Suicide tends to aggregate in families, but the influence may be transmitted indirectly through a cluster of personality traits including impulsivity, attention seeking, and hostility. McGirr et al. (p. 1124) report that the characteristics of the DSM-IV cluster B personality disorders—antisocial, borderline, histrionic, and narcissistic—were significantly associated with suicidal behavior in relatives of depressed people who committed suicide. These relatives had a higher rate of suicidal behavior than relatives of nonsuicidal depressed individuals, whose rate was higher than that for relatives of nondepressed, nonsuicidal comparison subjects. Further, the relatives’ level of cluster B traits was associated with cluster B traits in the primary subject, and the influence of personality traits on suicide risk was independent of major depression. In an editorial on p. 1087, Dr. David Brent considers the relationship between impulsive aggression and suicide.

Interviews with 8,580 members of a British population sample revealed that sexual abuse is more strongly associated with suicide attempts for women than for men. However, mood-related symptoms appeared to account for much of this association. Bebbington et al. (CME, p. 1135) found that 5% of women and 2% of men reported a history of sexual abuse, and 5% and 4% of women and men, respectively, reported lifetime suicide attempts. Women with a history of sexual abuse were nearly 10 times as likely to report a suicide attempt as were women without sexual abuse; men with a history of sexual abuse were seven times as likely to report a suicide attempt. Suicidal intent was also associated with a history of sexual abuse and mood disorder symptoms. Dr. Mindy Fullilove describes the social context of sexual abuse in an editorial on p. 1090.

As individuals age, the potential adverse consequences of binge drinking increase, and binge drinking was reported by 20% of the men and 6% of the women in a large national survey of people age 50 or older. In the analysis of 10,953 older adults by Blazer and Wu (CME, p. 1162), binge drinking was defined as five or more drinks on one occasion in the past month. It was most common among those age 50—64 but was also reported by 14% of men and 3% of women age 65 or older. Compared to respondents reporting no alcohol use, those who reported binge drinking were more likely to use tobacco or illicit drugs. In men, binge drinking was also associated with higher income and with being separated, divorced, or widowed. In women, it was also associated with nonmedical use of prescription drugs. Drs. Sarah Mathews and David Oslin advocate systematic substance use screening in an editorial on p. 1093.

One low dose of the antidepressant reboxetine increased depressed patients’ responses to positive facial expressions and personality characteristics, while their mood ratings remained unchanged. Harmer et al. (p. 1178) randomly assigned depressed patients and healthy comparison subjects to one dose of placebo or 4 mg of reboxetine. Among those taking placebo, the depressed patients were less able than the comparison subjects to identify facial expressions of happiness or surprise, took longer to respond to positive personality descriptors, and were less able to recall those descriptors later. Among those taking reboxetine 3 hours before testing, both groups had better recognition of happy faces than subjects taking placebo, and they responded faster to positive qualities. In addition, the depressed patients had better recollection of the positive qualities. These early drug effects might be useful in screening candidate antidepressants or predicting response to medication. The study is discussed further by Dr. Michael Thase in an editorial on p. 1096.