History of suicide attempt in male substance-dependent inpatients and relationship to borderline personality features, anger, hostility and aggression Cuneyt Evren a, ⁎, Ozgul Cınar a , Bilge Evren b , Selime Celik a a Bakirkoy State Hospital for Mental Health and Neurological Disorders, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul, Turkey b Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey abstract article info Article history: Received 9 March 2011 Received in revised form 16 June 2011 Accepted 2 August 2011 Keywords: Aggression Anger Anxiety Borderline Personality Depression Hostility Substance dependence The aim of this study was to investigate the relationship between severity of borderline personality features and history of suicide attempt (HSA) in male substance-dependent inpatients and the effect of anger, hostility and aggression on this relationship. Further, the effect of some variables that may be related to suicide and/or borderline personality, such as age at inception of regular substance use, substance of dependence (alcohol/ drug), depression, and both state and trait anxiety, were controlled. Participants were 200 consecutively admitted male substance-dependent inpatients. Patients were investigated with the Borderline Personality Inventory (BPI), the Buss–Perry Aggression Questionnaire (AQ), the Beck Depression Inventory (BDI) and the State–Trait Anxiety Inventory (STAI). Among substance-dependent inpatients, 33.0% (n = 66) were identified as the group with HSA. Mean scores employment status, marital status and duration of education did not differ between groups, whereas current age and age at onset of regular substance use were lower in group with HSA. Mean scores of BPI, AQ and its subscales (anger, hostility and physical/verbal aggression), BDI and STAI were higher in the HSA group. In addition, the rates of drug dependency and borderline personality disorder were higher in this group. The severity of borderline personality symptoms was highly correlated with subscales of the AQ, depression and anxiety, whereas it was negatively correlated with age at onset of regular substance use. The severity of anger and borderline personality features predicted HSA in the logistic regression model. Results suggest that, to reduce the risk of suicide attempt among substance- dependent patients, the feeling of anger must be the target of evaluation and treatment among those with borderline personality features. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Suicidal behaviour is complex and heterogeneous (Conner et al., 2006). In addition to the psychological impact of these behaviours on individuals and their families, they have enormous social costs in terms of medical treatment and loss of productivity (Linehan et al., 2006). Among other risk factors, history of suicide attempt (HSA) appears to be the strongest known predictor of completed suicide (Giegling et al., 2009). Nevertheless, it may be related to treatable conditions, such as substance dependence, depression, anxiety, anger, hostility and aggression (Bacaner et al., 2002; Diefenbach et al., 2009; Giegling et al., 2009). Thus, exploring the associations among these conditions for patients with HSA may contribute to elaborating effective and targeted preventive and intervention programmes for these patients. Suicidal behaviour is very common among substance-dependent individuals (Preuss et al., 2002; Roy, 2003). Studies have shown that substance dependence is related to suicide and HSA (Trezza and Popp, 2000). Among drug abusers, lifetime prevalence of suicide ranges between 15% and 20% and reaches up to 45% (Rossow and Lauritzen, 2001), whereas among alcohol-dependent individuals this rate ranges between 25.4% and 37.6% (Driessen et al., 1998). Substance-dependent individuals with HSAs were found to have a significantly more severe course of dependence and a higher prevalence of both independent and substance-induced psychiatric disorders and additional forms of substance dependence (Preuss et al., 2002). In a cohort of suicide attempters, male gender and substance use disorders were found as significant risk factors for both later suicide and other causes of death (Suominen et al., 2004). Thus, as suicide probability is higher in the subgroup of substance-dependent individuals with HSA (Demisbas et al., 2003), it is important to determine the characteristics of substance-dependent men with HSA to prevent suicide attempts in the future. In previous studies, hostility was found to be a risk factor for suicide among opiate-, cocaine- and alcohol-dependent patients (Roy, 2001a, 2001b, 2001c, 2002). Cognitive rather than behavioural hostility was found to be associated with an increased risk of suicide, independently of baseline depressive mood (Lemogne et al., 2011). Psychiatry Research 190 (2011) 126–131 ⁎ Corresponding author at: Icadiye Cad. Mentes Sok., Selcuk Apt. 1/17 Kuzguncuk, 34674 Uskudar, Istanbul, Turkey. Tel.: +90 216 3410609, +90 532 6040946 (GSM); fax: +90 212 6600026. E-mail addresses: cuneytevren@yahoo.com, cuneytevren@hotmail.com (C. Evren). 0165-1781/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2011.08.002 Contents lists available at SciVerse ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres