Unveiling Overt and Covert Suicidal Behavior in a Sample of Brazilian Impulsive Outpatients

The aim of this study is to perform an explorative analysis of potential risk and protective factors for overt and covert suicidal behaviors in a large sample of subjects with Impulse Control Disorder (ICD) and to assess the association between both domains. This is a cross-sectional study with all patients looking for treatment for any ICD, between 1998 and 2019. A total of 2,788 patients with ICD were interviewed at day 0 of treatment with structured and non-structured psychiatric interview. Several multiple regression analyses were performed in order to access potential risk and protective factors for these behaviors. The association between overt and covert suicidal behavior was highly significant (χ2[1] = 164.5, p < 0.001), with an odds ratio of 3.5. In all regression models, we found the nuclei of suicide risk factors of social vulnerability, mental disorder related vulnerability and personality/individual related vulnerability. Our study highlights the importance of including covert suicidal behavior measures when assessing a patient with potential suicidal risk.