Impulsivity and psychosocial determinants in patients with attempted suicide by poisoning: a mixed-methods study

Abstract Background Suicide claims more than 720,000 lives each year, and self-poisoning is among the most common methods seen in emergency departments (EDs). Impulsivity is a well-recognized risk factor for suicidal behavior, yet how impulsive traits combine with psychosocial stressors in patients who poison themselves has rarely been examined with both quantitative and qualitative data. We therefore characterized impulsivity, psychological distress, and their contributing factors in patients treated in the ED after attempted suicide by poisoning, and explored how these patients experienced the suicidal process itself. Methods We used a sequential explanatory mixed-methods design. The quantitative component was a cross-sectional survey conducted between January and December 2025 among 155 patients who presented with deliberate self-poisoning at three tertiary EDs, using a demographic questionnaire, the Nurses’ Global Assessment of Suicide Risk (NGASR), the Social Support Rating Scale (SSRS), the Generalized Anxiety Disorder-2 (GAD-2), the Patient Health Questionnaire-2 (PHQ-2), and the Barratt Impulsiveness Scale-11 (BIS-11). Binary logistic regression identified independent predictors. For the qualitative component, purposive sampling yielded 10 participants for semi-structured in-depth interviews, and transcripts were analyzed using thematic analysis. Results Quantitatively, 71.6% of participants were classified as low suicide risk, 26.5% as moderate risk, and 1.9% as high risk, while 12.3% reported previous attempts. BIS-11 scores indicated elevated impulsivity across all three subscales, with total scores above 70 for every participant. Regression analyses identified family per-capita monthly earnings, urban versus rural residency, domestic conflict, and perceived social support as determinants of both anxiety and depressive symptoms ( P < 0.05). Qualitatively, the 10 interviews revealed three phases—pre-attempt despair and hopelessness, a peri-attempt impulsive state marked by “mental blankness”, and post-attempt fear, remorse, and re-evaluation; contributing factors were both internal (hopelessness, impulsive traits) and external (interpersonal conflict or loss, poor support). Conclusions Patients in this cohort were markedly impulsive, and their attempts often followed acute stressors rather than sustained psychiatric illness. Economic strain, family conflict, and weak social support contributed to psychological distress. Adding impulsivity screening to ED triage, together with psychosocial intervention attuned to the different phases of the suicidal process, may help reduce the risk of repeated attempts.