Szücs Anna, Szanto Katalin, Aubry Jean-Michel, Dombrovski Alexandre Y
Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Decision Neuroscience and Psychopathology Laboratory, Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States.
Front Psychiatry. 2018 May 7;9:128. doi: 10.3389/fpsyt.2018.00128. eCollection 2018.
Suicide rates generally peak in the second half of life and are particularly high in older men; however, little is known about the contribution of dispositional factors to late-life suicide. Maladaptive personality traits have been strongly implicated in suicide among younger adults, but the extent to which they continue to play a role in late-life suicidal behavior is unclear. We also do not know whether specific personality profiles interact with the stressors of aging to cause suicidal behavior.
We sought to synthesize the data on personality pathology in late-life suicidal ideation and behavior a systematic review using the PubMed, Google Scholar, PsycInfo, Scopus, Ovid, Web of Science, Embase, and Cochrane search engines. The included key words related to three descriptors: "personality," "suicide," and "elderly." Included articles evaluated personality based on the Five-Factor Model (FFM) or ICD/DSM diagnostic criteria in older samples with minimum age cutoffs of 50 years or older. Our original search identified 1,183 articles, of which 31 were retained.
Included studies were heterogeneous in their design and personality measurements. Studies of categorical personality disorders were particularly scarce and suggested a stronger association with late-life suicidal ideation than with death by suicide. Only obsessive-compulsive and avoidant personality traits were associated with death by suicide in old age, but only in studies that did not control for depression. All personality constructs were positively linked to suicidal ideation, except for histrionic personality, which emerged as a negative predictor. Studies employing the FFM also indicated that older adults who died by suicide were less likely to display a maladaptive personality profile than elderly suicide attempters and younger suicide victims, having both lower levels of neuroticism and higher levels of conscientiousness than these comparison groups. Nevertheless, older suicide victims displayed lower levels of openness to experience than younger victims in two samples.
Maladaptive personality manifests in milder, subthreshold, and more heterogeneous forms in late-life vs. early-life suicide. An inability to adapt to the changes occurring in late life may help explain the association between suicide in old age and higher conscientiousness as well as obsessive-compulsive and avoidant personality disorders.
自杀率通常在生命的后半段达到峰值，在老年男性中尤其高；然而，关于性格因素对晚年自杀的影响知之甚少。适应不良的人格特质在年轻成年人的自杀行为中具有重要影响，但它们在晚年自杀行为中继续发挥作用的程度尚不清楚。我们也不知道特定的人格特征是否与衰老压力源相互作用导致自杀行为。
我们试图综合关于晚年自杀意念和行为中人格病理学的数据——使用PubMed、谷歌学术、PsycInfo、Scopus、Ovid、科学网、Embase和Cochrane搜索引擎进行系统综述。纳入的关键词与三个描述词相关：“人格”、“自杀”和“老年人”。纳入的文章在年龄下限为50岁或以上的老年样本中，基于五因素模型（FFM）或ICD/DSM诊断标准评估人格。我们最初的搜索识别出1183篇文章，其中31篇被保留。
纳入的研究在设计和人格测量方面存在异质性。关于分类人格障碍的研究特别稀少，且表明与晚年自杀意念的关联比与自杀死亡的关联更强。只有强迫和回避型人格特质与老年自杀死亡相关，但仅在未控制抑郁的研究中如此。除了表演型人格，所有的人格结构都与自杀意念呈正相关，表演型人格是一个负向预测因子。采用FFM的研究还表明，与老年自杀未遂者和年轻自杀受害者相比，自杀死亡的老年人表现出适应不良人格特征的可能性较小，其神经质水平较低，尽责性水平较高。然而，在两个样本中，老年自杀受害者的经验开放性水平低于年轻受害者。
与早年自杀相比,适应不良人格在晚年自杀中表现为更轻微、阈下和更异质的形式。无法适应晚年发生的变化可能有助于解释老年自杀与较高的尽责性以及强迫和回避型人格障碍之间的关联。
