Difficult temperament traits overrepresented among Asian youths with history of suicide attempts

Teens who have engaged in suicidal behaviour appear to possess “difficult” temperament traits, including negative mood, in addition to having psychiatric comorbidity, recent stressful life events, and perceived parental rejection, as reported in a study from Singapore.

This suggests that “temperament screening may be important to identify adolescents at higher or lower risk of suicide at an early stage,” according to researchers from the National University of Singapore, Queenstown, Singapore.

The study included 60 adolescents (mean age 16.40 years) with a recent suicide attempt (ie, past 6 months; cases) and 58 adolescents (mean age 16.00 years) without any history of self-harm (controls). All of them completed a semi-structured Columbia Suicide Severity Rating Scale and several self-report measures.

In the case group, 43 participants (71.7 percent) reported suicidal ideation, with 41 of them (68.3 percent) having suicidal thoughts for at least once a week and 23 (38.3 percent) describing themselves as active suicidal ideators with a specific plan. A total of 29 participants (48.3 percent) were first-time attempters, while the remaining 31 (51.7 percent) had a history of multiple attempts of self-harm. [BMC Psychiatry 2023;23:434]

Compared with the control group, the case group had lower temperament scores (four-point Likert scale ranging from 1 “usually false” to 4 “usually true”) on four “difficult” traits (flexibility/rigidity: p<0.001; rhythmicity in sleep: p<0.01; rhythmicity in eating: p<0.05; mood: p<0.001; approach/withdrawal: p<0.001). This means that participants with a history of self-harm had low adaptability, irregular sleeping and eating habits, and were in higher negative mood states. They also had low activity levels (p=0.050).

In adjusted logistic regression models, suicide attempt was significantly associated with major depressive disorder comorbidity (odds ratio [OR], 10.7, 95 percent confidence interval [Cl], 2.24–51.39), “negative mood” trait (OR, 1.12–1.18, 95 percent Cl, 1.00–1.27), and the interaction term of “positive mood” and “high adaptability” traits (OR, 0.943–0.955, 95 percent Cl, 0.900–0.986).

“Specifically, ‘positive mood’ predicted lower likelihood of a suicide attempt when ‘adaptability’ was high (OR, 0.335–0.342, 95 percent Cl, 0.186–0.500) but not low (OR, 0.968–0.993, 95 percent Cl, 0.797–1.31),” the researchers explained.

In light of the data, the researchers underscored the importance of identifying temperament traits early among Asian youths.

“Not only were the ‘difficult temperament’ traits significantly overrepresented among suicide attempters in Asia, but also the temperament trait of ‘negative mood’ should warrant greater attention as a robust predictor of adolescent suicide attempts independent of other established high-risk factors,” the researchers said.

“In a similar vein, our results on the interaction between ‘positive mood’ and ‘high flexibility’ traits being a protective mechanism notably challenged previous speculations that a positive outlook alone was sufficient to reduce adolescent suicide attempts,” they added.

Nevertheless, the researchers acknowledged that proceeding immediately with mandatory early screening of these “difficult” or “protective” traits may not be the best course of action, given that predictions of suicide attempts have been dominated with false-positive and false-negative findings. [Psychiatry Res 2009;170:212-217; Psychiatry Investig 2012;9:119-126; Psychiatr Danub 2017;29:171-178]

Minimizing false-positive findings and maximizing precision in suicide prevention efforts for adolescents can be done in several ways, according to the researchers.

“One, future researchers should aim to converge on these findings even with employing different study designs, samples, and measurement types. [Also], we suggest that collection of more neurobiological evidence (ie, biological markers and correlates) linking adolescent temperaments and suicidal behaviours may be very helpful in objectively validating these connections,” they said.