Impulsivity, decision-making and their role in suicidal behaviour

Suicide risk constitutes a complex set of interacting demographic, clinical, psychobiological and environmental variables. The association between aggression, impulsivity and suicidal behaviour is well established, well documented and is based on decades of research and clinical practice. Nonetheless, the research is confusing, contradictory, and not easy to organize in a coherent manner. Moreover, there is detaching between the emphasis on impulsivity in suicide as a risk factor and the state of the existing research. This is probably due to the difficulty in defining and separating out the different facets of impulsivity and the fact that there is much overlap between them. Other difficulties stem from the various methods used and the different types of behaviours that are measured under the concept of impulsivity. Impulsivity involves a failure of higher-order control, including decision-making. Thus, decision-making is an emerging field of study of self-harm behaviour and suicidal behaviour. The aim of this chapter is to review the past and current literature on the role of impulsivity, decision-making and mediating variables in the understanding of suicidal behaviour in general and high-lethal suicide attempts in particular