Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Int J Geriatr Psychiatry. 2009 Dec;24(12):1396-404. doi: 10.1002/gps.2276.
Depression, loss, and physical illness are associated with suicide in the elderly. However, the nature of individual vulnerability remains poorly understood. Poor problem solving has been suggested as a risk factor for suicide in younger adults. Unresolved problems may create an accumulation of stressors. Thus, those with perceived deficits in problem-solving ability may be predisposed to suicidal behavior. To test this hypothesis, we investigated whether elderly suicide attempters perceived their problem solving as deficient.
Sixty-four individuals aged 60 and older participated in the study including depressed suicide attempters, depressed non-attempters, and non-depressed controls. The social problem solving inventory-revised: short-version was used to measure participants' perceived social problem solving, assessing both adaptive problem-solving dimensions (positive problem orientation and rational problem solving) and dysfunctional dimensions (negative problem orientation, impulsivity/carelessness, and avoidance).
Depressed elderly who had attempted suicide perceived their overall problem solving as deficient, compared to non-suicidal depressed and non-depressed elderly. Suicide attempters perceived their problems more negatively and approached them in a more impulsive manner. On rational problem solving and avoidant style sub-scales, suicide attempters did not differ from non-suicidal depressed. However, both depressed groups reported lower rational problem solving and higher avoidance compared to non-depressed controls.
A perception of life problems as threatening and unsolvable and an impulsive approach to problem solving appear to predispose vulnerable elderly to suicide attempts.
抑郁、失落和身体疾病与老年人自杀有关。然而，个体易感性的本质仍知之甚少。解决问题能力差被认为是年轻人自杀的一个风险因素。未解决的问题可能会导致压力的积累。因此，那些被认为在解决问题能力上有缺陷的人可能更容易产生自杀行为。为了验证这一假设，我们调查了老年自杀未遂者是否认为自己的解决问题能力有缺陷。
共有 64 名年龄在 60 岁及以上的参与者参与了这项研究，包括抑郁自杀未遂者、抑郁非未遂者和非抑郁对照组。使用社会问题解决量表修订版：短版来衡量参与者感知的社会问题解决能力，评估适应性问题解决维度（积极问题取向和理性问题解决）和功能失调维度（消极问题取向、冲动/粗心和回避）。
与非自杀性抑郁和非抑郁的老年人相比，抑郁的老年自杀未遂者认为自己的整体问题解决能力有缺陷。自杀未遂者对自己的问题有更负面的看法，并以更冲动的方式对待这些问题。在理性问题解决和回避风格子量表上，自杀未遂者与非自杀性抑郁组没有差异。然而，与非抑郁对照组相比，两组抑郁患者的理性问题解决能力较低，回避倾向较高。
对生活问题的感知具有威胁性和无法解决，以及对问题解决的冲动态度，似乎使脆弱的老年人容易产生自杀未遂。
