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Staring Down Death

Is Abnormally Slow Blink Rate a Clinically Useful Indicator of Acute Suicide Risk?

Published Online:January 19, 2016https://doi.org/10.1027/0227-5910/a000367

Abstract

Abstract.Background: Lowered eye blink rate may be a clinically useful indicator of acute, imminent, and severe suicide risk. Diminished eye blink rates are often seen among individuals engaged in heightened concentration on a specific task that requires careful planning and attention. Indeed, overcoming one’s biological instinct for survival through suicide necessitates premeditation and concentration; thus, a diminished eye blink rate may signal imminent suicidality. Aims: This article aims to spur research and clinical inquiry into the role of eye blinks as an indicator of acute suicide risk. Method: Literature relevant to the potential connection between eye blink rate and suicidality was reviewed and synthesized. Results: Anecdotal, cognitive, neurological, and conceptual support for the relationship between decreased blink rate and suicide risk is outlined. Conclusion: Given that eye blinks are a highly observable behavior, the potential clinical utility of using eye blink rate as a marker of suicide risk is immense. Research is warranted to explore the association between eye blink rate and acute suicide risk.

References

  • Anestis, M. D., Joiner, T., Hanson, J. E., & Gutierrez, P. M. (2014). The modal suicide decedent did not consume alcohol just prior to the time of death: An analysis with implications for understanding suicidal behavior. Journal of Abnormal Psychology, 123(4), 835–840. 10.1037/a0037480 First citation in articleCrossref Medline, Google Scholar

  • Anestis, M. D., Pennings, S. M., & Williams, T. J. (2014). Preliminary results from an examination of episodic planning in suicidal behavior. Crisis, 35(3), 186–192. 10.1027/0227-5910/a000250 First citation in articleLink, Google Scholar

  • Anestis, M. D., Soberay, K. A., Gutierrez, P. M., Hernández, T. D., & Joiner, T. E. (2014). Reconsidering the link between impulsivity and suicidal behavior. Personality and Social Psychology Review, 18(4), 366–386. 10.1177/1088868314535988 First citation in articleCrossref Medline, Google Scholar

  • Baca-García, E., Diaz-Sastre, C., Basurte, E., Prieto, R., Ceverino, A., Saiz-Ruiz, J., & de Leon, J. (2001). A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts. Journal of Clinical Psychiatry, 62(7), 560–564. 10.4088/jcp.v62n07a11 First citation in articleCrossref Medline, Google Scholar

  • Blin, O., Masson, G., Azulay, J. P., Fondarai, J., & Serratrice, G. (1990). Apomorphine-induced blinking and yawning in healthy volunteers. British Journal of Clinical Pharmacology, 30(5), 769–773. 10.1111/j.1365-2125.1990.tb03848.x First citation in articleCrossref Medline, Google Scholar

  • Chermahini, S. A., & Hommel, B. (2010). The (b)link between creativity and dopamine: Spontaneous eye blink rates predict and dissociate divergent and convergent thinking. Cognition, 115(3), 458–465. 10.1016/j.cognition.2010.03.007 First citation in articleCrossref Medline, Google Scholar

  • Colzato, L. S., Slagter, H. A., van den Wildenberg, W. P., & Hommel, B. (2009). Closing one's eyes to reality: Evidence for a dopaminergic basis of psychoticism from spontaneous eye blink rates. Personality and Individual Differences, 46(3), 377–380. 10.1016/j.paid.2008.10.017 First citation in articleCrossref, Google Scholar

  • Colzato, L. S., van den Wildenberg, W. P., & Hommel, B. (2008). Reduced spontaneous eye blink rates in recreational cocaine users: Evidence for dopaminergic hypoactivity. PloS One, 3(10), e3461. 10.1371/journal.pone.0003461 First citation in articleCrossref, Google Scholar

  • Currier, D., & Mann, J. J. (2008). Stress, genes and the biology of suicidal behavior. Psychiatric Clinics of North America, 31(2), 247–269. 10.1016/j.psc.2008.01.005 First citation in articleCrossref Medline, Google Scholar

  • Deuschl, G., & Goddemeier, C. (1998). Spontaneous and reflex activity of facial muscles in dystonia, Parkinson's disease, and in normal subjects. Journal of Neurology, Neurosurgery, and Psychiatry, 64(3), 320–324. 10.1136/jnnp.64.3.320 First citation in articleCrossref Medline, Google Scholar

  • Dreisbach, G., Müller, J., Goschke, T., Strobel, A., Schulze, K., Lesch, K. P., & Brocke, B. (2005). Dopamine and cognitive control: The influence of spontaneous eyeblink rate and dopamine gene polymorphisms on perseveration and distractibility. Behavioral Neuroscience, 119(2), 483–490. 10.1037/0735-7044.119.2.483 First citation in articleCrossref Medline, Google Scholar

  • Dumais, A., Lesage, A. D., Alda, M., Rouleau, G., Dumont, M., Chawky, N., … Turecki, G. (2005). Risk factors for suicide completion in major depression: A case-control study of impulsive and aggressive behaviors in men. American Journal of Psychiatry, 162(11), 2116–2124. 10.1176/appi.ajp.162.11.2116 First citation in articleCrossref Medline, Google Scholar

  • Freed, W. J., Kleinman, J. E., Karson, C. N., Potkin, S. G., Murphy, D. L., & Wyatt, R. J. (1980). Eye-blink rates and platelet monoamine oxidase activity in chronic schizophrenic patients. Biological Psychiatry, 15(2), 329–332. First citation in articleMedline, Google Scholar

  • Hall, A. (1945). The origin and purpose of blinking. British Journal of Ophthalmology, 29(9), 445–67. 10.1136/bjo.29.9.445 First citation in articleCrossref Medline, Google Scholar

  • Holm-Denoma, J. M., Witte, T. K., Gordon, K. H., Herzog, D. B., Franko, D. L., Fichter, M., … Joiner Jr., T. E. (2008). Deaths by suicide among individuals with anorexia as arbiters between competing explanations of the anorexia-suicide link. Journal of Affective Disorders, 107(1–3), 231–236. 10.1016/j.jad.2007.07.029 First citation in articleCrossref Medline, Google Scholar

  • Homaifar, B. Y., Brenner, L. A., Forster, J. E., & Nagamoto, H. (2012). Traumatic brain injury, executive functioning, and suicidal behavior: A brief report. Rehabilitation Psychology, 57(4), 337–341. 10.1037/a0030480 First citation in articleCrossref Medline, Google Scholar

  • Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press. 10.5860/choice.44-1002 First citation in articleCrossref, Google Scholar

  • Joiner, T. E. (2014). The perversion of virtue: Understanding murder-suicide. New York, NY: Oxford University Press. First citation in articleGoogle Scholar

  • Joiner, T. E., Johnson, F., & Soderstrom, K. (2002). Association between serotonin transporter gene polymorphism and family history of attempted and completed suicide. Suicide and Life-Threatening Behavior, 32(3), 329–332. 10.1521/suli.32.3.329.22167 First citation in articleCrossref Medline, Google Scholar

  • Karson, C., Freed, W. J., Kleinman, J. E., Bigelow, L. B., & Wyatt, R. J. (1981). Neuroleptics decrease blinking in schizophrenic subjects. Biological Psychiatry, 16(7), 679–682. First citation in articleMedline, Google Scholar

  • Karson, C. N. (1983). Spontaneous eye-blink rates and dopaminergic systems. Brain, 106(Pt 3), 643–653. 10.1093/brain/106.3.643 First citation in articleCrossref Medline, Google Scholar

  • Keilp, J. G., Sackeim, H. A., Brodsky, B. S., Oquendo, M. A., Malone, K. M., & Mann, J. J. (2001). Neuropsychological dysfunction in depressed suicide attempters. American Journal of Psychiatry, 158(5), 735–741. 10.1176/appi.ajp.158.5.735 First citation in articleCrossref Medline, Google Scholar

  • King County Sheriff's Office. (2012, July 12). Press conference, King Country, WA, USA. First citation in articleGoogle Scholar

  • King County Sheriff's Office. (2012, July 12). Keller [Video file]. Retrieved from https://www.youtube.com/watch?v=aodgtiB7ShE First citation in articleGoogle Scholar

  • Kleven, M. S., & Koek, W. (1996). Differential effects of direct and indirect dopamine agonists on eye blink rate in cynomolgus monkeys. Journal of Pharmacology and Experimental Therapeutics, 279(3), 1211–1219. 10.1097/00008877-199605001-00128 First citation in articleCrossref Medline, Google Scholar

  • Kowal, M. A., Colzato, L. S., & Hommel, B. (2011). Decreased spontaneous eye blink rates in chronic cannabis users: Evidence for striatal cannabinoid-dopamine interactions. PloS One, 6(11), e26662. 10.1371/journal.pone.0026662 First citation in articleCrossref, Google Scholar

  • Ladas, A., Frantzidis, C., Bamidis, P., & Vivas, A. B. (2014). Eye blink rate as a biological marker of mild cognitive impairment. International Journal of Psychophysiology, 93(1), 12–16. 10.1016/j.ijpsycho.2013.07.010 First citation in articleCrossref Medline, Google Scholar

  • Linehan, M. M., Goodstein, J. L., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking of killing yourself: The reasons for living inventory. Journal of Consulting and Clinical Psychology, 51(2), 276–286. 10.1037//0022-006x.51.2.276 First citation in articleCrossref Medline, Google Scholar

  • Mackay, A. V., Iversen, L. L., Rossor, M., Spokes, E., Bird, E., Arregui, A., … Synder, S. H. (1982). Increased brain dopamine and dopamine receptors in schizophrenia. Archives of General Psychiatry, 39(9), 991–997. 10.1001/archpsyc.1982.04290090001001 First citation in articleCrossref Medline, Google Scholar

  • Mackintosh, J. H., Kumar, R., & Kitamura, T. (1983). Blink rate in psychiatric illness. British Journal of Psychiatry, 143, 55–57. 10.1192/bjp.143.1.55 First citation in articleCrossref Medline, Google Scholar

  • Mann, J. J. (2013). The serotonergic system in mood disorders and suicidal behaviour. Philosophical Transactions of the Royal Society B: Biological Sciences, 368(1615), 1–7. 10.1098/rstb.2012.0537 First citation in articleCrossref, Google Scholar

  • Martins, R., & Carvalho, J. M. (2015). Eye blinking as an indicator of fatigue and mental load – a systematic review. Occupational Safety and Hygiene III. 10.1201/b18042-48, 10.1201/b18042 First citation in articleCrossref, Google Scholar

  • Miglani, J., & Coats, L. R. (2005). Carilion New River Valley Medical Center Medical Record (MR# 236053). Radford, VA. Retrieved from http://www.unirel.vt.edu/documents/2009-08-ccrecords.pdf First citation in articleGoogle Scholar

  • New York Times. (2014, May 24). Retribution [Video file]. Retrieved from http://www.nytimes.com/video/us/100000002900707/youtube-video-retribution.html First citation in articleGoogle Scholar

  • Nock, M. K., Park, J. M., Finn, C. T., Deliberto, T. L., Dour, H. J., & Banaji, M. R. (2010). Measuring the suicidal mind: Implicit cognition predicts suicidal behavior. Psychological Science, 21(4), 511–517. 10.1177/0956797610364762 First citation in articleCrossref Medline, Google Scholar

  • Oquendo, M. A., & Mann, J. J. (2000). The biology of impulsivity and suicidality. Psychiatric Clinics of North America, 23(1), 11–25. 10.1016/s0193-953x(05)70140-4 First citation in articleCrossref Medline, Google Scholar

  • Pandey, G. N. (2013). Biological basis of suicide and suicidal behavior. Bipolar Disorders, 15(5), 524–541. 10.1111/bdi.12089 First citation in articleCrossref Medline, Google Scholar

  • Placidi, G. P., Oquendo, M. A., Malone, K. M., Huang, Y. Y., Ellis, S. P., & Mann, J. J. (2001). Aggressivity, suicide attempts, and depression: Relationship to cerebrospinal fluid monoamine metabolite levels. Biological Psychiatry, 50(10), 783–791. 10.1016/s0006-3223(01)01170-2 First citation in articleCrossref Medline, Google Scholar

  • Ribeiro, J. D., Silva, C., & Joiner, T. E. (2014). Overarousal interacts with a sense of fearlessness about death to predict suicide risk in a sample of clinical outpatients. Psychiatry Research, 218(1–2), 106–112. 10.1016/j.psychres.2014.03.036 First citation in articleCrossref Medline, Google Scholar

  • Richard-Devantoy, S., Gorwood, P., Annweiler, C., Olié, J. P., Le Gall, D., & Beauchet, O. (2012). Suicidal behaviours in affective disorders: A deficit of cognitive inhibition? Canadian Journal of Psychiatry, 57(4), 254–262. First citation in articleCrossref Medline, Google Scholar

  • Robins, E. (1981). The final months: A study of the lives of 134 persons who committed suicide. New York, NY: Oxford University Press. First citation in articleGoogle Scholar

  • Roy, A., Karoum, F., & Pollack, S. (1992). Marked reduction in indexes of dopamine metabolism among patients with depression who attempt suicide. Archives of General Psychiatry, 49(6), 447–450. 10.1001/archpsyc.1992.01820060027004 First citation in articleCrossref Medline, Google Scholar

  • Rujescu, D., Giegling, I., Sato, T., Hartmann, A. M., & Möller, H. J. (2003). Genetic variations in tryptophan hydroxylase in suicidal behavior: Analysis and meta-analysis. Biological Psychiatry, 54(4), 465–473. 10.1016/s0006-3223(02)01748-1 First citation in articleCrossref Medline, Google Scholar

  • Smith, P. N., Cukrowicz, K. C., Poindexter, E. K., Hobson, V., & Cohen, L. M. (2010). The acquired capability for suicide: A comparison of suicide attempters, suicide ideators, and non-suicidal controls. Depression and Anxiety, 27(9), 871–877. 10.1002/da.20701 First citation in articleCrossref Medline, Google Scholar

  • Stern, J. A., Boyer, D., & Schroeder, D. (1994). Blink rate: A possible measure of fatigue. Human Factors, 36(2), 285–297. First citation in articleCrossref Medline, Google Scholar

  • Taylor, J. R., Elsworth, J. D., Lawrence, M. S., Sladek, J. R., Roth, R. H., & Redmond, D. E. (1999). Spontaneous blink rates correlate with dopamine levels in the caudate nucleus of MPTP-treated monkeys. Experimental Neurology, 158(1), 214–220. 10.1006/exnr.1999.7093 First citation in articleCrossref Medline, Google Scholar

  • Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S. R., Selby, E. A., & Joiner Jr., T. E. (2010). The interpersonal theory of suicide. Psychological Review, 117(2), 575–600. 10.1037/a0018697 First citation in articleCrossref Medline, Google Scholar

  • Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal desire and the capability for suicide: Tests of the interpersonal-psychological theory of suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1), 72–83. 10.1037/0022-006X.76.1.72 First citation in articleCrossref Medline, Google Scholar

  • Wilson, G. F. (2002). An analysis of mental workload in pilots during flight using multiple psychophysiological measures. International Journal of Aviation Psychology, 12(1), 3–18. 10.1207/S15327108IJAP1201_2 First citation in articleCrossref, Google Scholar

  • Yamada, F. (1998). Frontal midline theta rhythm and eyeblinking activity during a VDT task and a video game: Useful tools for psychophysiology in ergonomics. Ergonomics, 41(5), 678–88. 10.1080/001401398186847 First citation in articleCrossref Medline, Google Scholar

  • Zouk, H., Tousignant, M., Seguin, M., Lesage, A., & Turecki, G. (2006). Characterization of impulsivity in suicide completers: Clinical, behavioral and psychosocial dimensions. Journal of Affective Disorders, 92(2–3), 195–204. 10.1016/j.jad.2006.01.016 First citation in articleCrossref Medline, Google Scholar