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The Pathways of Aggression – Differential Indirect Associations Between Anxiety Sensitivity Cognitive Concerns and Suicidality

Published Online:November 05, 2020https://doi.org/10.1027/0227-5910/a000725

Abstract

Abstract.Background: Suicide prevention efforts have focused on risk factors that help identify people with an increased risk for suicide. One risk factor related to suicide risk is anxiety sensitivity cognitive concerns (ASCC), which is the "fear of going crazy." The association between ASCC and suicidal ideation is hypothesized to result from the depression–distress amplification model, which postulates that ASCC exacerbates feelings of depression and concurrent distress. Furthermore, there is evidence for associations between ASCC/dysregulated anger and dysregulated anger/suicidal ideation. We hypothesized that aggression may provide pathways from ASCC to suicidality. The current study examined how facets of aggression (described as elevated agitation) meditated the association between ASCC and suicidality. Aims: The current study aimed to extend prior research by examining how different facets of aggression mediate the association between ASCC and suicidality. Method: Participants were 440 adults recruited online, 32.7% of whom endorsed experiencing lifetime suicidal ideation. Results: Our hypotheses were partially supported with two significant indirect effects. Results indicated that physical aggression and hostility provided significant indirect effects; however, verbal aggression and anger did not. Limitations: The study was cross-sectional in nature, limiting causal interpretations about the indirect effects. The sample included primarily White participants. Conclusion: Specific facets of aggression provide pathways through which ASCC is associated with suicidality. Aggression may be a catalyst for individuals to progress to suicidality. The current study provides foundational research for continued examination of physical aggression as a catalyst for suicide attempts.

References

  • Asnaani, A., Richey, J. A., Dimaite, R., Hinton, D. E., & Hofmann, S. G. (2010). A cross-ethnic comparison of lifetime prevalence rates of anxiety disorders. Journal of Nervous and Mental Disorders, 198(8), 551–555. 10.1097/NMD.0b013e3​181ea169f First citation in articleCrossref Medline, Google Scholar

  • Allan, N. P., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2014). Unique relations among anxiety sensitivity factors and anxiety, depression, and suicidal ideation. Journal of Anxiety Disorders, 28, 266–275. 10.1016/j.janxdis.2013.12.004 First citation in articleCrossref Medline, Google Scholar

  • Baumeister, R. F. (1990). Suicide as escape from self. Psychological Review, 97(1), 90–113. 10.1037/0033-295x.​97.1.90 First citation in articleCrossref Medline, Google Scholar

  • Bilgiç, A., Tufan, A. E., Yilmaz, S., Özcan, Ö., Özmen, S., Öztop, D., … Savci, U. (2017). Association of reactive-proactive aggression and anxiety sensitivity with internalizing and externalizing symptoms in children with attention-deficit/hyperactivity disorder. Child Psychiatry & Human Development, 48, 283–297. 10.1007/s10578-016-0640-9 First citation in articleCrossref Medline, Google Scholar

  • Brent, D. A., Bridge, J., Johnson, B. A., & Connolly, J. (1996). Suicidal behavior runs in families. A controlled family study of adolescent suicide victims. Archives of General Psychiatry, 53(12), 1145–1152. 10.1001/archpsyc.1996.01830120085015. First citation in articleCrossref Medline, Google Scholar

  • Broman-Fulks, J. J., McCloskey, M. S., & Berman, M. E. (2007). Anxiety sensitivity and retaliatory aggressive behavior in research volunteers. Aggressive Behavior, 33(2), 137–144. 10.1002/ab.20175 First citation in articleCrossref Medline, Google Scholar

  • Buss, A. H., & Perry, M. (1992). The Aggression Questionnaire. Journal of Personality and Social Psychology, 63(3), 452–459. 10.1037/0022-3514.63.3.452 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Allan, N. P., Ialongo, N. S., Leen-Feldner, E., & Schmidt, N. B. (2015). The depression distress amplification model in adolescents: A longitudinal examination of anxiety sensitivity cognitive concerns, depression and suicidal ideation. Journal of Adolescence, 41, 17–24. 10.1016/j.adoles​cence.2015.02.001 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Blumenthal, H., Medley, A. N., Lewis, S., Feldner, M. T., Zvolensky, M. J., & Schmidt, N. B. (2012). Anxiety sensitivity cognitive concerns predict suicidality among smokers. Journal of Affective Disorders, 138, 239–246. 10.1097/NMD.0000000000000465 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Cougle, J. R., Ribeiro, J. D., Joiner, T. E., & Schmidt, N. B. (2012). An interactive model of anxiety sensitivity relevant to suicide attempt history and future suicidal ideation. Journal of Psychiatric Research, 46(2), 174–180. 10.1016/j.jpsychires.2011.10.009 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Norr, A. M., Macatee, R. J., & Schmidt, N. B. (2013). Distress tolerance and anxiety sensitivity cognitive concerns: Testing the incremental contributions of affect dysregulation constructs on suicidal ideation and suicide attempt. Behavior Therapy, 44, 349–358. 10.1016/j.beth.2012.​12.002 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Norr, A. M., Zvolensky, M. J., & Schmidt, N. B. (2014). Prospective evaluation of the effect of an anxiety sensitivity intervention on suicidality among smokers. Cognitive Behaviour Therapy, 43, 72–82. 10.1080/16506073.2013.777466 First citation in articleCrossref Medline, Google Scholar

  • Capron, D. W., Lamis, D. A., & Schmidt, N. B. (2014). Test of the depression distress amplification model in young adults with elevated risk of current suicidality. Psychiatry Research, 219(3), 531–535. 10.1016/j.psychres.2014.07.005 First citation in articleCrossref Medline, Google Scholar

  • Centers for Disease Control and Prevention (CDC). (2018). Suicide: At a glance. Retrieved from https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf First citation in articleGoogle Scholar

  • Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. (2019). Web-based injury statistics query and reporting system (WISQARS) [online]. Retrieved from https://www.cdc.gov/injury/wisqars First citation in articleGoogle Scholar

  • Chavarria, J., Allan, N. P., Boffa, J. W., Albanese, B. J., Schmidt, N. B., & Zvolensky, M. J. (2015). Decomposing the relationship between anxiety sensitivity and alcohol use. Journal of Studies on Alcohol and Drugs, 76(6), 957–961. 10.15288%2Fjsad.2015.76.957 First citation in articleCrossref Medline, Google Scholar

  • Choi, S. S., Budhathoki, C., & Gitlin, L. N. (2017). Co-occurrence and predictors of three commonly occurring behavioral symptoms in dementia: Agitation, aggression, and rejection of care. American Journal of Geriatric Psychiatry, 25(5), 459–468. 10.1016/j.jagp.2016.10.013 First citation in articleCrossref Medline, Google Scholar

  • Conner, K. R., Duberstein, P. R., Conwell, Y., & Caine, E. D. (2003). Reactive aggression and suicide: Theory and evidence. Aggression and Violent Behavior, 8(4), 413–432. 10.1016/S1359-1789(02)00067-8 First citation in articleCrossref, Google Scholar

  • Conwell, Y., Van Orden, K., & Caine, E. D. (2011). Suicide in older adults. The Psychiatric Clinics of North America, 34(2), 451–468. 10.1016/j.psc.2011.02.002 First citation in articleCrossref Medline, Google Scholar

  • Doihara, C., Kawanishi, C., Yamada, T., Sato, R., Hasgawa, H., Funno, T., … Hiraysu, Y. (2008). Trait aggression in suicide attempters: A pilot study. Psychiatry Clinic Neuroscience, 62(3), 352–354. 10.1111/j.1440-1819.2008.01804.x First citation in articleCrossref Medline, Google Scholar

  • Farmer, R., & Creed, F. (1986). Hostility and deliberate self-poisoning. British Journal of Medical Psychology, 59(4), 311–316. 10.1111/j.2044-8341.1986.tb02699.x First citation in articleCrossref Medline, Google Scholar

  • Farris, S. G., DiBello, A. M., Allan, N. P., Hogan, J., Schmidt, N. B., & Zvolensky, M. J. (2015). Evaluation of the Anxiety Sensitivity Index-3 among treatment-seeking smokers. Psychol Assess, 27(3), 1123–1128. 10.1037%2Fpas0000112 First citation in articleCrossref Medline, Google Scholar

  • Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., … Nock, M. K. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232. ​10.1037/bul0000084 First citation in articleCrossref Medline, Google Scholar

  • Glick, A. R. (2015). The role of serotonin in impulsive aggression, suicide, and homicide in adolescents and adults: A literature review. International Journal of Adolescent Medicine and Health, 27(2), 143–150. 10.1515/ijamh-2015-5005 First citation in articleCrossref Medline, Google Scholar

  • Gormley, B., & McNeil, D. E. (2010). Adult attachment orientations, depressive symptoms, anger, and self-directed aggression by psychiatric patients. Cognitive Therapy and Research, 34(3), 272–281. 10.1007/s10608-009-9267-5 First citation in articleCrossref, Google Scholar

  • Gvion, Y. (2018). Aggression, impulsivity, and their predictive value on medical lethality of suicide attempts: A follow-up study on hospitalized patient. Journal of Affective Disorders, 227, 840–846. 10.1016/j.jad.2017.11.033 First citation in articleCrossref Medline, Google Scholar

  • Gvion, Y., & Apter, A. (2011). Aggression, impulsivity, and suicide behavior: A review of the literature. Archives of Suicide Research, 15(2), 93–112. 10.1080/13811118.2011.565265 First citation in articleCrossref Medline, Google Scholar

  • Harris, J. A. (1997). A further evaluation of the Aggression Questionnaire: Issues of validity and reliability. Behaviour Research and Therapy, 35(11), 1047–1053. 10.1016/s0005-7967(97)00064-8 First citation in articleCrossref Medline, Google Scholar

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis. New York, NY: The Guilford Press. First citation in articleGoogle Scholar

  • Janiri, D., De Rossi, P., Kotzalidis, G. D., Girardi, P., Koukopoulos, A. E., Reginaldi, R., … Sani, G. (2018). Psychopathological characteristics and adverse childhood events are differentially associated with suicidal ideation and suicidal acts in mood disorders. European Psychiatry, 53, 31–36. 10.1016/j/eur​psy.2018.05.009 First citation in articleCrossref Medline, Google Scholar

  • Joiner, T. E. (2005). Why people die by suicide. Cambridge, MA: Harvard University Press. First citation in articleGoogle Scholar

  • Katz, C. E., Yaseen, Z. S., Mojtabai, R., & Galynker, I. I. (2011). Panic as an independent risk factor for suicide attempt in depressive illness: Findings from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Journal of Clinical Psychiatry, 72(12), 1628–1635. 10.4088/JCP.10m06186blu First citation in articleCrossref Medline, Google Scholar

  • Klonsky, E. D., & May, A. M. (2015). The Three-Step Theory (3ST): A new theory of suicide rooted in the "ideation-to-action" framework. International Journal of Cognitive Therapy, 8(2), 114–129. First citation in articleCrossref, Google Scholar

  • Mann, J. J., Waternauz, C., Hass, G. L., & Malone, K. M. (1999). Toward a clinical model of suicidal behavior in psychiatric patients. American Journal of Psychiatry, 156, 181–189. 10.1176/ajp.156.2.181 First citation in articleCrossref Medline, Google Scholar

  • McCloskey, M. S., & Ammerman, B. A. (2018). Suicidal behavior and aggression-related disorders. Current Opinion in Psychology, 22, 54–58. 10.1016/j.copsyc.2017.08.010 First citation in articleCrossref Medline, Google Scholar

  • Millner, A. J., Ursano, R .J., Hwang, I., King, A. J., Naifeh, J. A., Sampson, N. A. & Kessler, R. C. (2019). Prior mental disorders and lifetime suicidal behaviors among US Army soldiers in the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Suicide and Life-Threatening Behavior, 48(2), 230–250. 10.1111/sltb.12394 First citation in articleCrossref, Google Scholar

  • Naifeh, J. A., Ursano, R. J., Kessler, R. C., Zaslavsky, A. M., Nock, M. K., Dempsey, C. L. & Stein, M. B. (2018). Transition to suicide attempt from recent suicide ideation in US Army soldiers: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS). Depression and Anxiety, 36(5), 412–422. 10.1002/da.22870 First citation in articleCrossref Medline, Google Scholar

  • Naragon-Gainey, K. (2010). Meta-analysis of the relations of anxiety sensitivity to the depressive and anxiety disorders. Psychological Bulletin, 136(1), 128–150. 10.1037/a0018055 First citation in articleCrossref Medline, Google Scholar

  • Nock, M. K., Hwang, I., Sampson, N. A., & Kessler, R. C. (2009). Mental disorders, comorbidity and suicidal behavior: Results from the National Comorbidity Survey Replication. Molecular Psychiatry, 15, 868–876. 10.1038/mp.2009.29 First citation in articleCrossref Medline, Google Scholar

  • Norr, A. M., Allan, N. P., Macatee, R. J., Capron, D. W., & Schmidt, N. B. (2016). The role of anxiety sensitivity cognitive concerns in suicidal ideation: A test of the depression-distress amplification model in clinical outpatients. Psychiatry Research, 238, 74–80. 10.1016/j.psychres.2016.02.016 First citation in articleCrossref Medline, Google Scholar

  • O'Connor, R. C., & Kirtley, O. J. (2018). The integrated motivational-volitional model of suicidal behaviour. Philosophical Transactions of the Royal Society B, 373, 20170268. 10.1098/rstb.2017.0268 First citation in articleCrossref Medline, Google Scholar

  • Oglesby, M. E., Capron, D. W., Raines, A. M., & Schmidt, N. B. (2015). Anxiety sensitivity cognitive concerns predict suicide risk. Psychiatry Research, 226(1), 252–256. 10.1016/j.psychres.2014.12.057 First citation in articleCrossref Medline, Google Scholar

  • Olantunji, B. O., & Wolitzky-Taylor, K. B. (2009). Anxiety sensitivity and the anxiety disorders: A meta-analytic review and synthesis. Psychol Bulletin, 135(6), 974–999. 10.1037/a0017428 First citation in articleCrossref Medline, Google Scholar

  • Papadopoulou, A., Efstathiou, V., Chrostodoulou, C., Gournellis, R., Papageorgiou, C., Douzenis, D., & Markianos, M. (2018). Clinical and psychometric features of psychiatric patients after a suicide attempt in relation with menstrual cycle phases. Archives of Women's Mental Health, 22, 1–7. 10.1007/s00737-018-0934-y First citation in articleCrossref Medline, Google Scholar

  • Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1–8. 10.1016/00057967(86)90143-9 First citation in articleCrossref Medline, Google Scholar

  • Schmidt, N. B., Capron, D. W., Raines, A. M., & Allan, N. P. (2014). Randomized clinical trial evaluating the efficacy of a brief intervention targeting anxiety sensitivity cognitive concerns. Journal of Consulting and Clinical Psychology, 82(6), 1023. 10.1037/a0036651 First citation in articleCrossref Medline, Google Scholar

  • Schmidt, N. B., Lerew, D. R., & Jackson, R. J. (1997). The role of anxiety sensitivity in the pathogenesis of panic: Prospective evaluation of spontaneous panic attacks during acute stress. Journal of Abnormal Psychology, 106, 355–364. ​10.1037/0021-843X.106.3.355 First citation in articleCrossref Medline, Google Scholar

  • Schmidt, N. B., Norr, A. M., Allan, N. P., Raines, A. M., & Capron, D. W. (2017). A randomized clinical trial targeting anxiety sensitivity for patients with suicidal ideation. Journal of Consulting and Clinical Psychology, 85, 596–610. 10.1037/ccp0000195 First citation in articleCrossref Medline, Google Scholar

  • Snir, A., Itzhaky, L., & Solomon, Z. (2017). The double-edged sword – outward and inward directed aggression among war combatants. Archives of Suicide Research, 21(4), 595–609. 10.1080/13811118.2016.1227740 First citation in articleCrossref Medline, Google Scholar

  • Stanley, I. H., Boffa, J. W., Rogers, M. L., Hom, M. A., Albanese, B. J., Chu, C., … Joiner, T. E. (2018). Anxiety sensitivity and suicidal ideation/suicide risk: A meta-analysis. Journal of Consulting and Clinical Psychology, 86(11), 946–960. 10.1037/ccp0000342 First citation in articleCrossref Medline, Google Scholar

  • Swogger, M. T., Van Orden, K. A., & Conner, K. R. (2014). The relationship of outwardly directed aggression to suicidal ideation and suicide attempts across two high-risk samples. Psychology of Violence, 4(2), 184–195. 10.1037/a0033212 First citation in articleCrossref Medline, Google Scholar

  • Swogger, M. T., You, S., Cashman-Brown, S., & Conner, K. R. (2011). Childhood physical abuse, aggression, and suicide attempts among criminal offenders. Psychiatry Research, 185, 363–367. 10.1016%2Fj.psychres.2010.07.036 First citation in articleCrossref Medline, Google Scholar

  • Taylor, S. (1999). Anxiety sensitivity: Theory, research, and treatment of the fear of anxiety. New York, NY: Routledge. First citation in articleGoogle Scholar

  • Taylor, S., Zvolensky, M. J., Cox, B. J., Deacon, B., Heimberg, R. G., Ledley, D. R., … Coles, M. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19(2), 176. 10.1037/1040-3590.19.2.176 First citation in articleCrossref Medline, Google Scholar

  • Tucker, R. P., Lengel, G. L., Smith, C. E., Capron, D. W., Mullins-Sweatt, S. N., & Wingate, L. R. (2016). Maladaptive five factor model personality traits associated with borderline personality disorder indirectly affect susceptibility to suicide ideation through increased anxiety sensitivity cognitive concerns. Psychiatry Research, 246, 432–437. 10.1016/j.psy​chres.2016.08.051 First citation in articleCrossref Medline, Google Scholar

  • Venables, N. C., & Patrick, C. J. (2012). Validity of the externalizing spectrum inventory in a criminal offender sample: Relations with disinhibitory psychopathology, personality, and psychopathic features. Psychological Assessment, 24(1), 88–100. 10.1037/a0024703 First citation in articleCrossref Medline, Google Scholar

  • Venables, N. C., Sellbom, M., Sourander, A., Kendler, K. S., Joiner, T. E., Dirslane, L. E., … Patrick, C. J. (2015). Separate and interactive contributions of weak inhibitory control and threat sensitivity to prediction of suicide risk. Psychiatry Research, 226(2–3), 461–466. 10.1016/j.psychres.2015.01.018 First citation in articleCrossref Medline, Google Scholar

  • Yu, X., Correll, C. U., Xiang, Y-T., Xu, Y., Haung, J., Yang, F., … Masand, P. (2016). Efficacy of atypical antipsychotics in the management of acute agitation and aggression in hospitalized patients with schizophrenia or bipolar disorder: Results from a systematic review. Shanghai Archives of Psychiatry, 28(5), 241–252. j.issn.1002-0829.216072 First citation in articleMedline, Google Scholar

  • Watson, D., O'Hara, M. W., Naragon-Gainey, K., Koffel, E., Chmielewski, M., Kotov, R., … Ruggero, C. J. (2012). Development and validation of new anxiety and bipolar symptoms scales for an expanded version of the IDAS (the IDAS-II). Assessment, 19(4), 399–420. 10.1177/1073191112449857 First citation in articleCrossref Medline, Google Scholar