title: A pilot study on differences in aggression in New York City and Madrid, Spain, and their possible impact on suicidal behavior.
abstract: OBJECTIVE
  Published results from a U.S. study of depressed suicide attempters and a Madrid, Spain, study including all consecutively admitted suicide attempters suggested that aggression scores were higher in U.S. attempters. This observation led us to compare depressed attempters and controls from both suicide research centers and explore whether New York City (NYC) patients carry out suicidal acts of greater lethality than patients in Madrid. The study goals were (1) to compare aggression scores in attempters and healthy volunteers between the 2 cities and (2) to determine whether higher aggression scores are associated with greater medical lethality of suicide attempts.
  
  
  METHODS
  The respective samples from NYC and Madrid included attempters with a DSM-IV diagnosis of major depressive disorder (N = 117 and N = 133) and healthy controls (N = 90 and N = 317). Aggression scores, measured by the Brown-Goodwin Scale, in attempters and healthy volunteers from both sites were compared using an analysis of variance model. The relationship between lethality of suicidal acts and aggression scores in attempters was assessed using logistic regression analyses. NYC subjects were recruited from 1998 to 2001, and Madrid subjects were selected from consecutive admissions in 1999.
  
  
  RESULTS
  Depressed suicide attempters from NYC made attempts of greater lethality and reported more lifetime aggressive behavior than depressed attempters in Madrid. NYC healthy volunteers also reported more aggression than their Madrid counterparts.
  
  
  CONCLUSIONS
  This pilot study suggests that the greater lethality of suicidal behavior in NYC compared to Madrid is related to higher aggression levels, although the data have limitations. Cross-cultural studies are needed to verify whether aggression and higher lethality suicide attempts share a common diathesis explaining the higher suicide rates in NYC.
authors.affiliation: Department of Psychiatry, Fundación Jiménez Diaz, Madrid, Spain.
authors.forename: Enrique
authors.initials: E
authors.lastname: Baca-García
authors.forename: Maria A
authors.initials: MA
authors.lastname: Oquendo
authors.forename: Jeronimo
authors.initials: J
authors.lastname: Saiz-Ruiz
authors.forename: J John
authors.initials: JJ
authors.lastname: Mann
authors.forename: Jose
authors.initials: J
authors.lastname: de Leon
mesh_terms: D000328:Adult; D000374:Aggression / Q000523:psychology*; D002423:Cause of Death; D003431:Cross-Cultural Comparison; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004198:Disease Susceptibility / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006801:Humans; D007175:Impulsive Behavior / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D016015:Logistic Models; D008297:Male; D009519:New York City / Q000453:epidemiology; D010554:Personality Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D013030:Spain / Q000453:epidemiology; D013405:Suicide / Q000523:psychology / Q000706:statistics & numerical data; D013406:Suicide, Attempted / Q000523:psychology / Q000706:statistics & numerical data*