BACKGROUND: Impulsivity and aggression are known risk factors for suicide, with observed age and sex differences in their impact. AIMS: To explore variations in impulsivity and aggression based on sex and age and examine their roles in predicting suicide. METHOD: We examined 582 participants (406 individuals who died by suicide, 176 non-suicidal sudden-death controls) using the psychological autopsy method. Measures of impulsivity and aggression included the Barratt Impulsiveness Scale (BIS) and the Brown-Goodwin History of Aggression (BGHA). Participants were categorised into four groups: suicide male, control male, suicide female and control female. For group comparisons, we used analyses of variance and Spearman's rank correlation to assess the relationship between age and BIS and/or BGHA ratings. Stepwise logistic regression was used to identify predictors of suicide for each sex. RESULTS: Higher levels of BIS and BGHA ratings were found in the suicide group compared with controls (BIS: 51.3 v. 42.2, P = 0.002, η2 = 0.017; BGHA: 7.1 v. 4.1, P < 0.001, η2 = 0.028), with no significant sex differences. BIS and BGHA ratings decreased with age in the suicide groups (suicide male: impulsivity ρ = -0.327, P < 0.001; suicide female: aggression ρ = -0.175, P = 0.038) but not among controls. Logistic regression analysis revealed that for men, aggression (odds ratio 1.072, 95% CI: 1.032-1.112) was a key predictor. For women, younger age (odds ratio 0.970, 95% CI: 0.948-0.993), low BIS impulsivity ratings (odds ratio 1.018, 95% CI: 1.001-1.036) and living with children (odds ratio 0.448, 95% CI: 0.208-0.966) were protective factors. CONCLUSIONS: Impulsive and aggressive behaviours are critical factors in suicide risk among younger individuals, indicating an age effect but no sex dimorphism, with aggressive behaviours being a better predictor for men and impulsive and aggressive behaviours for women.

CIBERSAM Carlos 3 Institute of Health Madrid Spain

Departamento de Psicología y Sociología Universidad de Zaragoza Zaragoza Spain

Department of Emergency Psychiatry and Post Acute Care CHRU Montpellier Montpellier France

Department of Psychiatry General Hospital of Villalba Madrid Spain

Department of Psychiatry Madrid Autonomous University Madrid Spain

Department of Psychiatry University Hospital Infanta Elena Valdemoro Spain

Department of Psychiatry University Hospital Infanta Sofia Madrid Spain

Department of Psychiatry University Hospital Jimenez Diaz Foundation Madrid Spain

Department of Psychiatry University Hospital Rey Juan Carlos Mostoles Spain

Department of Psychiatry University Hospital Virgen Macarena Seville Spain

Departmento de Psiquiatría Facultad de Medicina Universidad de Sevilla Seville Spain

Faculty of Information Technology Brno University of Technology Brno Czech Republic

Forensic Pathology Service of the Institute of Legal Medicine and Forensic Sciences of Seville Seville Spain

Institute of Psychiatry and Mental Health IiGSM Hospital General Universitario Gregorio Marañón Madrid Spain

Kempelen Institute of Intelligent Technologies Bratislava Slovakia

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