attempt in Sri Lanka found that just over half took the poison after less than 30 minutes of thought, often directly following an argument (Eddelston 2006). While most of the patients survived their attempts, 13 died. Like the nonfatal attempters, over half of those who died deliberated less than 30 minutes.
More studies (Impulsivity & Planning)

 

Hawton K.  Restricting access to methods of suicide. Crisis. 2007;28 (S1):4-9.

Simon, T.R., Swann, A.C., Powell, K.E., Potter, L.B., Kresnow, M., and O’Carroll, P.W.  Characteristics of Impulsive Suicide Attempts and Attempters. SLTB. 2001; 32(supp):49-59.

Personal communication, Thomas Simon, March 15, 2005.

Williams, C., Davidson, J., & Montgomery, I.  Impulsive suicidal behavior. Journal of Clinical Psychology. 1980;36, 90-94.

de Moore GM, Plew JD, Bray KM, and Snars JN. Survivors of self-inflicted firearm injury. A liaison psychiatry perspective. Medical journal of Australia. 1994;160(7):421-425.

Peterson L, Peterson M, O’Shanick G, and Swann A. Self-inflicted gunshot wounds: Lethality of method versus intent. American Journal of Psychiatry. 1985;142:228-231.

Eddleston M, Karunaratne A, Weerakoon M, et al. Choice of poison for intentional self-poisoning in rural Sri Lanka. Clinical Toxicology. 2006;44:283-6.

Deisenhammer EA, Ing CM, Strauss R, et al. The duration of the suicidal process: how much time is left for intervention between consideration and accomplishment of a suicide attempt? J Clin Psychiatry. 2009;70(1):19-24.