The relationship of outwardly-directed aggression to suicidal ideation and suicide attempts across two high-risk samples

Objective While research has established some relationships between risk factors and specific suicide-related outcomes, in large part the extent to which suicidal ideation and attempts have different risk profiles is unclear. Using two theories of suicidal behavior to guide our hypotheses, we studied the relationship of outwardly-directed aggression to suicidal ideation and attempts in two high-risk samples. Method Participants in study one were 271 criminal offenders in a pretrial diversion program. Participants in study two were 892 psychiatric inpatients who participated in the MacArthur Violence Risk Assessment Study. Results In both studies, after controlling for relevant covariates, outwardly-directed aggression was associated with suicide attempts, but not ideation. Among psychiatric patients, further analyses revealed that outwardly-directed aggression was associated with planned, but not unplanned, suicide attempts. Conclusions That aggression is related to suicide attempts and not ideation is consistent with hypotheses based on both Joiner's (2005) interpersonal theory of suicidal behavior and theories based on a diathesis toward behavioral dysregulation (e.g., Mann, 2009). That aggression was associated with planned suicide attempts is consistent with Joiner's theory. Competing explanations for the results include a potential role of proactive aggression in suicide attempts, particularly planned attempts.