Heisel Marnin J, Duberstein Paul R, Conner Kenneth R, Franus Nathan, Beckman Anthony, Conwell Yeates
Department of Psychiatry, Center for the Study and Prevention of Suicide, University of Rochester School of Medicine and Dentistry, USA.
J Affect Disord. 2006 Feb;90(2-3):175-80. doi: 10.1016/j.jad.2005.11.005. Epub 2005 Dec 27.
Accuracy in patient reports of suicide ideation is a concern in clinical assessment, given that some patients deny suicide ideation even when suicidal. Despite this concern, there is little research on the psychological processes driving reported suicide ideation in at-risk patients.
A cross-sectional design was used to examine the association of personality and suicide ideation in a clinical sample of 134 depressed adults 50 years and older. Patients completed a structured diagnostic interview, an interviewer-rated measure of current suicide ideation and self-report measures of personality (NEO-Personality Inventory Revised; NEO-PI-R) and hopelessness. The main outcome variable in logistic regression analyses was suicide ideator status; covariates included comorbid psychopathology, hopelessness and physical illness burden. Predictors were Neuroticism and Openness to Experience (OTE) scores on the NEO-PI-R.
Elevated OTE and neuroticism were associated with suicide ideation in unadjusted analyses; OTE was also associated with suicide ideation in adjusted regression analyses.
This study used a cross-sectional methodology with depressed patients 50 years or older; it is possible that patients' depression severity may have influenced their responses to personality measures. Prospective studies of personality vulnerability to future suicide ideation are warranted.
Elevated neuroticism increases the likelihood of reporting suicide ideation, just as it may enhance risk for suicidal behavior and death by suicide. The pattern for openness is markedly different. Although elevated openness increases the likelihood of reporting suicide ideation, previous research has shown that it may decrease risk of death by suicide, suggesting that the personality-mediated expression of suicide ideation may be adaptive in certain contexts. In contrast, low levels of openness may mute reports of suicide ideation in at-risk patients and confer risk for poor outcomes by potentially undermining clinician vigilance.
鉴于一些患者即使有自杀倾向也否认有自杀念头，因此患者自杀意念报告的准确性在临床评估中备受关注。尽管存在这一担忧，但对于高危患者报告自杀意念背后的心理过程，相关研究却很少。
采用横断面设计，对134名50岁及以上的成年抑郁症患者的临床样本进行研究，以检验人格与自杀意念之间的关联。患者完成了结构化诊断访谈、由访谈者评定的当前自杀意念测量以及人格（修订版大五人格量表；NEO-PI-R）和绝望感的自我报告测量。逻辑回归分析中的主要结局变量是自杀意念者状态；协变量包括共病精神病理学、绝望感和身体疾病负担。预测因素是NEO-PI-R上的神经质和开放性经验（OTE）得分。
在未调整分析中，OTE升高和神经质与自杀意念相关；在调整后的回归分析中，OTE也与自杀意念相关。
本研究采用横断面方法，研究对象为50岁及以上的抑郁症患者；患者的抑郁严重程度可能影响了他们对人格测量的回答。有必要对人格易感性与未来自杀意念进行前瞻性研究。
神经质升高会增加报告自杀意念的可能性，就像它可能会增加自杀行为和自杀死亡风险一样。开放性的模式则明显不同。虽然开放性升高会增加报告自杀意念的可能性，但先前的研究表明，它可能会降低自杀死亡风险，这表明人格介导的自杀意念表达在某些情况下可能具有适应性。相比之下，低水平的开放性可能会抑制高危患者的自杀意念报告，并可能因削弱临床医生的警惕性而导致不良后果的风险。
