A preliminary examination of impulsivity as a risk factor for suicidal thoughts and behaviors among Native American young people

Abstract

Native American young people are disproportionately burdened by suicidal thoughts and behaviors, and research has sought to better understand this risk. This dissertation takes a developmental stress and culturally grounded lens to characterize risk as a working model for suicide risk among Native American youth and employs three empirical studies to examine one possible risk factor outlined in this model: impulsivity. Study 1 used data from two epidemiological samples of Native American and non-Native American adolescents to examine reports of suicide attempts among those who reported ideation and reports of suicide ideation among those who reported an attempt. We found that Native American youth were more likely than youth from other racial/ethnic backgrounds to report engaging in a suicide attempt regardless of whether they also reported experiencing suicide ideation in the past year. Though speculative, it is possible that the elevated likelihood of engaging in a suicide attempt with and without reporting suicide ideation is facilitated by impulsive responding to negative affective states. Study 2 used data from an epidemiologically informed sample of Native American youth in late childhood to examine whether lifetime reports of suicide ideation were associated with indexes of impulsivity measured across multiple levels of analysis (self-report, behavioral, neurobiological). We found that negative urgency (i.e., impulsive behaviors in the context of negative emotions) was significantly associated with lifetime suicide ideation. We also found that when looking at these characteristics within-individuals, youth with elevated negative urgency and positive were more likely to report lifetime suicide ideation when compared to youth with “normative” (i.e., the most common) reports. This study marks a considerable advancement to the literature given the use of multiple levels of analysis and direct measurement of impulsivity. Study 3 used data from a short-term longitudinal survey study to examine how suicide ideation changed week-by-week, whether this change was related to same week life stress, and whether impulsivity (i.e., negative urgency, impulse control) was a significant moderator in these associations among Native American emerging adults. We found that Native American emerging adults reported changes in suicide ideation week to week and that these fluctuations tracked with weeks where they experienced greater impacts of stressors (i.e., the impact of the stressor on finances and on one’s feelings about themselves, or self-concept). These weekly associations were exacerbated by difficulties in emotion regulation related to impulse control. Taken together, these three studies provide preliminary evidence for the role of impulsivity in shaping protracted (i.e., lifetime) and proximal (i.e., weekly) suicide risk trajectories among Native American young people. Predicting changes in acute suicide risk is a difficult task, which may be made even more difficult when impulsivity is at play. Because of this critical clinical concern, there is an express need for future research that continues to characterize the role of impulsivity in suicide risk among Native American young people as well as work that identifies approaches to risk assessment and safety planning that are effective for those who do demonstrate greater impulsivity during intense affective states.