Childhood Maltreatment, Impulsive Aggression, and Suicidality Among Patients Diagnosed With Bipolar Disorder

Clinical Impact Statement The purpose of this study was to understand how different types of childhood maltreatment relate to impulsive aggression and suicidality among patients with bipolar disorder. It was found that impulsive aggression mediates the relation between childhood abuse and suicidality for sexual and emotional abuse but not physical abuse. These findings suggest that varying types of childhood abuse may impact the expression of suicidality differently for individuals with bipolar disorder. Moreover, results demonstrate that impulsive aggression serves as a meaningful construct in the prediction of suicidality for this demographic. Objective: Bipolar disorder is associated with a history of childhood maltreatment, impulsive aggression, and lethal suicide attempts. Often, aggression and violence prevent the diagnosed individual from receiving timely access to mental health care, leading to adverse outcomes such as repeated psychiatric hospitalization or even incarceration. Method: In this study, we recruited a sample of 150 low-income patients with bipolar disorder from an outpatient behavioral health clinic affiliated with an urban public hospital in Southeastern United States. We explored whether different types of childhood maltreatment (physical, sexual, emotional) are associated with impulsive aggression among individuals with bipolar disorder. Additionally, we examined whether impulsive aggression is related to suicidality. Finally, we sought to test the potential mediated effect of impulsive aggression on the relationship between childhood maltreatment and suicidality. Results: Findings suggest that all direct associations were significant and that impulsive aggression was a significant mediator in the relationship between childhood emotional and sexual abuse. However, when childhood physical abuse was included as an independent variable in the model, impulsive aggression did not mediate the association, even though impulsive aggression was related to suicidality. Conclusion: Results from this study suggest that impulsive aggression exerts a wide-ranging impact on suicidality in the context of childhood trauma in those with bipolar disorder. In the future, targeted interventions to address the underlying etiologies of aggression may translate into an improved quality of life, decreased rates of suicidality, and positive clinical outcomes among individuals with bipolar disorder.